基于不同运动亚型的帕金森脑灰质体积及自发活动功能的临床研究  

Clinical study of gray matter volume and spontaneous brain activity in different motor subtypes of Parkinson′s disease

作　　者：熊思宁 郭瑞 陈宁 邓得峰 吴英 宋秋霞 马静 XIONG Si-ning;GUO Rui;CHEN Ning(Department of Radiology,the Second Affiliated Hospital of Shihezi University,Urumqi 830002,China)

机构地区：[1]石河子大学医学院第二附属医院(新疆生产建设兵团医院)医学影像科,乌鲁木齐830002 [2]石河子大学医学院第二附属医院(新疆生产建设兵团医院)神经内科,乌鲁木齐830002

出　　处：《放射学实践》2023年第9期1108-1113,共6页Radiologic Practice

基　　金：新疆生产建设兵团财政科技计划项目(编号:2020AB024)。

摘　　要：目的:探讨不同运动亚型帕金森病(PD)患者灰质体积及静息状态下局部脑功能自发活动的改变及其临床意义。方法:前瞻性纳入PD患者56例,其中姿势不稳步态障碍(PIGD)型35例,震颤(TD)型21例,选取40例健康者作为对照组。所有被试均接受BOLD rs-fMRI和高分辨率3D-T1WI扫描及临床评估。MRI图像采用基于体素的形态学测量(VBM)、低频振幅(ALFF)、低频振荡振幅百分比(PerAF)算法进行分析处理,观察三组间灰质结构和自发脑活动差异。提取差异脑区的灰质体积、PerAF值与统一帕金森病等级量表评分(UPDRS)、简易状态评分量表(MMSE)评分、PIGD评分、TD评分之间的相关性。结果:与HC组相比,PIGD组右侧海马、右侧颞极(颞上回)、右侧颞中回及左侧海马旁回的灰质体积明显缩小(P<0.05)。与HC组相比,PIGD组的PerAF值在右侧直回显著降低,在左侧岛盖部额下回显著增加(P<0.05);与HC组相比,TD组的PerAF值在右侧内侧额上回显著降低(P<0.05)。PIGD患者右侧海马的灰质体积与MMSE评分呈正相关(r=0.541,P=0.001)。结论:PIGD和TD患者均存在额叶自发脑功能活动的异常,PIGD患者存在颞叶灰质体积的萎缩,与认知功能有关,这些结果可能有助于解释PD不同运动亚型之间的临床差异。Objective:To investigate the changes in gray matter volume and characteristics of spontaneous brain activity at resting-state in different motor subtypes of Parkinson′s disease,and to explore the correlation between these changes and clinical manifestations.Methods:Fifty-six PD patients were prospectively enrolled,including 35 postural instability/gait difficulty(PIGD),21 tremor-dominant(TD),and 40 healthy subjects as the control group.All enrolled subjects were underwent BOLD rs-fMRI and high-resolution 3D-T 1WI scans and clinical assessments.MRI images were analyzed using voxel-based morphometry(VBM),amplitude of low-frequency fluctuation(ALFF)and percent amplitude of fluctuation(PerAF)to observe gray matter structure and spontaneous brain activity differences among the three groups.The correlations among GMV,PerAF values in abnormal brain regions and the unified PD Rating Scale(UPDRS)score,Mini-Mental State Examination(MMSE)score,PIGD score,and TD score were analyzed.Results:Compared with the HC group,the gray matter volume of the right hippocampus,the right temporal pole:superior temporal gyrus,the right middle temporal gyrus and the left parahippocampal gyrus were significantly reduced in the PIGD group.Compared with the HC group,the PerAF value of the right rectus gyrus was significantly decreased and the left insular inferior frontal gyrus was significantly increased in PIGD group,and the PerAF value of the right medial superior frontal gyrus decreased in TD group(P<0.05,GFR corrected for).The GMV of the right hippocampus in PIGD patients was positively correlated with MMSE score(r=0.541,P=0.001).Conclusion:Both PIGD and TD patients have abnormalities in frontal spontaneous brain function activity,and PIGD patients have atrophy of temporal gray matter volume associated with cognitive function.These may help to explain the clinical differences in different motor subtypes of PD.

关 键 词：帕金森病 运动亚型 灰质体积 自发脑活动 磁共振成像 

分 类 号：R742.5[医药卫生—神经病学与精神病学] R445.2[医药卫生—临床医学]