不同脑区白质高信号负荷与帕金森病患者认知功能的相关性研究  

Association between regional white matter hyperintensity burden and cognitive impairment in Parkinson's disease patients

作　　者：陈慧敏 苏闻[1] 张美美 冯涛[2] 王伊龙[2] Chen Huimin;Su Wen;Zhang Meimei;Feng Tao;Wang Yilong(Department of Neurology,Beijing Hospital,National Center of Gerontology,Institute of Geriatric Medicine,Chinese Academy of Medical Sciences,Beijing 100730,China;Department of Neurology,Beijing Tiantan Hospital,Capital Medical University,China National Clinical Research Center for Neurological Diseases,Beijing 100070,China)

机构地区：[1]北京医院神经内科、国家老年医学中心、中国医学科学院老年医学研究院,北京100730 [2]首都医科大学附属北京天坛医院神经病学中心、国家神经系统疾病临床医学研究中心,北京100070

出　　处：《中华神经科杂志》2024年第2期157-163,共7页Chinese Journal of Neurology

基　　金：中央高水平医院临床科研业务资助项目(BJ-2021-197);北京高校卓越青年科学家计划(BJJWZYJH01201910025030)。

摘　　要：目的观察不同脑区白质高信号(WMH)体积与帕金森病患者认知障碍之间的相关性。方法回顾性分析2018年10月至2019年8月首都医科大学附属北京天坛医院运动障碍性疾病科连续收治的帕金森病患者,并采集其人口学、疾病信息及头颅三维磁共振影像学资料。采用简易精神状态检查量表(MMSE)评估患者的认知功能;采用汉密尔顿焦虑量表、汉密尔顿抑郁量表(HAMD)评估患者的情绪,并根据MMSE评分结果将患者分为帕金森病伴痴呆组和不伴痴呆组。采用不明亮点探测器算法,基于解剖自动标记模板,自动化定量分析患者脑区的WMH体积。比较帕金森病伴痴呆与不伴痴呆患者的人口学特征、疾病特点、WMH总体积之间的差异。采用偏相关[错误发现率(FDR)校正]及主成分回归分析患者不同脑区的WMH体积与MMSE评分之间的相关性。结果帕金森病伴痴呆组患者的WMH总体积显著大于帕金森病不伴痴呆组患者[5125(2727,13718)mm^(3)比3214(1959,7205)mm^(3),Z=-2.256,P=0.024]。校正年龄、低密度脂蛋白、血清胆固醇、HAMD评分后,偏相关分析结果提示,帕金森病患者的MMSE评分与右侧距状回(r=-0.204,P_(FDR校正)=0.034)、右侧梭状回(r=-0.180,P_(FDR校正)=0.046)、右侧舌回(r=-0.146,P_(FDR校正)=0.047)、左侧颞中回(r=-0.168,P_(FDR校正)=0.047)、左侧顶下小叶(r=-0.145,P_(FDR校正)=0.047)和右侧顶下小叶(r=-0.148,P_(FDR校正)=0.047)的WMH体积显著相关。主成分回归分析结果显示,MMSE评分与主成分2(B=-0.632,95%CI-1.222~-0.041,P=0.036)、主成分13(B=-1.384,95%CI-2.155~-0.613,P=0.001)、主成分14(B=-0.913,95%CI-1.599~-0.227,P=0.009)显著相关;主成分2、主成分13、主成分14主要由脑后部颞-顶-枕叶WMH体积构成,可解释WMH变异率的9.668%。结论脑后部颞-顶-枕叶WMH体积与帕金森病患者的认知障碍显著相关,但其可能不是帕金森病患者认知障碍的主要因素。Objective To investigate the association between regional white matter hyperintensity(WMH)volumes and cognitive impairment in Parkinson's disease(PD)patients.Methods The consecutive samples of PD cohort between October 2018 and August 2019 from the Department of Movement Disorders,Beijing Tiantan Hospital,Capital Medical University were retrospectively analyzed.Demographic and disease profiles,three-dimensional brain magnetic resonance imaging data were collected.Cognition was evaluated by Mini-Mental State Examination(MMSE),and mood was evaluated by Hamilton Anxiety Scale and Hamilton Depression Scale(HAMD).According to the MMSE score,patients were divided into PD with dementia group and PD without dementia group.WMH volume was automatically calculated using unidentified bright objects detector pipeline based on anatomical autonomic labeling atlas.Firstly,demographic and disease profiles,and WMH total volume were compared between groups with and without dementia.Then,partial correlation analysis[false discovery rate(FDR)corrected]and principal component(PC)regression analysis were used to assess the association between regional WMH volumes and the MMSE score.Results Compared with PD without dementia group,PD with dementia group showed significantly higher WMH volume[5125(2727,13718)mm^(3)vs 3214(1959,7205)mm^(3),Z=-2.256,P=0.024].After adjusting for age,low density lipoprotein,cholesterol,and HAMD score,partial correlation analysis(FDR corrected)showed that WMH volumes in the right calcarine(r=-0.204,P_(FDR-corrected)=0.034),the right fusiform(r=-0.180,P_(FDR-corrected)=0.046),the right lingual(r=-0.146,P_(FDR-corrected)=0.047),the left middle temporal(r=-0.168,P_(FDR-corrected)=0.047),the left inferior parietal lobes(r=-0.145,P_(FDR-corrected)=0.047)and the right inferior parietal lobes(r=-0.148,P_(FDR-corrected)=0.047)were significantly associated with MMSE score.PC regression analysis demonstrated that MMSE score was significantly associated with PC2(B=-0.632,95%CI-1.222--0.041,P=0.036),PC13(B=-1.384,95%CI-2.

关 键 词：帕金森病 认知障碍 脑白质高信号 

分 类 号：R742.5[医药卫生—神经病学与精神病学]