沿血管周围间隙扩散张量成像分析评价帕金森病患者年龄相关类淋巴通路的改变及其与认知功能的关系  

Age-related changes in glymphatic pathways in Parkinson′s disease patients based on diffusion tensor imaging analysis along the perivascular space and their relationship with cognitive function

作　　者：赵阳 徐长媛 陈昱帆 卓梦圆 巩涛 相媛媛 王光彬 Zhao Yang;Xu Changyuan;Chen Yufan;Zhuo Mengyuan;Gong Tao;Xiang Yuanyuan;Wang Guangbin(Department of Radiology,Shandong Provincial Hospital Afiliated to Shandong First Medical University,Jinan 250021,China;Department of Medical Imaging Center,Central Hospital Affiliated to Shandong First Medical University,Jinan 250013,China;Cheeloo College of Medicine,Shandong University,Jinan 250021,China;Department of Neurology,Shandong Provincial Hospital Affiliated to ShandongFirst Medical University,Jinan250021,China)

机构地区：[1]山东第一医科大学附属省立医院(山东省立医院)医学影像科,济南250021 [2]山东第一医科大学附属中心医院医学影像中心,济南250013 [3]山东大学齐鲁医学院,济南250021 [4]山东第一医科大学附属省立医院(山东省立医院)神经内科,济南250021

出　　处：《中华放射学杂志》2025年第1期64-69,共6页Chinese Journal of Radiology

摘　　要：目的基于沿血管周围间隙扩散张量成像分析(DTI-ALPS)指数探讨年龄因素对帕金森病(PD)患者类淋巴功能的影响及其与整体认知能力的潜在相关性。方法该研究为横断面研究。回顾性分析2021年10月至2024年6月在山东第一医科大学附属省立医院就诊的77例PD患者(PD组)的临床及影像资料。同期收集年龄、性别相匹配的30名健康志愿者作为正常对照(NC)组。所有受检者均接受MRI扫描并根据扩散张量成像计算DTI-ALPS指数。采用简易精神状态检查表(MMSE)、蒙特利尔认知评估量表(MoCA)评分对46例PD组患者的认知功能进行评估。采用独立样本t检验比较PD组和NC组DTI-ALPS指数的差异。调整混杂因素后,使用偏相关分析、多元线性回归模型探讨DTI-ALPS与年龄之间的关系,建立中介模型探讨DTI-ALPS指数在年龄与认知功能评分之间的中介效应,计算中介效应占比。结果PD组和NC组的DTI-ALPS指数分别为1.66±0.20,1.44±0.17,差异有统计学意义(t=5.27,P<0.001)。PD组患者年龄与DTI-ALPS指数呈负相关(r=-0.54,P<0.001),且年龄(β=-0.467,P<0.001)是DTI-ALPS指数的独立影响因子。DTI-ALPS指数与MMSE评分呈正相关(r=0.53,P<0.001),与MoCA评分呈正相关(r=0.56,P<0.001)。中介模型显示,DTI-ALPS指数在年龄与MMSE评分之间起完全中介作用,在年龄与MoCA分数之间起部分中介作用,中介效应占比为33.25%。结论年龄是PD患者类淋巴通路受损的独立风险因素,其可能通过加剧类淋巴通路损伤,诱发PD患者的认知功能下降。ObjectiveTo investigate the effect of age factor on glymphatic function in patients with Parkinson′s disease(PD)and its potential correlation with overall cognitive performance based on diffusion tensor imaging analysis along the perivascular space(DTI-ALPS)index.MethodsThe study was cross-sectional.Clinical and imaging data of 77 PD patients(PD group)who attended the Provincial Hospital of Shandong First Medical University from October 2021 to June 2024 were retrospectively analyzed.In the same period,30 healthy volunteers matched by age and gender were collected as the normal control(NC)group.All subjects underwent MRI scanning and DTI-ALPS index was calculated based on diffusion tensor imaging.Cognitive functions of 46 patients in the PD group were assessed using the mini-mental state examination(MMSE)and montreal cognitive assessment(MoCA)scores.Independent samples t-tests were used to compare the differences in DTI-ALPS index between the PD and NC groups.After adjusting for confounders,the relationship between DTI-ALPS and age was explored using partial correlation analyses,multiple linear regression models.A mediation model was further developed to explore the mediating effect of DTI-ALPS index between age and cognitive function scores.ResultsThe DTI-ALPS indices of PD and NC groups were 1.66±0.20 and 1.44±0.17,respectively,and the differences were statistically significant(t=5.27,P<0.001).The age of patients in the PD group was negatively correlated with the DTI-ALPS index(r=-0.54,P<0.001),and age(β=-0.467,P<0.001)was an independent influencer of DTI-ALPS index.The DTI-ALPS index was positively correlated with MMSE scores(r=0.53,P<0.001)and positively correlated with MoCA scores(r=0.56,P<0.001).The mediation model showed that the DTI-ALPS index fully mediated between age and MMSE scores and partially mediated between age and MoCA scores,with an effect share of 33.25%.ConclusionAge is an independent risk factor for impaired glymphatic pathway in PD patients,and it may induce cognitive decline in PD pat

关 键 词：帕金森病 认知功能 年龄因素 类淋巴系统 沿血管周围间隙扩散张量成像 

分 类 号：R742.5[医药卫生—神经病学与精神病学]