基于黑质高回声结合临床特征构建预测帕金森病认知障碍的列线图  

Construction of a nomogram for predicting cognitive impairment in Parkinson's disease based on substantia nigra hyperechogenicity and clinical features

作　　者：范小兰 刘海莲[1] 谢其燕 童娅 侯超 FAN Xiaolan;LIU Hailian;XIE Qiyan;TONG Ya;HOU Chao(Department of Ultrasound,Chengdu Qingbaijiang District People's Hospital,Chengdu 610000,China;Department of Neurology,Chengdu Qingbaijiang District People's Hospital,Chengdu 610000,China;Department of Ultrasound,The Second Hospital of Lanzhou University,Lanzhou 730030,China;Department of Ultrasound,the Affiliated Hospital,Southwest Medical University,Luzhou 646000,China)

机构地区：[1]四川省成都市青白江区人民医院超声医学科,四川成都610000 [2]四川省成都市青白江区人民医院神经内科,四川成都610000 [3]兰州大学第二临床医学院,甘肃兰州730030 [4]西南医科大学附属医院超声医学科,四川泸州646000

出　　处：《分子影像学杂志》2025年第3期302-308,共7页Journal of Molecular Imaging

基　　金：四川省科技计划项目(2025ZNSFSC1753);泸州市科技计划项目(2024JYJ047)。

摘　　要：目的 分析帕金森病认知障碍(PD-CI)患者的经颅黑质超声与临床特征,并构建用于预测PD-CI的列线图。方法 纳入2021年1月~2023年12月于我院完成经颅黑质超声检查的帕金森病(PD)患者,按7∶3比例将其随机分为训练集(n=246,63.46±9.68岁,男性65.9%)和验证集(n=106,64.3±8.43岁,男性60.4%)。搜集黑质回声分级、高回声面积、血浆神经元特异性烯醇化酶(NSE)及其他临床特征,认知水平根据蒙特利尔认知评估量表(MoCA)评分。采用逻辑回归筛选潜在风险因子并构建列线图,受试者工作特征曲线和校正曲线评估模型的预测性能。结果 训练集和测试集中患者年龄、帕金森病评分量表Ⅲ(UPDRS-Ⅲ)评分、Hoehn Yah分期、MoCA评分、黑质高回声比例、血浆NSE与同型半胱氨酸水平、教育程度等在认知正常的PD和PD-CI间的差异均有统计学意义(P<0.05)。性别、年龄、教育水平、UPDRS-Ⅲ评分、NSE浓度及黑质高回声是PD-CI的独立危险因子。利用此6个危险因子构建的列线图在训练集和验证集均具有较好的鉴别效能(曲线下面积分别为0.867,95%CI:0.824~0.911,P<0.001;0.873,95%CI:0.805~0.941,P<0.001)。校准曲线显示预测结果和实际值之间具有较好一致性。结论血浆NSE浓度与黑质高回声与帕金森病患者认知水平相关,构建的列线图可能具有预测帕金森病认知障碍的潜能。Objective To explore the correlation between substantia nigra hyperechogenicity(SNH),clinical data and cognitive function in Parkinson's disease(PD),as well as develop a nomogram to predict cognitive impairment(CI)in PD patients.Methods PD patients who underwent transcranial sonography in our hospital from January 2021 to December 2023 were included and randomly divided into the training set(n=246 cases,63.46±9.68 years old,65.9%male)and testing set(n=106,64.3±8.43 years old,60.4%male)in a 7:3 ratio.The echogenicity of SN,area of SNH,plasma neuron-specific enolase(NSE)and other clinical features were collected,and the cognitive level was scored according to the Montreal Cognitive Assessment(MoCA).Logistic regression analysis was used to screen potential risk factors and construct a nomogram,and the receiver operating characteristic curves and calibration curves were used to evaluate the predictive performance of the nomogram.Results Age,UPDRS-Ⅲscores,Hoehn Yah stage,MoCA score,SNH proportion,NSE and homocysteine levels,and education level in the training set and test set were all significant different between PD patients with normal cognition and PD-CI.Gender,age,education level,UPDRS-Ⅲscores,NSE concentration and SNH were identified as independent risk factors for PD-CI.The nomogram constructed using these six factors has good identification performance in both the training set and the test set(AUC were 0.867,95%CI:0.824-0.911,P<0.001;0.873,95%CI:0.805-0.941,P<0.001,respectively).The calibration curve demonstrated acceptable agreement between predicted outcomes and actual values.Conclusion Plasma NSE concentration and SNH are related to the cognitive function of PD patients,and the constructed nomogram may have the potential to predict cognitive impairment in Parkinson's disease.

关 键 词：帕金森病 认知障碍 黑质 经颅超声 神经元特异性烯醇化酶 

分 类 号：R74[医药卫生—神经病学与精神病学]