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帕金森病异质性的质子磁共振波谱研究

Study of idiopathic Parkinson’s disease detected by proton magnetic resonance spectrum(~1H-MRS) technology

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【作者】 潘晓波卓文燕杜中立杨建豪陈超凃宇

【Author】 Pan Xiaobo;Zhuo Wenyan;Du Zhongli;Yang Jianhao;Chen Chao;Tu Yu;Department of Neurology,the People’s Hospital of Zhuhai;

【机构】 广东珠海市人民医院神经内科

【摘要】 目的利用质子磁共振波谱(1 H-MRS)技术研究不同运动亚型原发性帕金森病(IPD)患者纹状体、额叶皮质运动区的变化,并比较其认知障碍的发生率,研究帕金森病认知障碍(PD-CIND)患者海马区的变化,探讨1 H-MRS在IPD诊断及分型诊断的价值。方法对70例IPD患者行帕金森病统一评分量表(UPDRS)运动障碍评分,并进行临床分型,依据主要运动症状分为震颤为主型IPD 38例、姿势异常、步态障碍(PIGD)型IPD 32例,同时对各运动亚型行蒙特利尔认知量表评分(MOCA),选出MOCA<26分的PD-CIND患者共27例,无认知障碍IPD(MOCA≥26分)患者43例,健康对照组(HC)30例,对各组双侧纹状体,额叶皮质运动区、海马区行1 H-MRS检测,计算N-乙酰天门冬氨酸/肌酸(NAA/CR)和胆碱复合物/肌酸(CHO/CR)的比值。结果震颤为主型IPD伴发认知障碍10例。PIGD型IPD伴发认知障碍17例,2组比较有显著性差异(P<0.05),IPD组纹状体、额叶皮质运动区NAA/CR比值较HC组明显下降(P<0.05),震颤为主型IPD双侧纹状体、额叶皮质运动区NAA/CR比值高于PIGD型IPD(P<0.05),PD-CIND组海马区NAA/CR比值低于IPD组及HC组(P<0.05)。而各组CHO/CR比值差异均无统计学意义(P>0.05)。结论 IPD患者双侧纹状体、额叶皮质运动区NAA/CR比值降低,尤以PIGD型IPD下降明显,同时震颤为主型PD认知障碍伴发率低于PIGD型,而IPD患者海马区NAA/CR比值降低,尤以PD-CIND患者下降明显,1 H-MRS有助于IPD的诊断及分型诊断。

【Abstract】 Objective To research the striatum and the change of the frontal cortex movement area in the treatment of idiopathic Parkinson’s disease(IPD)with different sports subtypes performed by proton magnetic resonance spectrum(1 H-MRS)technology,and to compare the prevalence of cognitive impairment and investigate the changes in hippocampus in Parkinson’s disease with cognitive impairment(PD-CIND)so as to testify the value of 1 H-MRS detection technology in the diagnosis and typed-diagnosis of IPD.Methods According to the assessment of the movement disorder by UPDRS and the main clinical manifestations,70 cases with IPD were selected and classified into different clinical subtypes:tremor group(38cases),both abnormal posture and gait disorder(PIGD)group(32cases),at the same time all of patients in different subtypes received the assessment of MOCA rating scale,and a total of 27 IPD patients with PD-CIND(MOCA<26points),43 IPD patients without cognitive impairment(MOCA≥26points),30 normal cases(HC)as for controls.We detected 1 H-MRS in bilateral striatum,prefrontal cortex motor area and the hippocampus,and then calculated the ratio of N-acetyl aspartate and creatine(NAA/CR)and the ratio of choline compounds and creatine(CHO/CR).Results There were 10 cases with cognitive impairment in tremor group and 17 cases in PIGD group with significant difference(P<0.05).Compared with HC group,NAA/CR ratio in frontal cortex motor area and striatum area in IPD group decreased significantly(P<0.05);NAA/CR ratio in frontal cortex motor area and bilateral striatum area in tremor group was obviously higher than that in PIGD group(P<0.05),NAA/CR ratio in hippocampus area in PD-CIND group was lower than that in PD group and HC group(P<0.05).The CHO/CR ratio showed no significant difference in all groups(P<0.05).Conclusion NAA/CR ratio in bilateral striatum and prefrontal cortex motor area in IPD patients decreases significantly,especially in the PD-PIGD PD patients.The occurrence rate of cognitive impairment in tremor subtype shows lower than PIGD subtype.NAA/CR ratio in hippocampus is lower in IPD patients,especially in PDCIND patients.In a word,1 H-MRS detection technology has a clinical effect on the diagnosis and typed-diagnosis of IPD.

【基金】 珠海市科技计划项目,编号:2013115
  • 【文献出处】 中国实用神经疾病杂志 ,Chinese Journal of Practical Neruous Diseases , 编辑部邮箱 ,2015年12期
  • 【分类号】R742.5
  • 【被引频次】9
  • 【下载频次】71
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