【摘要】 目的:探讨帕金森病(PD)胶质淋巴系统与自主神经功能障碍间的关联性。方法:选取2011年1月至2017年12月在帕金森进展标志物倡议计划参与调查的96例PD患者为研究对象，采用一般人口资料、帕金森病自主神经量表(SCOPA-AUT)、血管周围间隙扩散张量成像(ALPS)等数据进行横断面及纵向研究。通过Spearman相关分析、多变量线性回归、线性混合分析并进一步检验中介效应探究PD胶质淋巴系统与自主神经功能障碍间的关系。结果:基线期共纳入96例患者，随访期共纳入78例患者。Spearman相关分析显示泌尿功能与ALPS指数负相关(r=-0.247,P<0.05)。多变量线性回归显示泌尿功能与ALPS指数负相关(β=-0.023,P=0.010)。混合效应模型显示泌尿功能对ALPS指数具有主效应(β=-0.021,P=0.009)和交互效应(β=0.005,P=0.047)。中介分析显示，ALPS指数在泌尿功能障碍与Hoehn-Yahr分级间起部分中介效应(b×c=0.012,95%CI 0.003～0.028,P=0.008),占自主神经泌尿功能障碍对HY分级的29.70%。结论:PD中自主神经泌尿功能障碍与胶质淋巴系统损害密切相关，并通过胶质淋巴系统介导疾病进展。更多还原

【Abstract】 Objective: To investigate the association between the glymphatic system and autonomic dysfunction in Parkinson’s disease(PD). Methods: A total of 96 patients with PD enrolled in the Parkinson’s Progression Markers Initiative(PPMI) from January 2011 to December 2017 were included in this cross-sectional and longitudinal study. Data including general demographic characteristics, the Scales for Outcomes in Parkinson’s Disease-Autonomic(SCOPA-AUT), and the diffusion tensor imaging analysis along the perivascular space(ALPS) index were collected. Spearman correlation analysis, multivariate linear regression, linear mixed-effects models, and mediation analysis were performed to explore the relationship between the glymphatic system and autonomic dysfunction in PD. Results: 96 patients at baseline and 78 patients at follow-up were included. Spearman correlation analysis showed that urinary function was negatively correlated with the ALPS index(r=-0.247, P<0.05). Multivariate linear regression revealed that urinary function was independently and negatively associated with the ALPS index(β=-0.023, P=0.010). Linear mixed-effects models demonstrated that urinary function had a main effect(β=-0.021, P=0.009) and an interaction effect(β=0.005, P=0.047) on the ALPS index. Mediation analysis indicated that the ALPS index exerted a partial mediating effect between urinary dysfunction and Hoehn-Yahr stage(b×c=0.012, 95%CI 0.003-0.028, P=0.008), accounting for 29.70% of the effect of urinary autonomic dysfunction on the Hoehn-Yahr stage. Conclusion: Autonomic urinary dysfunction is closely related to glymphatic impairment in PD, and the glymphatic system mediates the progression of the disease.更多还原