伴快速眼动睡眠期行为障碍的帕金森患者蓝斑下核与运动脑区功能连接的分析

Abnormal functional connectivity between sublaterodorsal nucleus and the motor cortex in Parkinson′s disease with rapid-eye-movement sleep behavior disorder

目的采用功能磁共振成像技术对伴/不伴快速眼动睡眠期行为障碍的帕金森(PD-RBD/PD-nRBD)患者进行观察,探讨PD-RBD患者蓝斑下核与运动脑区是否存在功能连接异常。方法纳入2014年8月至2017年12月于郑州大学人民医院就诊的PD-RBD患者20例(PD-RBD组)、PD-nRBD患者23例(PD-nRBD组)、健康对照者21名(HC组),采用Hoehn-Yahr(H-Y)分期量表和统一帕金森病评价量表第三部分(UPDRS-Ⅲ)进行运动功能评估,并对三组行静息态功能磁共振扫描并比较。结果PD-RBD组UPDRS-Ⅲ评分与H-Y评分高于HC组,差异有统计学意义(KW=-27.35,P<0.001),与PD-nRBD组比较差异无统计学意义(KW=6.01,P=0.807)。与HC组相比,PD-RBD组左侧蓝斑下核与右侧额中回眶部(T=-4.567 8,P<0.001)、左侧扣带回中部(T=-3.196 0,P<0.001)、左侧小脑(T=-4.267 0,P<0.001)及右侧中脑功能(T=-4.773 7,P<0.001)连接减弱;右侧蓝斑下核与双侧小脑(T左=-5.040 1,T右=-4.210 5,P<0.001)、左侧楔前叶(T=-4.468 2,P<0.001)、左侧中央前回(T=-4.473 9,P<0.001)功能连接减弱;且左侧蓝斑下核与左侧小脑及右侧中脑,右侧蓝斑下核与左侧楔前叶、左侧中央前回功能连接强度与运动量表得分呈负相关。结论PD-RBD患者的蓝斑下核与运动脑区连接存在异常,并参与构成PD-RBD患者运动功能障碍及运动症状。

Objective To investigate the abnormal functional connectivity between sublaterodorsal nucleus (SLD) and the brain motor areas in Parkinson′s disease with or without rapid-eye-movement (REM) sleep behavior disorder by resting state functional magnetic resonance imaging (rfMRI). Methods A total of 64 subjects recruited in the Department of Neurology, the People′s Hospital of Zhengzhou University were enrolled in this study from August 2014 to December 2017 according to international diagnosis criteria, 20 cases with PD-RBD (PD-RBD group), 23 cases without PD-nRBD (PD-nRBD group) and 21 age, gender-matched healthy controls (HC group). All subjects were examined by Hoehn-Yahr, UPDRS-Ⅲ and rfMRI. ReslutsUPDRS-Ⅲ scores and Hoehn-Yahr staging were showed significantly different from that in the HC group(KW=-27.35, P<0.001) but showed no significantly difference from that in the PD-nRBD group(KW=6.01, P=0.807). Compared with the control group, the FC analysis showed reduced correlations from the left SLD to the right orbital middle frontal gyrus(T=-4.567 8, P<0.001), the left cingulate gyrus(T=-3.196 0,P<0.001), the left cerebellum(T=-4.267 0,P<0.001) and the right midbrain(T=-4.773 7, P<0.001), from the right SLD to the bilateral cerebellum (Tleft=-5.040 1, Tright=-4.210 5, P<0.001), the left precuneus(T=-4.468 2,P<0.001) and the left precentral gyrus (T=-4.473 9,P<0.001) in the PD-RBD. The correlations between the left SLD and left cerebellum, right midbrain and between the right SLD and left precuneus, left precentral gyrus were negative correlated with the motor functional tests. Conclusions There are abnormal functional connectivity from the SLD to the motor areas in PD-RBD patients, leading to clinical PD-RBD motor symptoms and movement disorders.