脑白质病变对老年轻度帕金森样体征的影响

The correlation between white matter lesions and mild parkinsonian signs in elderly individuals

目的探讨脑白质病变(WMLs)对老年轻度帕金森样体征(MPSs)的影响。方法临床收集335名老年男性,根据MRIT2加权像将WMLs分为4级,以WMLs0级作为对照组,所有受试者进行UP-DRS运动评定,比较不同程度WMLs组UPDRS运动总评分及各单项评分之间的差异。结果(1)与WMLs0级组比较,WMLs2级组UPDRS运动总分、运动迟缓及轴性损害单项评分显著增加(P<0.05),WMLs3级组UPDRS运动总分、强直、运动迟缓和轴性损害单项评分显著增加(P<0.05);与WMLs1级组比较,WMLs2级组UPDRS运动总分、轴性损害单项评分显著增加(P<0.05),WMLs3级组UPDRS运动总分、强直、运动迟缓及轴性损害单项评分显著增加(P<0.05);与WMLs2级组比较,WMLs3级组UPDRS运动总分、运动迟缓和轴性损害单项评分显著增加(P<0.05);(2)logistic回归分析控制了年龄、高血压病、糖尿病后,轻度帕金森样体征尤其运动迟缓和轴性损害与WMLs2～3级密切相关。结论中到重度WMLs会导致或者加重老年MPSs,尤其运动迟缓和轴性损害症状,而较少产生震颤;轻度WMLs相对是一种良性病变;积极防治WMLs可能会改善老年人的MPSs。

Objective To explore the correlation between white matter lesions （WMLs） and mild parkinsonian signs （MPSs） in elderty individuals. Methods 335 elderly individuals were classified into WMLs grade 0 group, grade I group, grade ：2 group and grade 3 group by MRI. The MPSs in the patients were assessed with motor portion of unified parkinson＇s disease rating scale （UDPRS）. Results （1） Compared with WMLs grade 0 group, elderly individuals in WMLs grade 2 group had higher scores in motor portion of UPDRS, bradykinesia and axial function. The elderly individuals in WMLs grade 3 group had higher scores in motor portion of UPDRS, rigidity, bradykinesia and axial function. Compared with WMLs grade 1 group, elderly individuals in WMLs grade 2 group had higher scores in motor portion of UPDRS and axial function. The elderly individuals in WMLs grade 3 group had higher scores in motor portion of UPDRS, rigidity, bradykinesia and axial function. Compared with WMLs grade 2 group, elderly individuals in WMLs grade 3 group had higher scores in motor portion of UPDRS, bradykinesia and axial function. （2） Ajusting for age, hypertention and diabetes mellitus, MPSs, especially bradykinesia and axial impairment were associated with WMLs grade 2-3. Conclusions Moderate to severe WMLs may lead to or deteriorate MPSs, especially bradykinesia and axial impairment in elderly individuals, but they have little influences on tremor. Mild WMLs is a benign condition. The prevention of WMLs may be helpful to decrease the prevalence of MPSs in elderly individuals.