同型半胱氨酸与颅内单光子计算机断层摄影检查对帕金森病患者的临床意义

Significance of homocysteine and cerebral SPECT in clinical diagnosis of Parkinson's disease

目的探讨帕金森病(PD)与同型半胱氨酸(Hcy)、PD与脑血流灌注的相关性。方法选择在我院神经内科门诊及住院的患者,经头颅CT或MRI检查无异常的PD患者97例,将PD患者分为美多巴组(51例)和非美多巴组(46例),另选择正常对照者65例(正常组),均为我院同期体检者;根据改良Webster评分≤10分为轻症组(56例),>10分为重症组(41例);PD患者行单光子计算机断层摄影检查,观察脑血流灌注和Hcy水平情况。结果与正常组比较,非美多巴组和美多巴组Hcy水平明显升高,差异有统计学意义(P<0.01);与非美多巴组比较,美多巴组Hcy水平明显升高(P<0.05);重症组较轻症组Hcy水平明显升高(P<0.05)。重症组与轻症组脑血流灌注下降比率比较,差异有统计学意义(P<0.01);69例脑血流灌注下降患者中,位于顶枕区24例(34.8%)、枕区22例(31.9%)、项区13例(18.8%)、颞顶区10例(14.5%)。结论 PD患者血浆Hcy水平明显增高,且病情越重Hcy水平越高,重症组较轻症组脑血流灌注下降比率明显升高,脑血流灌注下降部位多位于顶枕叶,服用美多巴可明显增高Hcy水平。

Objective To study the relation of Parkinson＇s disease（PD） with homocysteine（Hcy） and cerebral perfusion. Methods Ninety-seven PD patients who underwent CT and MRI were di- vided into madopar group（n=51） and non-madopar group（n=46）. Fifty-six subjects served as a normal control group. The 97 PD patients were further divided into mild PD group with its modi- fied Webster score ≤10 and severe PD group with its modified Webster score 〉10. The patients underwent single photon emission computerized tomography. Their cerebral perfusion and Hcy level were measured. Results The serum Hcy level was significantly higher in non-madopar group and madopar group than in normal control group,in madopar group than in non-madopar group,and in severe PD group than in mild group（P〈0.05）. The cerebral perfusion rate was sig- nificantly higher in severe PD group than in mild PD group（P〈0.05）. The cerebral perfusion de- creased in parieto-occipital region of 24 patients （34. 8%）, in occipital region of 22 patients （31.9%） ,in parietal region of 13 patients（18.8%） ,and in temporo-occipital region of 10 patients （14.5%）. Conclusion The serum Hcy level increases significantly in PD patients. The severer the disease is,the higher the Hcy level is. The cerebral perfusion rate is significantly higher in se- vere PD patients than in mild PD patients. The cerebral perfusion usually decreases at the parieto- occipital site. Madopar can significantly elevate the Hcy level.