多系统萎缩P型与帕金森病患者静息态脑镜像同伦功能连接的差异

Interhemispheric synchrony differences between multiple system atrophy （Parkinsonian type） and Parkinson＇s disease

目的探讨多系统萎缩P型（MSA-P）与帕金森病患者静息态大脑镜像脑区的功能连接的差异性。方法对2013年6月至2015年12月就诊于南京医科大学附属脑科医院的25例MSA-P、29例帕金森病患者和29名健康对照行常规静息态功能磁共振成像检查，采用镜像同伦功能连接（VMHC）方法分析组间差异，并将差异脑区的VMHC值与病程、简易精神状态检查、蒙特利尔认知评估量表、额叶功能评定量表及统一帕金森病评定量表第三部分（UPDRS-Ⅲ）评分进行相关分析。结果与健康对照组比较，MSA-P组和帕金森病组的双侧小脑后叶、中央后回、楔前叶、颞中回的VMHC值均减低；与帕金森病组和健康对照组相比，MSA-P组壳核的VMHC值减低，且壳核的VMHC值与UPDRS-Ⅲ评分呈显著负相关（r=-0.607，P=0.001）。结论MSA-P与帕金森病患者静息状态下多个大脑半球镜像脑区之间功能连接改变，可以为研究MSA-P与帕金森病的病理生理机制提供一个新的视角，且两侧壳核的功能连接改变有助于MSA-P与帕金森病的鉴别诊断。

Objective To investigate the resting-state functional connectivity of the two hemispheres between multiple system atrophy （Parkinsonian type, MSA-P） and Parkinson′s disease （PD）. Methods A total of 25 MSA-P, 29 PD patients and 29 well-matched healthy controls recruited in the Nanjing Brain Hospital Affiliated to Nanjing Medical University from June 2013 to December 2015 were scanned with resting-state functional magnetic resonance imaging for voxel mirrored homotopic correlation （VMHC） analysis. The Mini Mental State Examination, Montreal Cognitive Assessment, Frontal Assessment Battery and Unified Parkinson′s Disease Rating Scale-Ⅲ （UPDRS-Ⅲ） were used to assess the clinical symptom. Then the relationship between the change of VMHC values and severity of clinical symptoms was investigated.Results Compared with healthy controls, MSA-P and PD patients both showed decreased VMHC in bilateral cerebellum posterior lobe, precuneus gyrus, middle temporal gyrus, and postcentral gyrus. Compared with PD or healthy controls, MSA-P patients exhibited lower VMHC in bilateral putamen. Significant negative correlation between VMHC values of putamen and UPDRS-Ⅲ scores was found in MSA-P patients （r=-0.607, P=0.001）.Conclusion These functional changes suggest that the abnormal interhemispheric synchrony probably plays an important role in pathophysiology of both MSA-P and PD, and abnormal VMHC values in putamen of MSA-P may be helpful in differentiating MSA-P from PD.