快速眼球运动睡眠行为障碍患者黑质与运动脑区的功能连接研究

Functional connectivity between the substantia nigra and the motor cortex in the rapid eye movement sleep behavior disorder

目的 采用功能磁共振成像技术对快速眼球运动睡眠行为障碍（RBD）患者及帕金森病患者进行观察,了解RBD是否存在黑质与运动脑区的功能连接异常.方法 根据入选标准,纳入2014-2015年河南省人民医院神经内科门诊就诊的RBD患者14例（RBD组）、帕金森病患者12例（帕金森病组）、正常对照者8名（正常对照组）,进行统一帕金森病评定量表（UPDRS）及Hoehn-Yahr分期、静息态功能磁共振扫描.结果 RBD组的UPDRS评分及Hoehn-Yahr分期分别为0.00（0.00,3.75）分、0.00（0.00,0.50）,与帕金森病组[30.5（18.75,33.00）分、1.75（1.50,2.50）]比较差异有统计学意义（Z=-3.782,P〈0.05;Z=-2.963, P〈0.05）,与正常对照组[0.00 （0.00, 0.00）分,0.00 （0.00, 0.00）]比较差异无统计学意义（Z=1.16,P〉0.05;Z=1.10,P〉0.05）.3组比较右侧黑质与双侧小脑功能连接差异有统计学意义（F右小脑=12.975,F左小脑=6.144,均P〈0.05）,RBD组较帕金森病组右侧黑质与左、右小脑功能连接增强显著（t=-4.602、-5.080,均P〈0.005）;与正常对照组比较,RBD组和帕金森病组均出现右侧黑质与左前额区功能连接下降（t=-4.899、-3.500,均P〈0.005）,但RBD组和帕金森病组比较差异无统计学意义（t=2.035,P〉0.05）.结论 RBD患者存在黑质与运动脑区功能连接异常,为RBD是帕金森病的临床前期提供了影像证据.

Objective To investigate the abnormal functional connectivity （FC） between the substantia nigra （SN） and the brain motor area in rapid eye movement sleep behavior disorder （RBD） by Unified Parkinson＇s Disease Rating Scale （UPDRS）, Hoehn-Yahr Scale and resting state functional magnetic resonance imaging （rfMRI）.Methods A total of 34 subjects （14 with RBD （RBD group）, 12 with Parkinson＇s disease （PD group）, and 8 age, sex-matched normal controls （control group）） recruited in the Department of Neurology, Henan Provincial People＇s Hospital from 2014 to 2015 were enrolled in this study according to international diagnosis criteria.All subjects were examined by UPDRS, Hoehn-Yahr Scale and rfMRI.Results UPDRS scores and Hoehn-Yahr staging were 0.00 （0.00, 3.75） and 0.00 （0.00, 0.50） respectively in the RBD group, which were significantly different from that in the PD group （30.5 （18.75, 33.00） and 1.75 （1.50, 2.50）, respectively;Z=-3.782, P〈0.05 and Z=-2.963, P〈0.05）, whereas not significantly different from that in the control group （0.00 （0.00, 0.00）,0.00 （0.00, 0.00）, respectively;Z=1.16, P〉0.05 and Z=1.10, P〉0.05）.The FC analysis showed alterations from the right SN to bilateral cerebellum respectively among the three groups （Fright cerebellum=12.975, Fleft cerebellum=6.144;P〈0.05）;furthermore, there were significant increases in the RBD group compared with the PD group （t=-4.602,-5.080, P〈0.005）.The FC analysis showed reduced correlation from the right SN to the left prefrontal cortex in the RBD and the PD groups compared with the control group （t=-4.899,-3.500, P〈0.005）, but there was no statistically significant difference between the RBD and the PD groups （t=2.035, P〉0.05）.Conclusions There was abnormal FC from the SN to motor areas in RBD patients, and partial alterations were similar as PD patients.rfMRI provided an evidence that RBD might be presymptom of PD.