帕金森病和阿尔茨海默病患者脑内血管周围间隙扩大的差异

Difference of Enlarged Perivascular Spaces in PD and AD Patients

目的初步分析帕金森病(PD)和阿尔茨海默病(AD)基底节区及半卵圆中心区血管周围间隙扩大(EPVS)的情况及两者是否存在差异。方法 67例AD患者,平均年龄(70.57±10.44)岁,男32例,女35例;58例PD患者,平均年龄(66.96±8.45)岁,男28例,女30例;60名年龄、性别相匹配的健康老年人,平均年龄(69.83±7.26)岁,男28名,女32名,被纳入本次研究。通过观察MRI T_2WI及T_2FLAIR图像,分别计数各组基底节区及半卵圆中心区EPVS的数目并进行4级评分。采用SPSS 17.0软件进行统计学处理,计数资料比较采用单因素方差分析,组间均数比较采用t检验,等级资料用Kruskal-Wallis及Kolmogorov-Smirnov Z检验分析组间差异。应用Spearman相关分析EPVS与简易精神状态检查量表(MMSE)评分之间的相关性。P<0.05为差异有统计学意义。结果三组间基底节、半卵圆中心区EPVS评分均有统计学意义(H值分别为17.91,46.28,P均<0.01)。与正常对照组比较,AD组基底节区的EPVS评分差异有统计学意义(Z=1.939,P<0.001),PD组与对照组及AD组的EPVS评分差异均无统计学差异(Z分别=1.314,0.83,P均>0.05);在半卵圆中心区域,AD组及PD组分别与正常对照组比较EPVS评分差异均有统计学意义(Z=2.786,Z=1.518,P<0.05),除此之外,PD组与AD组间评分差异也有统计学意义(Z=1.585,P<0.01)。三组间基底节区及半卵圆中心区EPVS累计得分符合正态分布,AD组总EPVS评分(4.38±1.34)显著高于PD组(3.55±1.17)(P<0.01)。<65岁时,AD组与PD组两者间EPVS评分差异无统计学意义(P>0.05),但AD组及PD组EPVS评分均高于正常对照组(P均<0.01);65~75岁时,三组间EPVS评分两两比较差异均有统计学意义(P<0.05);>75岁时,三组间EPVS评分两两比较差异均有统计学意义(P均<0.01)。结论 EPVS是PD和AD患者脑内的微血管改变,而且PD和AD脑内EPVS分布也有所区别,且随着年龄的增长,两者间的差异性逐渐增加。

Objective To analyze the difference in the degree of enlarged perivascular spaces（ EPVS） in the basal ganglia and centrum semiovale between patients with Parkinson disease（ PD） and Alzheimer disease（ AD）. Methods The MRI images were retrospectively reviewed in 67 patients with Alzheimer＇s disease（ AD group）（ male = 32 female = 35,70. 57 ± 10. 44 years old）,58 patients with Parkinson disease（ PD group）（ male = 28 female = 30,66. 96 ± 8. 45 years old） and 60 normal controls（ NC group）（ male = 28 female = 32,69. 83 ± 7. 26 years old）. EPVS in both the basal ganglia and centrum semiovale were counted with the following scale applied to standard axial images： 1 score below 10 EPVS,2 score for 11 to 20 EPVS,3 score for 21 to 40 EPVS,and 4 score up 40 EPVS. basal ganglia and centrum semiovale EPVS were summed to form a total EPVS score（ 2 to 8）. Statistics package for social science（ SPSS） 17. 0 was used. KruskaWallis test,Kolmogorov-Smirnov Z test was used to analyze group difference. Results Significant statistical difference of EVPS score in both the basal ganglia and centrum semiovale were found in the comparison of the three groups（ H values respectively = 17. 91,46. 28,all P〈 0. 01）; In the basal ganglia,The EPVS score in AD and NC group was significantly different（ Z = 1. 939,P 〈0. 001）,and there was no difference between EPVS in PD and NC group and AD group（ Z = 1. 314,0. 83,all P 〉0. 05）; Compared with the NC group in centrum semiovale,The EPVS score in AD and PD groups were significantly different（ Z = 2. 78,Z = 1. 518,all P 〈0. 05）. Moreover,there was a difference between EPVS in PD and AD group（ Z = 1. 585,P 〈0. 01）. Basal ganglia EPVS and centrum semiovale EPVS were not normally distributed,but Total EPVSwas normally distributed; Total EPVS in AD group（ 4. 38 ± 1. 34） was significantly higher than that in PD group（ 3. 55 ±1. 17）（ P 〈0. 01）. At the age of 〈65,there was no statistically significant difference in EPVS between AD and PD group.But EPVS in AD group and PD group were significantly higher than that in the NC group（ all P〈 0. 01）. At the age of 65 ~75,statistical difference of EPVS score was found in multiple comparison in the three groups（ P 〈0. 05）. At the age of 〉75,significant statistical difference of EPVS score was found in multiple comparisons in the three groups（ P〈 0. 01）.Conclusion EPVS is a manifestation of microvessel changes and the EPVS distribution of different regions have differences in PD and AD Patients,and as the age advances,the difference increases gradually.