R2~*值在不同运动障碍亚型原发性帕金森病异质性的研究价值

The R2~* value quantitative study on different movement disorder subtypes of Idiopathic Parkinson's disease

目的探讨R2~*值在原发性帕金森病(Idiopathic Parkinson’s disease,IPD)运动障碍分型诊断中的价值。方法 122例IPD患者,据主要运动症状分为震颤为主型(61例)、混合型(33例)和姿势异常、步态障碍(postural instability and gait disorder,PIGD)为主型(28例)。患者与对照组均采用ESWAN(enhanced gradient echo T2 star-weighted angiography)序列扫描,测量不同脑区的R2~*值,进行统计分析。结果 PIGD为主型与震颤为主型相比,MMSE评分低(P<0.05),改良Hoehn-Yahr病情分级重(P<0.01),但发病年龄、病程及起病侧无统计学差异(P>0.05)。对照组R2~*值在苍白球最高,其次为黑质网状带、红核,额叶白质区最低。PIGD为主型与对照组相比,红核、黑质网状带及致密带、苍白球R2~*值有统计学差异(P<0.05);与震颤为主型相比,红核、黑质致密带R2~*值有统计学意义(P<0.05);与混合型相比,红核、黑质网状部及致密部、壳核、苍白球及丘脑的R2~*值有统计学意义(P<0.05)。震颤为主型与混合型相比,黑质网状带、壳核的R2~*值有统计学意义(P<0.05)。余脑区R2~*值无统计学差异。结论 PIGD为主型与震颤为主型有较明显的异质性。不同运动障碍亚型PD的脑铁沉积部位存在异质性,R2~*值有助于IPD的诊断及分型诊断。

Objective To investigate the diagnostic value of R2~＊value on different subtypes of IPD according to motor symptoms. Methods 122 patients with IPD were divided into tremor-dominant PD（n = 61）,mixed subtype PD（n =33）,postural instability and gait disorder（PIGD）-dominant PD（n = 28）. All patients and control subjects were performed ESWAN sequence. R2~＊value was measured and stasistically analyzed. Results The amended Hoehn-Yahr stage of PIGD-dominant PD was significantly higher than that of the tremor-dominant PD（P 0. 01）,while the score of Mini-Mental State Examination（MMSE） was significantly lower in the former（P 0. 05）. No statistical difference was found in age,gender,course of disease and onset side between different subtypes of PD（P 0. 05）. In control subjects,the R2~＊value of globus pallidus（GP） was the highest,followed by substantia nigra pars reticulate（SNr） and red nucleus（RN）. The lowest R2~＊value was seen in frontal white matter（FWM）. R2~＊value decreased significantly in substantia nigra pars compacta（SNc）,SNr,RN and GP of PIGD-dominant PD compared with control subjects（P 0. 05）,and decreased in RN and SNc of PIGD-dominant PD compared with tremor-dominant PD（P 0. 05）,and decreased in RN,SNr,SNc,putamen（PUT）,GP and thalamus（THA） of PIGD-dominant PD compared with mixed subtype PD（P 0. 05）. R2~＊value decreased in SNr and PUT of tremor-dominant PD compared with mixed subtype PD（P 0. 05）. Conclusion There is significant difference in clinic symptom between tremor-dominant PD and PIGD-dominant PD. The sites of pathologic brain iron deposition were heterogeneity in different movement disorder subtypes of PD. The R2~＊value may help diagnose IPD and distinguish different movement disorder subtypes of IPD.