磁敏感加权成像及全身铁代谢指标在帕金森病中的应用

Application of Susceptibility-Weighted Imaging and the indicators of iron metabolism in diagnosis and severity evaluation of Parkinson's Disease

目的探讨磁敏感加权成像(SWI)黑质标准化体积、相位值及血清铁代谢指标在帕金森病的诊断及其病情评估中的临床应用。方法选取2015年2月至2017年4月帕金森病患者33例(PD组)和健康志愿者20例(对照组),PD组按Hoehn-Yahr分级分为早期PD(≤2.5级)17例和中晚期PD(>2.5级)16例。对所有受试者应用3.0T MRI仪进行SWI,测量黑质标准化体积并计算相位值,采用化学发光法检测所有对象血清铁、铁蛋白、转铁蛋白、总铁结合力,并进行统计学分析。结果 PD组黑质标准化体积及相位值均低于对照组,差异有统计学意义(P均<0.01)。中晚期PD黑质标准化体积与相位值低于早期PD(P均<0.01)。黑质标准化体积与Hoehn-Yahr分级呈负相关(r=-0.525,P<0.01);相位值与Hoehn-Yahr分级呈负相关(r=-0.873,P<0.01)。血清铁代谢指标(铁、铁蛋白、转铁蛋白、总铁结合力)在对照组和PD组之间差异无统计学意义(P均>0.05)。结论 SWI技术通过对黑质的体积和相位值测量在帕金森病的早期诊断及病情评估具有重要的临床价值,而血清铁代谢指标与帕金森脑铁沉积无明显关系。

Objective To investigate the clinical application of standardized substantia nigra（ SN） volume,phase values of susceptibility weighted imaging（ SWI） and serum iron metabolism index in the diagnosis and disease evaluation of Parkinson＇s disease. Methods Thirty-three patients with Parkinson＇ s disease were selected from February 2015 to April 2017（ PD group） and 20 healthy volunteers were served as control group. According to Hoehn-Yahr classification,the patients in PD group were divided into early PD subgroup（ grade ≤2. 5,n = 17） and moderate or advanced PD subgroup（ grade 〉2. 5,n = 16）. 3. 0 T magnetic resonance imaging（ MRI）-SWI was used in all subjects to measure the SN standardized volume and calculate phase values. The serum iron,ferritin,transferrin and total iron binding capacity were detected by chemiluminescence method and analyzed statistically. Results The SN standardized volume and phase value in PD group significantly reduced compared with control group（ all P〈0. 01）. SN standardized volume and SN phase value in moderate or advanced PD subgroup were significantly lower than those in early PD subgroup（ all P〈0. 01）. Both SN area（ r =-0. 525,P〈0. 01） and phase value（ r =-0. 873,P〈0. 01） were negatively correlated with Hoehn-Yahr grading. There were no significant differences in serum iron metabolism indexes among control group and two PD subgroups（ all P〉0. 05）. Conclusion SWI technique has important clinical value in the early diagnosis and assessment of Parkinson＇s disease by measuring the standardized volume and phase value of substantia nigra,but there is no significant relationship between serum iron metabolism index and brain iron deposition in Parkinson＇s disease.