脑白质病变与老年帕金森病患者运动功能障碍的相关性研究

Association between white matter lesions and motor impairment in patients with Parkinson's disease

目的探讨脑白质病变(white matter lesions,WML)与帕金森病(Parkinson’s disease,PD)患者不同程度运动功能障碍及其主要症状的关系。方法纳入281例60岁以上的PD患者进行研究。PD患者运动功能障碍症状严重程度的判断基于Hoehn&Yahr分期。根据PD运动功能障碍的严重程度不同,将入组的PD患者分为轻度PD组及中重度PD组。WML的严重程度按Fazekas视觉模拟评分法分为轻中重3级。使用多因素Logistic回归分析统计分析WML与中重度PD及PD各运动功能障碍症状的相关性。结果多因素Logistic回归分析结果显示年龄、PD病程>3年、高血压、糖尿病、代谢综合征以及WML是中重度PD的独立危险因素(均P<0.05)。同时,WML与PD患者的静止性震颤、肌强直及姿势步态障碍症状均有明显相关性(均P<0.05)。另外,中度及重度WML是静止性震颤的独立危险因素(均P<0.05),不同严重程度的WML均为肌强直及姿势步态障碍的独立危险因素(均P<0.05)。结论 WML会增加PD患者严重运动功能障碍的风险,同时WML与PD患者的主要运动功能障碍症状均有明显相关性。

Objective To investigate the association between white matter lesions （WML） and motor impairment in pa- tients with Parkinson＇ s disease （PD）. Methods A total of 281 patients with PD over 60 years old were enrolled in this study. Diagnosis of severity of motor impairment in patients with PD was based on Hoehn ＆ Yahr staging scale. The pa- tients with PD were divided into mild PD group and moderate/severe PD group according to the severity of motor impair- ment. The severity of WML was divided into 3 grades according to the modified visual scale of Fazekas. The association between WML and moderate/severe PD and main symptoms of motor impairment were analyzed. Results Muhifactorial logistic regression analysis showed that the association between age, PD pathogenesis 〉 3 years, hypertension, diabetes, metabolic syndrome, WML and moderate/severe PD was statistically significant （ all P 〈 0.05 ）. Meanwhile, WML was significantly associated with tremor at rest, rigidity, and postural/gait instability （ all P 〈 0.05 ）. In addition, moderate and severe WML were the independent risk factors for tremor at rest （ all P 〈 0.05 ）, and different severities of WML were the independent risk factors for rigidity and postural/gait instability （ all P 〈 0.05 ）. Conclusion WML might in- crease the risk of severe motor impairment in patients with PD, and WML was associated with major symptoms of motor impairment in patients with PD.