路易体痴呆与帕金森病多模态功能磁共振比较研究

Alterations of dementia with Lewy body and Parkinson's disease:a multimodal fMRI study

目的:探讨路易体痴呆(dementia with Lewy body,DLB)患者和帕金森病(Parkinson’s disease,PD)患者静息状态下脑结构及功能的改变。方法:对16例DLB患者、20例PD患者和20例正常者对照进行T1结构像、静息态功能磁共振扫描,比较3组间脑区局部一致性(regional homogeneity,Re Ho)和灰质体积(grey matter volume,GMV)的差异,并将差异与蒙特利尔认知评估量表(Montreal cognitive assessment,MOCA)、简易精神状态量表(mini mental state examination,MMSE)、统一的PD评分量表第三部分(unified Parkinson’s disease rating scale-Ⅲ,UPDRS-Ⅲ)进行相关分析。结果:(1)与对照组比较,DLB组左侧小脑前叶、双侧距状裂、双侧尾状核Re Ho增高,左侧额中回Re Ho减低;PD组右侧颞上回、右侧缘上回Re Ho增高;与PD组比较,DLB组双侧尾状核Re Ho增高,右侧缘上回、左侧额下回Re Ho减低。(2)与对照组比较,DLB组双侧尾状核、右侧颞叶GMV减少;与PD组比较,DLB组右侧尾状核、右侧颞叶GMV减少。(3)DLB组双侧尾状核Re Ho值与UPDRS-Ⅲ评分呈负相关。结论:DLB患者静息态下脑结构和功能发生改变,这些改变可能与疾病的病理生理机制有关。

Objective：To investigate brain changes of cortical gray volume and function between dementia with Lewy body （DLB） and Parkinson＇ s disease （PD）. Methods： A total of 16 DLB patients, 20 PD patients and 20 well-matched healthy controls were scanned with T1 structure and resting-state functional magnetic resonance imaging for regional homogeneity （ReHo） and gray matter volume （GMV） analyses. The Mini mental state examination （MMSE）, Montreal cognitive assessment （MoCA） and unified Parkinsou ＇ s disease rating scale-Ⅲ （UPDRS-Ⅲ ）were performed to assess the clinical symptom, as well as its correlations with ReHo and GMV. Results： （1） Compared with the controls, the DLB groups showed higher ReHo in left cerebellum anterior lobe, bilateral calcarine, bilateral caudate, and lower ReHo in left middle frontal gyrus, while PD patients had increased ReHo in right superior temporal gyrus, right supra marginal. Compared with the PD patients, the DLB patients had significantly increased ReHo in bilateral caudate, as well as decreased ReHo in right supra marginal, left inferior frontal gyrus.（2） Compared with the controls, the DLB patients show reduced GMV in bilateral caudate, right temporal lobe ; Compared with the PD patients, the DLB patients show reduced GMV in right caudate, right temporal lobe.（3） There are significantly negative correlation between ReHo and UPDRS- Ⅲ scores in bilateral caudate in DLB patients. Conclusion ：The structural and functional changes in brain of DLB patients may be related to disease＇ s physiopathologic mechanism.