脑微出血对帕金森病认知功能的影响

Clinical analysis of the effect of cerebral microbleeds on cognitive function in patients with Parkinson's disease

目的探讨合并脑微出血(CMBs)以及不同部位CMBs帕金森病(PD)患者的临床特点以及CMBs对PD患者认知功能的影响。方法收集2016-09—2018-03于苏州高新区人民医院、南京医科大学附属苏州医院就诊的PD患者112例,根据是否合并CMBs病灶分为PD合并CMBs组和PD不合并CMBs组。进一步根据CMBs所处的分布区域分为单纯脑叶CMBs和非单纯脑叶CMBs亚组。比较各组患者临床特征、统一帕金森病评分量表(UPDRS)评分、Hoehn-Yahr(H-Y)分级、蒙特利尔认知评估量表(MoCA)等差异。采用非条件Logistics回归分析影响PD认知功能障碍的相关因素。结果与PD未合并CMBs组(n=81)比较,PD合并CMBs组(n=31)患者MoCA评分更低、服用左旋多巴等效剂量更大,侧脑室周围白质病(periventricular white matter hyperintensity,PWMH)和深部白质病变(deep white matter hyperintensity,DWPH)的Fazekas得分均更高(均P<0.05)。与单纯脑叶CMBs亚组(n=10)比较,非单纯脑叶CMBs组患者MocA评分以及视空间与执行、语言项目评分升高(P<0.05或P<0.01),非单纯脑叶CMBs组体位性低血压比例升高(P<0.05)。非条件多因素Logistic回归分析显示,CMBs是PD患者认知障碍的重要影响因素之一。结论合并CMBs的PD患者认知功能更差,对药物反应性越差,脑白质病变和腔隙性脑梗死的程度越重。CMBs对PD患者的认知功能产生一定影响,且CMBs的分布区域不同,认知损害的领域及程度也有所不同。

Objective To explore the clinical characteristics and the effects of cerebral microbleeds(CMBs)on cognitive function in patients with Parkinson s disease(PD).Methods 112 PD patients were enrolled.Participants were divided into PD patients with CMB group and PD patients without CMB group according to the results of SWI.Then,PD patients with CMB group were divided into lobe only subgroup and non-lobe only subgroup based on the location of CMBs.Clinical characteristics,unified Parkinson s Disease Rating Scale(UPDRS),Hoehn-Yahr(H-Y)stage,Montreal cognitive assessment(MoCA)were compared between each group.The related factors of PD patients with cognitive dysfunction were analyzed by non-conditional logistics regression analysis.Results Compared with the PD patients without CMBs(n=81),the PD patients with CMBs(n=31)had significantly lower score of MoCA,more levodopa-equivalent daily dose(LED)and higher Fazekas scores of periventricular white matter hyperintensity(PWMH)and deep white matter hyperintensity(DWMH)(all P<0.05).In addition,compared with the lobar only subgroup,the non-lobar only subgroup had significantly higher score of MoCA,especially for memory score,visuospatial and executive performance score.However,non-lobar only subgroup had higher proportion patients with postural hypotension.Non-conditional logistic regression analysis showed that the presence of CMBs was one of the main prognostic factors for cognitive impairment.Conclusions PD patients with CMBs have worse cognition,treatment effectiveness and more severe WMH and Lacunar infarcts(LI).CMBs may have an effect on cognition.There were differences in the domain and severity of cognitive impairment based on location of CMBs.