帕金森病合并痴呆患者经颅超声特点

The study on characteristics of transcranial sonography in Parkinson disease with dementia

目的探讨帕金森病不合并痴呆(Parkinson disease without dementia,n-PDD)与帕金森病合并痴呆(Parkinson disease with dementia,PDD)患者的经颅超声(transcranial sonography,TCS)特征。方法对最终纳入统计学分析的163例受试者(58例PDD、64例n-PDD、41例对照)行经颅超声检测黑质(substantia nigra, SN)回声、第三脑室(third ventricle, TV)宽度等指标,使用简明精神状态量表(MMSE)、蒙特利尔认知评估量表(MoCA,北京版)、统一帕金森病评定量表第三部分(UPDRS-Ⅲ)、非运动症状问卷(NMSQ)、Hoehn-Yahr(H-Y)分期等进行评估,分析黑质(SN)回声、第三脑室(TV)宽度与认知功能(MMSE、MoCA)的关系。结果 PDD组TV宽度、SN+率明显高于n-PDD组和对照组[TV宽度分别为(7.2±0.4)、(5.8±1.0)、(5.8±1.1),F=43.48,P<0.001;SN+率分别为(87.93%,85.94%,9.76%),χ~2=83.251,P<0.001];根据SN强回声阳性及阴性将PDD组分为SN+组和SN-组,SN+组年龄(t=2.16,P=0.0352)、Hoehn-Yahr分期(χ~2=7.628,P=0.0057)、NMSQ评分(t=2.37,P=0.0214)均明显高于SN-组。第三脑室宽度与各项临床特征均无显著相关性(P>0.05)。黑质强回声阳性与H-Y分期(r=0.249,P=0.010)、UPDRS-Ⅲ(r=0.279,P=0.004)、NMSQ(r=0.242,P=0.013)呈正相关,与年龄、性别、病程、MMSE、MoCA等无统计学相关性(P>0.05)。结论通过TCS测量SN无法鉴别PD患者是否伴有痴呆,而测量第三脑室宽度对鉴别PD患者是否伴有痴呆有一定的帮助,并对PD患者是否进展为PDD起一定的预测作用。

Objective To investigate the characteristics of Transcranial Sonography(TCS)in Parkinson disease patients with or without dementia.Methods One hundred sixty-three subjects including 58 PDD,64 n-PDD,and 41 controls were recruited in the study.Transcranial ultrasound was used to detect the echo of substantia nigra and the width of third ventricle.The status of PD patients were evaluated using minimum mental state examination,Montreal Cognitive Assessment Scale,Unified Parkinson's Disease Rating Scale Part 3,Non-Sports Symptom Questionnaire and Hoehn-Yahr Staging.A statistical analysis was used to evaluate the relationship between substantia nigra(SN)echo,third ventricle(TV)width,and cognitive function(MMSE,MoCA).Results The TV width and SN+rate of PDD group were significantly higher than those of n-PDD group and control group[TV width were(7.2±0.4),(5.8±1.0),(5.8±1.1),F=43.48,P<0.001;SN+rate were(87.93%,85.94%,9.76%),χ2=83.251,P<0.001].Patients with PDD were further divided into SN+group and SN-group according to TCS result.Age(t=2.16,P=0.0352),Hoehn-Yahr stage(χ2=7.628,P=0.0057),NMSQ score(t=2.37,P=0.0214)were significantly higher in SN+group than in SN-group.There was no significant correlation between the width of the third ventricle and clinical features(P>0.05).Positive echogenicity of SN was positively correlated with HY stage(r=0.249,P=0.010),UPDRS-III(r=0.279,P=0.004),NMSQ(r=0.242,P=0.013),but not with age,gender and disease duration.There was no significant correlation between MMSE and MoCA(P>0.05).Conclusion Measurement of third ventricle width by not SN by TCS is helpful for identifying whether PD patients are accompanied by dementia and predicting whether PD patients progress to PDD.