采用T2*值研究姿势异常步态障碍亚型帕金森病的临床异质性

The research of postural instability and gait disorder-dominant Parkinson's disease in the brain using T_2~* values

目的通过应用3. 0T增强梯度回波T_2加权血管成像(enhanced gradient echo T2star-weighted angiography,ESWAN)来定量测量姿势异常步态障碍(postural instability and gait disorder,PIGD)亚型帕金森病(Parkinson’s disease,PD)与正常对照组额叶白质区及灰质核团的T_2~*值,研究T_2~*值在PIGD亚型PD中的诊断价值。方法分别对PD患者及年龄、性别相匹配的正常对照组各122例进行常规及ESWAN序列扫描。根据主要临床表现分为PIGD亚型PD(59例)和震颤亚型PD(63例)两型。通过图像后处理在T_2~*图像上分别测量左右侧额叶白质区、红核、黑质网状带、黑质致密带、尾状核头、壳核、苍白球和丘脑的T_2~*值,并将所获得数据进行统计分析。结果PIGD亚型PD的首发症状多为强直、运动迟缓及步态障碍,其MMSE评分较震颤亚型PD低(P <0. 05),改良Hoehn-Yahr病情分级较震颤亚型重(P <0. 01);两型PD在发病年龄、性别构成、病程、起病侧等方面相比无统计学差异(P> 0. 05)。正常对照组在苍白球的T_2~*值最低,其次为黑质网状带、红核,额叶白质区的T_2~*值最高。PIGD亚型PD与正常对照组在黑质致密带的T_2~*值比较有显著统计学意义意义(P <0. 01); PIGD亚型PD与震颤亚型PD在壳核、丘脑的T_2~*值比较有统计学意义(P <0. 05),余感兴趣区的T_2~*值无统计学差异。结论 PIGD亚型PD与震颤亚型PD在首发疾病、典型症状方面具有较明显的异质性。PIGD亚型PD与正常对照组相比在黑质致密带脑铁异常沉积较为明显,PIGD亚型PD在壳核、丘脑的脑铁异常沉积较震颤亚型PD明显,T_2~*值有助于PIGD亚型PD的诊断及不同运动障碍亚型分型诊断。

Objective To quantitatively analyze the iron deposition in deep brain gray nucleus and frontal white matter between different movement disorder subtypes of Parkinson’s disease(PD)and control subjects and its correlation with age using ESWAN(enhanced gradient echo T 2 star-weighted angiography)with 3.0 Tesla scanner,and investigate the diagnostic value of the T 2*postural instability and gait disorder(PIGD)-dominant PD value and distinguish from different subtypes of PD according to motor symptoms.Methods 122 patients with PD and 122 control subjects,ranging in same ages and gender,had been manned with routine sequences and ESWAN sequences by 3.0T MR.122 cases(male 67,female 55)who have PD were divided into PIGD-dominant PD(n=59)and tremor-dominant PD(n=63)groups.The T 2*value was measured in both sides of frontal white matter(FWM),red nucleus(RN),substantia nigra pars reticulate(SNr),substantia nigra pars compacta(SNc),putamen(PUT),globus pallidus(GP),head of caudate nucleus(CN)and thalamus(THA),and statistically analyzed.Results The initial symptom of PIGD-dominant PD was rigidity and gait disorder,but patients with tremor-dominant PD had tremor as the initial symptoms.The amended Hoehn-Yahr stage of PIGD-dominant PD was significantly lower than that of tremor-dominant PD(P<0.05),while the score of Mini-Mental State Examination(MMSE)was significantly higher in the former(P<0.01).No statistical differences were found in the age,gender,course of disease and onset side between the patients with different subtypes of PD(P>0.05).The T 2*value of GP was the lowest,followed by the SNr and RN.The highest T 2*value was seen in the FWM.The T 2*value was significant reduced in SNc of PIGD-dominant PD compared with the control subjects group(P<0.05),and the T 2*value was reduced in PUT and THA of tremor-dominant PD compared with PIGD-dominant PD(P<0.05).There were no statistical differences in others regions(P>0.05).Conclusion There are significant differences in the initial and typical symptoms between PIGD-dominant PD and tremor-dominant PD.The abnormal brain iron deposition was significant reduced in SNc of PIGD-dominant PD compared with the control subjects group,and the abnormal brain iron deposition was reduced in PUT and THA of PIGD-dominant PD compared with tremor-dominant PD.The T 2*value can help to diagnose PIGD-dominant PD and distinguish from different subtypes of PD according to motor symptoms.