帕金森病患者黄斑区视网膜厚度变化的特点分析

Analysis of the characteristic changes of macular thickness in patients with Parkinson's disease

目的通过频域光学相干断层扫描(SD-OCT)技术研究帕金森病患者黄斑区视网膜厚度的变化特点,以及与运动症状严重程度、运动症状受累严重侧别、认知障碍、视空间障碍发生的相关性。方法收集2016年1月至2018年5月在上海交通大学医学院附属新华医院神经内科门诊就诊和住院治疗的帕金森病患者71例作为帕金森病组,以及同期来医院门诊体检以及自愿参加本研究的正常对照者61名作为正常对照组,行SD-OCT检查。对比分析帕金森病组与对照组黄斑区视网膜厚度之间的差异,并采用广义估计方程(GEE)拟合线性回归分析帕金森病患者SD-OCT测量指标与其病程、统一帕金森病评定量表第三部分(UPDRS-Ⅲ)评分、蒙特利尔认知评估量表(MoCA)总分及视空间子评分之间的相关性。结果帕金森病组黄斑区平均视网膜厚度较对照组明显减小[(261.94±12.90)μm与(270.96±10.71)μm,B=-8.135,P<0.01),其他黄斑区各象限(中央凹、1 mm中央区除外)视网膜厚度及黄斑体积也较对照组减小,差异均有统计学意义。其中内环上方黄斑厚度有较好的诊断价值,其受试者工作特征曲线下面积为0.727(95%CI 0.662~0.792,P<0.01)。UPDRS-Ⅲ评分与中央凹(B=-9.132,P=0.034)、黄斑中央区(B=-6.963,P=0.036)以及内环各象限[上方(B=-7.727,P<0.01)、下方(B=-5.169,P=0.044)、鼻侧(B=-5.960,P<0.01)、颞侧(B=-5.905,P<0.01)]黄斑区视网膜厚度间呈负相关,病程长度与黄斑区视网膜各象限位置厚度无线性相关性,帕金森病运动症状受累较重侧黄斑区视网膜厚度与受累较轻侧之间差异无统计学意义(P>0.05)。MoCA总分与内环各象限[上方(B=2.693,P=0.007)、下方(B=3.391,P=0.002)、鼻侧(B=2.609,P=0.001)、颞侧(B=2.115,P=0.013)]黄斑区视网膜厚度间呈正相关,视空间子评分与黄斑区平均视网膜厚度(B=4.368,P=0.042)、黄斑体积(B=0.161,P=0.004)、内环和外环[鼻侧(B=8.130、6.017)、下方(B=8.582、6.541)、颞侧(B=5.938、5.316),均P<0.05]的象限视网膜厚度间呈正相关。结论帕金森病患者黄斑区视网膜厚度明显变薄,黄斑体积变小,且黄斑区视网膜厚度改变无非对称受累特点,3 mm圈以内各象限的黄斑区视网膜厚度与帕金森病病情严重程度相关,鼻侧、下方、颞侧象限的黄斑区视网膜厚度与视空间障碍相关。

Objective To analyze the characteristic changes of macular thickness in patients with Parkinson′s disease by spectral-domain optical coherence tomography (SD-OCT), and find out the association between macular thickness and disease progression, cognitive dysfunction, visuospatial impairment and asymmetry of motor symptoms. Methods Seventy-one Parkinson′s disease (PD) patients who were admitted to the Department of Neurology, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine from January 2016 to May 2018 and sixty-one healthy controls who volunteered to participate for the same period were enrolled and underwent SD-OCT examination. The macular thickness of all retinal quadrant segments, foveal thickness, and macular volume between the two groups were comparatively analyzed. Associations between macular measurements and clinical parameters such as disease duration, Unified Parkinson′s Disease Rating Scale part Ⅲ(UPDRS-Ⅲ) scores, Montreal Cognitive Assessment (MoCA) total scores, and visuospatial subscores were analyzed using generalized estimated equation fitted with linear regression models. Results Mean macular thickness in the PD group was significantly reduced compared with those in the control group ((261.94±12.90)μm vs (270.96±10.71)μm, B=-8.135, P<0.01). All quadrants of macular thickness (except fovea and 1 mm central zone) in the PD group were reduced compared with those in the control group. Receiver operating characteristic (ROC) curve analysis revealed that inner superior thickness could predict the presence of PD with an area under ROC of 0.727 (95%CI 0.662-0.792, P<0.01). UPDRS-Ⅲscores were negatively correlated with foveal thickness (B=-9.132, P=0.034), 1 mm central zone thickness (B=6.963, P=0.036) and all quadrants of the inner ring (superior (B=-7.727, P<0.01), inferior (B=-5.169, P=0.044), nasal (B=-5.960, P<0.01) and temporal (B=-5.905,P<0.01)) macular thickness. The disease duration had no relationship with any quadrant of macular measurements. No statistically significant difference was found between the macula parameters of the hemiretinae corresponding to more and less severely affected cerebral hemisphere. MoCA total scores were positively correlated with all quadrants of the inner ring (superior (B=2.693, P=0.007), inferior (B=3.391, P=0.002), nasal (B=2.609, P=0.001) and temporal (B=2.115, P=0.013)) macular thickness. MoCA visuospatial subscores were positively associated with average macular thickness (B=4.368, P=0.042), macular volume (B=0.161, P=0.004), inferior (B=8.582, 6.541), nasal (B=8.130, 6.017) and temporal (B=5.938, 5.316) quadrants of outer and inner rings macular thickness (all P<0.05). Conclusions In PD patients, the macular thickness and macular volume were decreased. Asymmetry was not identified between hemiretinae in PD. Some quadrants of macular thickness were associated with disease progression, cognitive dysfunction, and visuospatial impairment.