震颤起病与非震颤起病的帕金森病脑结构差异与脑深部电刺激的预后差异分析

Structural difference of tremor onset and non-tremor onset in Parkinson disease patients and prognosis of two groups

目的脑深部电刺激(DBS)是治疗帕金森病(PD)的常用方法,但是不同患者有着不同的预后。震颤和僵直、运动迟缓等非震颤症状是PD的常见起病症状。以震颤起病和非震颤起病的帕金森病对DBS的疗效差异及两组核磁结构像是否存在差异还不清楚,本研究对此问题进行相关研究。方法回顾性分析2014年—2018年收治的137例帕金森病患者的临床资料。其中以震颤起病的患者70例(男20例,女50例,平均年龄64岁,Hoehn-Yahr分期中位数为3);以非震颤起病的患者67例(男19例,女48例,平均年龄60岁,Hoehn-Yahr分期中位数为3)。对比两组患者手术前后运动量表评分和非运动量表评分的差异。通过基于体素的形态学分析方法(VBM)分析两组患者的结构像差异。结果两组患者的年龄、性别、Hoehn-Yahr分期的差异均无统计学意义;UPDRSⅡ、UPDRSⅢ、HAMD、HAMA及MOCA量表评分的差异均无统计学意义(均P>0.05)。术前评分显示,以震颤起病患者的震颤亚项评分高,以僵直、运动迟缓起病患者的僵直亚项评分高(均P<0.05)。术后开机后评分比较,两组在震颤、僵直评分上仍然有明显差异;以震颤起病患者的震颤评分高,以僵直、运动迟缓起病患者的僵直评分高(均P<0.05)。VBM分析显示,与非震颤起病组相比,震颤起病组患者的眶回后部灰质体积降低(FWE校正后,P<0.05)。结论帕金森病患者术后症状的改善与术前起病症状相关,以震颤起病患者的眶回后部灰质体积明显小于非震颤起病患者;这种差异可能与震颤网络有关。

Objective The deep brain stimulation(DBS)is the most useful surgical method in Parkinson disease(PD),but different patients have discrepant prognosis.The tremor and non-tremor syndrome(like rigidity,bradykinesia)are the most common onset syndrome in PD.However,the prognosis of DBS and the brain grey matter difference have not been clarified.Methods 137 Parkinson patients from 2014 to 2018 were included in this research.70 patients were tremor onset(average age of 64,20 males,50 females,Hoehn-Yahr median score of 3).67 patients were non-tremor onset(average age of 60,19 males,48 females,Hoehn-Yahr median score of 3).The movement and non-movement scores as well as the structure image were collected.The voxel-based morphometry method was used to evaluate the structure image.Results No significant difference was found in age,gender,Hoehn-Yahr scale,UPDRSⅡ,UPDRSⅢ,HAMA,HAMD,MoCA score(all P>0.05).The pre-operation scores and the post-stimulation score both showed the tremor onset patients had higher sub-score in tremor and the non-tremor onset patients have higher sub-score in rigidity(all P<0.05).The VBM results showed the tremor onset patients have lower gray matter volume in posterior orbital cortex(FWE corrected,P<0.05).Conclusions The post-operation prognosis is related to the onset syndrome.The posterior orbital cortex has lower gray matter volume in tremor onset patients,which might correlate with the tremor network.