多系统萎缩不同亚型间的临床特征及脑葡萄糖代谢差异分析

An Analysis of Differences on Clinical Characteristics and Cerebral Glucose Metabolism between Subtypes of Multiple System Atrophy

目的分析多系统萎缩-帕金森亚型和多系统萎缩-小脑共济失调亚型患者的临床特征以及18氟-脱氧葡萄糖正电子发射断层(l8F-FDG PET)显像的特征差异。方法收集8例多系统萎缩-帕金森亚型患者和17例多系统萎缩-小脑共济失调亚型患者的临床资料,回顾性分析包括统一帕金森病评定量表-运动部分(UPDRS Ⅲ)评分和Hoehn-Yahr分级的运动症状评估,认知功能、抑郁、嗅觉、快速眼动期睡眠行为紊乱等非运动症状评估,以及基于l8F-FDG PET脑葡萄糖代谢显像的特征差异。结果多系统萎缩-帕金森亚型与多系统萎缩-小脑共济失调亚型患者UPDRS Ⅲ评分(P=0.004)及Hoehn-Yahr分级(P<0.001)比较,差异有统计学意义,而非运动症状组间比较,差异无统计学意义(P>0.05)。多系统萎缩-帕金森亚型在基底节(尤其是后壳核)脑葡萄糖代谢(P<0.001)、小脑及顶枕叶呈低代谢,多系统萎缩-小脑共济失调亚型基底节脑葡萄糖代谢未见减低,仅在小脑和枕叶呈低代谢。结论多系统萎缩的临床特征异质性大,l8F-FDG PET脑葡萄糖代谢显像特征差异可为深入研究多系统萎缩的发病机制、开发更精准治疗奠定基础。

Aim To explore the differences on clinical characteristics and cerebral glucose metabolism patterns between multiple system atrophy-parkinsonian subtype(M SA-P)and multiple system atrophy-cerebellar ataxia subtype(MSA-C).Methods Unified Parkinson's Disease Rating Scale-motor Section(UPDRS Ⅲ),Hoehn-Yahr stage,four non-motor presentations including cognition,depression,olfaction,rapid eye movement behavior disorder and cerebral glucose metabolism pattern using 18F-fluorodeoxyglucose positron emission tomography(18F-FDG PET/CT)were retrospectively analyzed in 25 MSA patients(including 8 MSA-P and 17 MSA-C)from Huashan Hospital affiliated to Fudan University.Results There were statistically differences in UPDRS Ⅲ scores and Hoehn-Yahr stages between the two subtypes of MSA(P=O.004,P<0.001),but no difference in non-motor presentations(P>0.050).MSA-P patients had hypometabolism in striatum(particularly in posterior putamen),cerebellum and parietooccipital lobe while MSA-C patients presented hypometabolism only in cerebellum and occipital lobe with no changes in striatum.Conclusion MSA had great heterogeneity,and different cerebral glucose metabolism patterns can lay the foundation for further investigation of pathogenesis of MSA and accurate symptomatic treatments.