帕金森病患者脑白质病变的半定量评估及其影响因素研究

Semi-quantitative evaluation of white matter lesions and its influencing factor in patients with Parkinson’s disease

目的探讨帕金森病(PD)患者磁共振成像上脑白质病变(WML)的特点及其与临床表征间的相关性。方法回顾性研究,应用T2WI-FLAIR序列,通过Fazekas和Scheltens视觉量表对87例PD患者的WML进行评估,将其分为早期组(H-Y分级1.0~2.0期)47例和中晚期组(H-Y分级2.5~4.0期)40例、非抑郁组71例和抑郁组16例、非焦虑组62例和焦虑组25例,运用有序分类Logistic回归对WML与性别、年龄等危险因素及简易精神状态量表(MMSE)、统一帕金森病评定量表第三部分(UPDRS-Ⅲ)、汉密尔顿抑郁量表(HAMD)、汉密尔顿焦虑量表(HAMA)评分进行相关性分析。结果与PD早期组患者比较,中晚期组患者脑叶白质病变增多(P<0.05),以枕叶明显(P<0.05)。PD抑郁/焦虑组和非抑郁/焦虑组患者WML差异无统计学意义(P>0.05)。在Scheltens量表中,PD患者脑室旁(OR=1.13,P<0.01)、脑叶(OR=1.10,P<0.01)及基底节区(OR=1.15,P<0.01)WML与年龄相关,脑室旁WML与MMSE评分相关(OR=0.68,P<0.01),以枕角(OR=0.60,P<0.01)及侧脑室旁(OR=0.68,P<0.05)更为显著,颞叶WML与MMSE评分亦相关(OR=0.68,P<0.05);脑叶WML与H-Y分级相关(OR=2.10,P<0.05),以枕叶更为显著(OR=3.33,P<0.05);顶叶WML与HAMD评分相关(OR=1.13,P<0.05);基底节区WML与糖尿病相关(OR=6.34,P<0.05),以壳核更为显著(OR=6.86,P<0.01)。在Fazekas量表中,脑室旁(OR=1.16,P<0.01)和深部WML(OR=1.13,P<0.01)均与年龄相关,且脑室旁WML与MMSE评分(OR=0.65,P<0.01)相关。PD患者WML评分与性别、高血压、冠心病、血脂异常、UPDRS-Ⅲ及HAMA评分无关。结论PD患者存在WML,且与患者年龄、糖尿病、疾病严重程度、抑郁症状及认知功能相关。

Objective To investigate the characteristics of white matter lesions(WML)found by magnetic resonance imaging(MRI)and the relationship with clinical features in patients with Parkinson's disease(PD).Methods This was a retrospective study by using a method of MRI T2W1-FLAIR.The WML in 87 PD patients were evaluated by using the Fazekas scale and Scheltens scale.Patients were divided into the early PD group[n=47,Hoehn-Yahr(H-Y)stage 1.0-2.0]us.the middle-advanced PD group(n=40,H-Y stage 2.5-4.0)。the non-depressed PD group(n=71)us.the:depressed PD group(n=16),the non-anxions PD group(n=62)us.the anxions PD group(n=25).An ordinal regression model was used to investigate the correlations of WMI.with gender.age.Mini-Mental State Examination(MMSE)score.Unified Parkinson's disease Rating Scale-II score(UPDRS-II),Hamilton Rating Scale for Depression score(HAMD)and Harmiton Rating Scale for Anxiety score(HAMA).Results Compared with the early PD group.the rmiddle advanced PD group showed that the WML.were increased in lobe of brain(5.30±4.85 us.3.43±3.13.P<0.05),especially in the occipital lobe(0.48±0.99 us。0.11±0.31.P<0.05).There was no significant difference in the W ML.between the non depressed/anxions and the depressed/anxions PD group.After being evaluated by the Scheltens scale.WMI.in periventricular hyperintensities(PVH)regions(OR=1.13.P<0.01).in brain lobe(OR=1.10.P<0.01)and in basal ganglia regions(OR=1.15.P<0.01)were correlated with age.WMI.in the brain besides the PV region were correlated with MMSE score(OR=0.68,P<0.01),especially in posterior horns(OR=0.60,P<0.01)and lateral ventricles(OR=0.68,P<0.05)WMI.in temporal lobe was correlated with MMSE score(OR=0.68,P<0.05).WML.in brain lobe was correlated with H-Y stages(OR=2.10.P<0.05),especially in the occipital lobe(OR=3.33,P<0.05).WMI.in parietal lobe was associated with HAMD score(OR=l.13.P<0.05).WML.in basal ganglia regions was related to diabetes(OR=6.34.P<0.05),especially in the putamen(OR=6.86.P<0.01).After being evaluated by the Fazekas scale.WMI.in PVH region(OR=1.16.P<0.01)and deep white matter hyperintensities(OR=l.13.P<0.01)were correlated with age.WMI.in PVH region were associated with MMSE score(OR=0.65.P<0.01).WMI.scores in PD patients had no correlation with gender.hypertension,coronary heart disease.hyperlipemia.UPDRS-Il score and HAMA score..Conclusions The WMI.is present in PD patients,and it is correlated with age.diabetes.severity of disease,depression and cognitive function.