进行性核上性麻痹患者正压性脑积水的相关性研究

Correlative study of normal pressure hydrocephalus in patients with progressive supranuclear palsy

目的探究进行性核上性麻痹(progressive supranuclear palsy,PSP)患者脑积水程度与病程发展、炎症指标、认知功能的相关性及其临床意义。方法收集郑州大学第一附属医院神经内科收治的33例PSP患者、33例帕金森病患者及31例健康对照者的临床基本资料、影像学检查结果、血清样本,分析各组人群中脑积水程度、认知功能水平及血清炎性指标水平的差异,并探究PSP患者脑积水程度与认知功能、血清炎症因子的相关性。结果进行性核上性麻痹患者与对照组相比认知功能(MMSE评分、MoCA评分)显著降低(t=6.187,P<0.001;t=6.960,P<0.001),血清炎症指标CRP、IL-6均显著升高(t=2.081,P=0.042;t=5.327,P<0.001),Evans指数显著升高(t=5.519,P<0.001)。亚组分析中,中晚期PSP患者较早期PSP患者Evans指数显著升高(t=3.025,P=0.005),PSP患者脑积水程度与病程进展、炎症因子IL-6水平、认知功能评分均显著相关。结论PSP患者在病程发展中逐渐出现正压性脑积水,与血清炎症指标IL-6、认知功能障碍呈显著相关,可作为辅助临床诊断的重要手段。

Objective To investigate the relationship between hydrocephalus and inflammatory factors in patients with progressive supranuclear palsy(PSP)and related clinical significance.Methods The data about basic clinical features,magnetic resonance imagings as well as serum samples of 33 patients with PSP,33 patients with Parkinson’s disease(PD)and 31 healthy controls admitted to the Department of Neurology,the First Affiliated Hospital of Zhengzhou University were collected.The differences about the proportion of hydrocephalus,cognitive function scores and the inflammatory index levels in each group were analyzed.The correlation between cognitive function,serum inflammatory index levels and the degree of hydrocephalus was explored.Results Compared with healthy controls,Cognitive function scores of PSP patients,including MMSE score and MoCA score,were significantly lower(t=6.187,P<0.001;t=6.960,P<0.001).The levels of serum C-reactive protein and IL-6 and the Evans index were significantly increased(t=2.081,P=0.042;t=5.327,P<0.001,t=5.519,P<0.001).In the subgroup analysis,the Evans index of later period of PSP patients was significantly higher than early stage of PSP patients(t=3.025,P=0.005).Moreover,the degree of hydrocephalus of PSP patients was related with the level of IL-6 in serum and cognitive function scores.Conclusion During the process of Progressive supranuclear palsy hydrocephalus,the degree of normal pressure hydrocephalus gradually worsens,and there is a significant correlation with the level of serum IL-6 and cognitive dysfunction,which can be used as an important means of clinical auxiliary examination.