磁共振波谱在原发性帕金森病治疗效果评估中的应用价值

Value of magnetic resonance spectroscopy in evaluating the therapeutic effect of primary Parkinson′s disease

目的探讨磁共振波谱(MRS)在原发性帕金森病(PD)药物治疗效果评估中的作用。方法选择2019年10月至2020年10月盐城市第一人民医院收治的双侧症状的原发性PD患者20例为研究对象。患者均给予口服多巴丝肼片治疗4周(0.125 g,每日3次)。分别于治疗前后进行氢质子磁共振波谱(1H-MRS)检查并采用PD统一评分量表第三部分(UPDRS-Ⅲ)评分来评估患者运动症状。比较患者治疗前后豆状核、苍白球、丘脑、黑质中N-乙酰天门冬氨酸(NAA)/胆碱(Cho)、NAA/肌酐(Cr)、Cho/Cr比值的变化及UPDRS-Ⅲ评分变化,使用单因素线性回归和多因素线性回归分析患者UPDRS-Ⅲ评分与1H-MRS的相关性。结果治疗后患者左右两侧豆状核、苍白球、丘脑及黑质中的NAA/Cho、NAA/Cr比值均显著高于治疗前(P<0.05),Cho/Cr比值与治疗前比较差异无统计学意义(P>0.05)。患者治疗后UPDRS-Ⅲ评分显著低于治疗前(P<0.05)。患者治疗前后的NAA/Cho、NAA/Cr比值变化值与UPDRS-Ⅲ评分变化值均呈显著负相关(P<0.05);在校正了年龄、性别和病程等因素后,治疗前后的NAA/Cho、NAA/Cr比值变化值与UPDRS-Ⅲ评分变化值仍呈显著负相关(P<0.05);Cho/Cr比值变化值与UPDRS-Ⅲ评分变化值无相关性(P>0.05)。结论1H-MRS可用于PD的病情评估及药物疗效评价。

Objective To explore the role of magnetic resonance spectroscopy(MRS)in the evaluation of drug efficacy in primary Parkinson′s disease(PD).Methods Twenty patients with primary PD with bilateral symptoms admitted to Yancheng First People′s Hospital from October 2019 to October 2020 were selected as study objects.All patients were treated with dopashydrazine tablets for 4 weeks(0.125 g,3 times a day).Proton magnetic resonance spectroscopy(1H-MRS)examination was performed,and the motor symptoms of patients were evaluated by the unified PD rating scale PartⅢ(UPDRS-Ⅲ)before and after treatment.The changes of the N-acetylaspartate(NAA)/choline(Cho),NAA/creatine(Cr)and Cho/Cr ratios in the lenticular nucleus,globus pallidus,thalamus and substantia nigra and the UPDRS-Ⅲscores were compared before and after treatment.The univariate and multivariate linear regression was used to analyze the correlation between the UPDRS-Ⅲscores and 1H-MRS.Results The NAA/Cho and NAA/Cr ratios of the left and right sides of the lenticular nucleus,globus pallidus,thalamus and substantia nigra of patients with PD after treatment were significantly higher than those before treatment(P<0.05);there was no significant difference in Cho/Cr ratio before and after treatment(P>0.05).The UPDRS-Ⅲscore of PD patients after treatment was significantly lower than that before tretment(P<0.05).The changes of NAA/Cho and NAA/Cr ratio before and after treatment were negatively correlated with the changes of UPDRS-Ⅲscores(P<0.05);after adjusting for age,sex and course of disease,the changes of NAA/Cho and NAA/Cr ratio before and after treatment were still negatively correlated with the changes of UPDRS-Ⅲscores(P<0.05).There was no correlation between the change of Cho/Cr ratio and the change of UPDRS-Ⅲscore(P>0.05).Conclusion 1H-MRS can be used for evaluation of severity and drug efficacy of PD.