帕金森病合并剂峰异动患者低频振幅的静息态fMRI研究

Resting-state fMRI study of Parkinson disease patients with peak-dose dyskinesia:an ALFF analysis

目的观察帕金森病(Parkinson's disease,PD)合并剂峰异动患者的静息态脑活动特点,并探索其发病机制。方法招募2017年3月至2019年11月就诊于南京医科大学第一附属医院的PD伴剂峰异动患者(剂峰异动组)27例,PD不伴异动患者(非异动组)29例和来自社区的健康对照27例。采集静息态功能磁共振(resting-state functional magnetic resonance imaging,rs-fMRI)数据和临床量表数据。采用SPSS 26.0和REST软件进行统计分析,比较三组间全脑低频振幅(amplitude of low-frequency fluctuation,ALFF)差异,将差异脑区的ALFF值与量表评分进行相关性分析,最后采用受试者特征曲线(receiver operating characteristic,ROC)评价差异脑区的ALFF值以鉴别三组被试的效能。结果与非异动组和健康对照组相比,剂峰异动组的患者右侧额下回ALFF减低(MNI:x=36,y=21,z=30;x=36,y=18,z=30)、右侧辅助运动区ALFF增高(MNI:x=9,y=0,z=69;x=6,y=-3,z=72)(均P<0.05,Alphasim校正),其中右侧额下回ALFF值与统一运动障碍评定量表(unified dyskinesia rating scale,UDysRS)评分呈负相关(r=-0.47,P=0.018)。右侧额下回ALFF值鉴别剂峰异动组和非异动组、剂峰异动组和健康对照组的效能较高,ROC曲线下面积分别为0.881和0.787(均P<0.01)。结论右侧额下回和右侧辅助运动区脑自发活动异常可能是PD患者出现剂峰异动的神经生物学基础。右侧额下回脑活动异常与剂峰异动患者的病情严重程度相关,其ALFF值是识别剂峰异动患者潜在的影像标志物。

Objective To observe the characteristics of resting-state brain activity in Parkinson disease(PD)patients with peak-dose dyskinesia,and to explore its pathogenesis.Methods From March 2017 to November 2019,totally 27 PD patients with peak-dose dyskinesia(dyskinetic group),and 29 PD patients without dyskinesia(non-dyskinetic group)treated in the First Affiliated Hospital of Nanjing Medical University and 27 healthy controls from the community were recruited.Resting-state functional magnetic resonance imaging(rs-fMRI)and clinical scale data were collected.SPSS 26.0 software and REST software were used for data analysis.The whole brain amplitude of low-frequency fluctuation(ALFF)values were compared among the three groups.Correlation analysis was performed between ALFF values of the significant brain regions and the scale scores.Finally,receiver operating characteristic(ROC)curve was used to evaluate the efficacy of ALFF values of significant brain regions in identifying three groups of subjects.Results The peak-dose dyskinetic group showed decreased ALFF in right inferior frontal gyrus(MNI:x=36,y=21,z=30;x=36,y=18,z=30)and increased ALFF in right supplementary motor area(MNI:x=9,y=0,z=69;x=6,y=-3,z=72)(all P<0.05,Alphasim correction)compared with non-dyskinetic group and healthy controls.ALFF value in right inferior frontal gyrus was negatively correlated with unified dyskinesia rating scale(UDysRS)scores(r=-0.47,P=0.018).The ALFF value of the right inferior frontal gyrus was more effective in identifying peak-dose dyskinetic patients from non-dyskinetic patients and healthy controls,and the area under the curve of right inferior frontal gyrus were 0.881 and 0.787(both P<0.01),respectively.Conclusion Abnormal spontaneous brain activity in right inferior frontal gyrus and right supplementary motor area can be the neurobiological basis of peak-dose dyskinesia in PD patients.The severity of peak-dose dyskinesia is associated with abnormal brain activity of right inferior frontal gyrus.The ALFF value of right inferior frontal gyrus is a potential imaging marker for identifying peak-dose dyskinetic patient.