早中期帕金森病患者脑铁沉积及血流量改变对运动症状的影响

Effect of brain iron deposition and blood flow on motor symptoms of Parkinson disease in early and middle stage

目的探讨早中期帕金森病(PD)患者丘脑底核(STN)、苍白球内侧部(GPi)的铁沉积和脑血流量(CBF)改变,以及两者与运动症状的关系,并分析PD铁沉积与血流量改变之间的关系。方法纳入2020年7—10月在首都医科大学附属北京康复医院神经康复中心住院的34例Hoehn-Yahr分期为Ⅰ~Ⅲ期的PD患者为PD组,同期纳入17名健康体检者为对照组。对所有受试者行全脑磁共振常规序列、3D T1 Bravo、定量磁化率图(QSM)及三维动脉自旋标记(3D-ASL)序列扫描,基于基底神经节亚区图谱、QSM和3D-ASL成像方法,使用Matlab软件和自定义代码提取STN及GPi的QSM值和CBF值。采用Hoehn-Yahr分期、国际运动障碍协会统一PD评定量表第2、3部分(MDS-UPDRSⅡandⅢ)、10 m步行速度及三维步态分析(包括步频、步速、跨步时间、摆动相、对侧支撑相及步长)评估患者的运动症状。采用Pearson相关或Spearman相关分析PD患者影像学指标与运动症状的相关性。结果两组年龄、性别比较,差异无统计学意义(P>0.05)。PD组STN及GPi的QSM值、GPi的CBF值高于对照组[0.008(0,0.019)ppm比-0.003(-0.015,0.009)ppm、-0.003(-0.011,0.009)ppm比-0.014(-0.023,-0.007)ppm、0.715(0.657,0.790)比0.617(0.584,0.704)],差异有统计学意义(P<0.05)。PD患者STN、GPi的CBF值与MDS-UPDRSⅡ评分呈正相关(r=0.352、0.376;P<0.05),GPi的QSM值与跨步时间呈正相关(r=0.381,P<0.05);PD患者GPi的QSM值与10 m步行舒适速度、步速、步频、步长呈负相关(r=-0.475、-0.584、-0.462、-0.533;P<0.05)。PD患者STN及GPi的QSM值与CBF值不存在相关性(P>0.05)。结论通过QSM和3D-ASL同时评估PD早中期患者特定脑区的铁沉积和CBF具有一定的价值,有助于监测PD进展,而PD脑铁含量和血流量间的准确关系仍待进一步研究。

Objective To investigate the effect of iron deposition and blood flow in subthalamic nucleus(STN)and globus pallidus internus(GPi)on motor symptoms of early and middle stage of Parkinson disease(PD).Andto analyzethe relation between iron deposition and blood flow of PD.Methods A total of 34 PD patients hospitalized in Neurorehabilitation Center of Beijing Rehabilitation Hospital affiliated to Capital Medical University,who were diagnosed as stageⅠtoⅢaccording to Hoehn-Yahr(H-Y),from July to October 2020 were recruited as PD group,and another 17 healthy people were enrolled as control group in the same period.All subjects underwent whole-brain MR conventional sequence,3D T1 Bravo,quantitative magnetic resonance imaging(QSM)and 3D arterial spin labeling(3D-ASL)sequence scanning.Based on the map of basal ganglia subregion,QSM and 3D-ASL imaging methods,the QSM and CBF values of STN and GPi were extracted by Matlab software and user-defined code.All patients'motor symptoms were assessed by H-Y Scale,MDS-UPDRSⅡandⅢ,10-meter walking speed and 3D gait analysis(including step frequency,step speed,step time,swing phase,contralateral support phase and step length).Pearson correlation or Spearman correlation were used to analyze the correlation between imaging indexes and motor symptoms in PD patients.Results There were no significant differences in age and gender between the two groups(P>0.05).The QSM values in STN and GPi,and the CBF value in GPi of PD group were higher than those of the control group[0.008(0,0.019)ppm vs-0.003(-0.015,0.009)ppm;-0.003(-0.011,0.009)ppm vs-0.014(-0.023,-0.007)ppm;0.715(0.657,0.790)vs 0.617(0.584,0.704)],and the differences were statistically significant(P<0.05).The CBF values in STN and GPi of PD patients were positively correlated with MDS-UPDRSⅡ(r=0.352,0.376;P<0.05).The QSM value in GPi was positively correlated with step time(r=0.381,P<0.05).The QSM value in GPi of PD patients were negatively correlated with 10-meter walking speed,step speed,step frequency and step length(r=-0.475,-0.584,-0.462,-0.533;P<0.05).There was no correlation between the QSM value and the CBF value of STN and GPi in PD patients(P>0.05).Conclusions The simultaneous assessment of iron deposition and CBF in specific brain regions of PD patients in early and middle stage by QSM and 3D-ASL is of certain value,and may help monitor the progress of PD.However,the exact relationship between the content of iron brain and blood flow in PD remains to be further studied.