经颅超声下帕金森病偏侧性特征的研究

Study on laterality of Parkinson's disease under transcranial ultrasound

目的探究在经颅超声(transcranial sonography,TCS)下帕金森病(Parkinson's disease,PD)患者的黑质高回声(substantia nigra,SN+)面积是否有偏侧性特征,并进一步分析其与临床资料的相关性,以求更全面地认识帕金森病。方法收集81例帕金森病患者,分别分析早发型帕金森病(early-onset Parkinson's disease,EOPD)及晚发型帕金森病(late-onset Parkinson's disease,LOPD)患者,TCS下起始侧黑质高回声面积(SN+O)与非起始侧黑质高回声面积(SN+N)、左侧黑质高回声面积(SN+L)与右侧黑质高回声面积(SN+R)的差异性,以及SN+O与双侧黑质高回声总面积/中脑面积(Hyper-substantia nigra/Midbrain,S/M)比值与临床资料的相关性。应用非参数检验进行差异性分析,Spearman相关进行相关性分析。结果PD患者的SN+O面积明显大于SN+N面积,左右侧SN+面积无明显差异,早发型帕金森病患者的SN+O面积与发病年龄呈负相关。结论经颅超声下两侧黑质高回声面积具有偏侧性特征,PD患者起始侧SN+面积明显大于非起始侧SN+面积,较大的S/M比值常出现在早发型PD患者中而不是晚发型PD患者,亚组分析发现EOPD患者的发病年龄与起始侧SN+面积呈明显的负相关关系。PD患者起始侧SN+面积和S/M并不受年龄、疾病持续时间、病情严重程度、自主神经功能障碍以及抑郁程度的影响,但两者作为生物标记物的稳定性尚需进一步探讨。

Objective To explore the laterality of SN+area in patients with PD under TCS,and to further analyze its correlation with clinical data,in order to have a more comprehensive understanding of Parkinson's disease.Methods 81 patients with Parkinson's disease were collected,and the differences between SN+O and SN+N,SN+L and SN+R under transcranial ultrasound,and the correlation between SN+O and S/M and clinical data in patients with EOPD and LOPD were analyzed.Nonparametric test was used for difference analysis and spearman correlation was used for correlation analysis.Results The SN+O of PD was significantly larger than that of SN+N,and there was no significant difference in SN+between left and right substantia nigra.The SN+O of early-onset PD was negatively correlated with the age of onset.Conclusion The area of SN+on both sides of Parkinson's disease was asymmetrical under transcranial ultrasound.SN+O in Parkinson's disease was significantly larger than that in SN+N.The larger S/M often occurred in patients with early-onset PD rather than in patients with late-onset PD.Subgroup analysis showed that the age of onset of EOPD was negatively correlated with SN+O.SN+O and S/M in Parkinson's disease are not affected by age,disease duration,severity,autonomic nervous dysfunction and depression,but their stability as biomarkers needs to be further studied.