震颤为主型帕金森病与特发性震颤患者脑灌注对比分析

Comparison of cerebral perfusion between patients with tremor dominant Parkinson's disease and essential tremor

目的探讨震颤为主型帕金森病与特发性震颤患者的脑灌注差异。方法纳入2016年10月至2018年12月复旦大学附属中山医院收治的25例震颤为主型帕金森病患者和23例特发性震颤患者,并招募性别、年龄相匹配的39例对照者,采用三维伪连续动脉自旋标记(3D-pCASL)测定脑血流量。结果3组受试者双侧额中回、尾状核、小脑后叶,左侧额上回、海马旁回、枕叶舌回、枕下回、楔前叶,右侧眶部额中回、楔叶、枕上回、枕中回脑血流量存在差异(均P<0.05,AlphaSim校正)。帕金森病组左侧额上回(t=4.891,P<0.05)、左侧额中回(t=4.993,P<0.05)、左侧枕下回(t=4.403,P<0.05)脑血流量低于对照组,右侧眶部额中回脑血流量高于对照组(t=4.162,P<0.05);以及左侧(t=5.471,P<0.05)和右侧(t=4.798,P<0.05)额中回、左侧枕叶舌回(t=4.972,P<0.05)、左侧顶下回(t=4.532,P<0.05)、左侧尾状核(t=5.001,P<0.05)、右侧小脑后叶(t=3.852,P<0.05)脑血流量低于特发性震颤组。结论震颤为主型帕金森病与特发性震颤存在不同的脑灌注模式,提示二者病理生理学机制存在一定差异。

Objective To investigate the cerebral perfusion difference between tremor dominant Parkinson's disease(PD)and essential tremor(ET).Methods Twenty-five patients with tremor dominant PD and 23 with ET admitted to Zhongshan Hospital Fudan University from October 2016 to December 2018 were included,and 39 normal controls matched by sex and age were recruited.Cerebral blood flow(CBF)was acquired through three dimensional pseudo-continuous arterial spin labeling(3D-pCASL).Results Significant differences of CBF were observed among 3 groups in bilateral middle frontal gyrus,caudate nucleus,posterior cerebellar lobes,left superior frontal gyrus,left parahippocampal gyrus,left inferior occipital gyrus,left lingual gyrus,left precuneus,right orbital middle frontal gyrus,right cuneus,right superior occipital gyrus,right middle occipital gyrus(P<0.05,for all;AlphaSim correction).Compared with the control group,PD patients demonstrated decreased CBF in the left superior frontal gyrus(t=4.891,P<0.05),left middle frontal gyrus(t=4.993,P<0.05)and left inferior occipital gyrus(t=4.403,P<0.05),as well as increased CBF in the right orbital middle frontal gyrus(t=4.162,P<0.05).Compared with the ET group,PD patients demonstrated decreased CBF in the left middle frontal gyrus(t=5.471,P<0.05),right middle frontal gyrus(t=4.798,P<0.05),left lingual gyrus(t=4.972,P<0.05),left inferior parietal gyrus(t=4.532,P<0.05),left caudate nucleus(t=5.001,P<0.05)and right posterior cerebellar lobe(t=3.852,P<0.05).Conclusions There are distinctive cerebral perfusion patterns in PD and ET patients,which implies that these two conditions may be associated with distinct pathophysiological mechanisms.