基于静息态磁共振对左旋多巴诱导的异动症患者的局部脑功能度中心度特征的研究

A resting-state MRI-based study on the characteristics of degree centrality of local brain function in patients with levodopa-induced dyskinesias

目的 探讨左旋多巴诱导的异动症(LID)患者局部脑功能度中心度(DC)的特征变化以期发现LID的发病机制.方法 病例对照研究.收集就诊于南京医科大学第一附属医院的33例帕金森病(PD)伴LID患者(PD-LID)、41例PD不伴LID(PD-nLID)患者及37例健康对照组的静息态功能影像(rs-fMRI)数据.比较3组间DC差异,并将差异脑区的Z-DC值与不自主运动量表(第1~7项)评分进行相关分析.结果 与对照组相比,PD-LID组患者右侧杏仁核(延伸至右侧苍白球)DC 增加(MNI 坐标:x=30,y=-3,z=-18,t=4.00,AlphaSim 校正后 P<0.05),右侧中央后回(MNI 坐标:x=57,y=-9,z=39,t=-3.59;MNI 坐标:x=42,y=-33,z=57,t=-4.23,均AlphaSim 校正后 P<0.05)、右侧顶上小叶 DC 减少(MNI 坐标:x=24,y=-51,z=72,t=-3.95,AlphaSim校正后P<0.05);与PD-nLID组相比,PD-LID组右侧苍白球DC增加(MNI坐标:x=30,y=-12,z=-3,t=3.09,AlphaSim校正后P<0.05).其中右侧苍白球DC改变与AIMS评分呈正相关(r=0.482,P=0.004).结论 右侧苍白球DC功能的增强可能与LID发病和病情严重程度密切相关.

Objective To investigate the characteristics of regional brain functional centrality(DC)in patients with levodopa-induced dyskinesia(LID)and to explore the pathogenesis of LID.Methods A total of 33 PD patients with LID(PD-LID),41 PD patients without LID(PD-nLID)and 37 healthy controls from the First Affiliated Hospital of Nanjing Medical University were enrolled in this study.Differences in DC among the three groups were compared and the correlation between Z-DC values of the brain regions with differences and the scores of the involuntary movement scale(items 1-7)was analyzed.Results Compared with Controls,PD-LID patients showed increased DC in the right amygdala(extending to the right globus pallidus)(MNI:x=30,y=-3,z=-18,t=4.00,P<0.05 after AlphaSim correction)and in the right postcentral gyrus(MNI:x=57,y=-9,z=39,t=-3.59;MNI:x=42,y=-33,z=57,t=-4.23,P<0.05 after AlphaSim correction)and reduced DC in the right superior parietal lobule(MNI:x=24,y=-51,z=72,t=-3.95,P<0.05 after AlphaSim correction).Compared with the PD-nLID group,the PD-LID group showed increased DC in the right globus pallidus(MNI:x=30,y=-12,z=-3,t=3.09,P<0.05 after AlphaSim correction).DC changes in the right globus pallidus were positively correlated with AIMS score(r=0.482,P=0.004).Conclusions The enhancement of DC function in the right globus pallidus may be closely related to the onset and severity of LID.