深部脑电刺激后帕金森病患者运动症状改善与黑质纹状体不同亚区的相关性

Correlation between improvement of motor symptoms in Parkinson's disease after deep brain stimulation and different sub-regions of nigrostriatal

目的观察深部脑电刺激(DBS)后帕金森病(PD)患者运动症状改善与黑质纹状体不同亚区的相关性。方法回顾性分析6例经丘脑底核(STN)-DBS后运动症状改善的PD患者,分别于STN-DBS前及后7个月采用PD统一评分量表第Ⅲ部分(UPDRS-Ⅲ)及Hoehn-Yahr(H-Y)分级进行评估,计算运动症状改善值;同时行多巴胺转运蛋白(DAT)PET脑显像,以SPM12软件于双侧尾状核、壳核前部、壳核后部及黑质勾画ROI,获得各ROI内平均放射性计数,并以小脑为参考,计算双侧尾状核、壳核前部、壳核后部及黑质的DAT摄取及DAT摄取改善率;采用Spearman相关分析观察运动症状改善值与STN-DBS后7个月DAT摄取显著增高脑区治疗前DAT摄取及DAT摄取改善率的相关性。结果STN-DBS前UPDRS-Ⅲ评分及H-Y分级与其后7个月差异均有统计学意义(P均<0.05)。STN-DBS后7个月双侧壳核后部部分区域及起病侧黑质致密部DAT摄取显著高于STN-DBS前(P均<0.01),而双侧尾状核及壳核前部部分区域DAT摄取显著低于STN-DBS前(P均<0.01)。STN-DBS前起病对侧黑质致密部DAT摄取与运动症状改善值呈高度负相关(r=-1.0,P<0.05);双侧壳核后部及起病侧黑质致密部DAT摄取、双侧壳核后部及双侧黑质致密部DAT摄取改善率与运动症状改善值均无明显相关(P均>0.05)。结论PD患者STN-DBS后双侧壳核后部部分区域及起病侧黑质致密部DAT摄取增高;STN-DBS前起病对侧黑质致密部DAT摄取与运动症状改善值呈高度负相关。

Objective To observe the correlations of improvement of motor symptoms in Parkinson's disease(PD)after deep brain stimulation(DBS)and sub-regions of nigrostriatal.Methods Data of 6 PD patients with improved motor symptoms after subthalamic nucleus(STN)-DBS were retrospectively analyzed.The unified PD rating scale partⅢ(UPDRS-Ⅲ)and the Hoehn-Yahr(H-Y)stage were evaluated,the improved motor symptom scores were calculated,and dopamine transporter(DAT)PET brain imaging was performed before and 7 months after STN-DBS.SPM12 software was used to automatically delineate ROI in bilateral caudate nucleus,bilateral anterior putamen,bilateral posterior putamen and bilateral substantia nigra,with the average radiation counts were obtained.Taken cerebellum as the reference region,DAT uptake and improvement rate of DAT uptake of bilateral caudate nucleus,bilateral anterior putamen,bilateral posterior putamen and bilateral substantia nigra were calculated.Spearman correlation analysis was used to observe the correlations of the improved motor symptom scores with DAT uptake before treatment and improvement rate of DAT uptake 7 months after STN-DBS in sub-regions with significantly increased DAT uptake.Results There were significant differences of UPDRS-Ⅲscores and H-Y stages before and 7 months after STN-DBS(all P<0.05).DAT uptake in partial area of bilateral posterior putamen and ipsilateral substantia nigra pars compacta 7 months after STN-DBS were significantly higher,while in bilateral caudate nucleus and partial area of bilateral anterior putamen were significantly lower than those before(all P<0.01).DAT uptake in contralateral substantia nigra pars compacta before STN-DBS was highly negatively correlated with the improved motor symptom scores(r=-1.0,P<0.05).No significant correlation was found between DAT uptake of bilateral posterior putamen and ipsilateral substantia nigra pars compacta,the improvement rate of DAT uptake of bilateral posterior putamen and bilateral substantia nigra pars compacta,nor the improved motor symptom scores(all P>0.05).Conclusion DAT uptake in PD patients increased in bilateral posterior putamen and substantia nigra pars compacta after STN-DBS,which in contralateral substantia nigra pars compacta before STN-DBS was highly negatively correlated with the improved motor symptom scores.