脑功能连接密度对不同运动亚型帕金森病的鉴别诊断价值及其与临床症状评分的相关性分析

Value of brain functional connectivity density in differentially diagnosing different motor subtypes of Parkinson's disease and its correlation with clinical symptom scores

目的探讨基于静息态功能磁共振成像(rs-fMRI)的脑功能连接密度(FCD)对震颤为主型(TD)和非震颤为主型(nTD)帕金森病(PD)患者的鉴别诊断价值及其与临床症状评分的相关性。方法选择南京大学医学院附属鼓楼医院神经内科自2017年10月至2019年12月收治的45例PD患者,其中TD 25例(TD组)、nTD 20例(nTD组)。另外同时期招募与PD患者的年龄、性别及受教育年限相匹配的中老年志愿者24例作为正常对照组。采集3组受试者rs-fMRI数据并计算全脑FCD。比较3组受试者全脑FCD的差异、有差异脑区FCD值的差异。采用受试者工作特征(ROC)曲线分析有差异脑区FCD值对TD和nTD的鉴别诊断效能。采用Pearson或Spearman相关性分析检验PD患者有差异脑区FCD值与病程、Hoehn-Yahr分级(H-Y分级)、统一帕金森病评定量表第三部分(UPDRSⅢ)评分、震颤评分及非震颤评分的相关性。结果 3组受试者FCD存在差异的脑区位于右侧舌回、右侧眶部额中回、右侧脑岛、左侧颞上回、左侧脑岛、右侧中央前回、左侧中央后回、右侧内侧和旁扣带脑回和左侧角回。TD组患者右侧眶部额中回和左侧角回的FCD值高于nTD组,右侧脑岛、右侧中央前回、左侧中央后回和右侧内侧和旁扣带脑回的FCD值低于nTD组,差异均有统计学意义(P<0.05)。联合应用各有差异脑区FCD值鉴别TD和nTD的曲线下面积为0.842,敏感度和特异度均为80%。PD患者左侧颞上回、左侧中央后回的FCD值与H-Y分级呈正相关关系(P<0.05),左侧角回的FCD值与H-Y分级呈负相关关系(P<0.05);左侧颞上回的FCD值与UPDRSⅢ评分呈正相关关系(P<0.05);右侧舌回、右侧脑岛、左侧脑岛、右侧中央前回、左侧中央后回、右侧内侧和旁扣带脑回的FCD值与震颤评分呈负相关关系(P<0.05);左侧颞上回、右侧内侧和旁扣带脑回的FCD值与非震颤评分呈正相关关系(P<0.05),左侧角回的FCD值与非震颤评分呈负相关关系(P<0.05)。结论 PD患者部分脑区FCD存在异常,且在TD和nTD PD患者之间存在差异。联合应用各差异脑区的FCD值对TD和nTD PD患者具有较高的鉴别诊断效能,且部分有差异脑区FCD值与PD患者的临床症状评分相关。

Objective To investigate the value of brain functional connectivity density(FCD)derived from resting-state functional magnetic resonance imaging(rs-fMRI)in differentially diagnosing 2 subtypes of Parkinson's disease(PD):tremor dominant(TD)and non-tremor dominant(nTD),as well as its correlation with clinical symptom scores.Methods A retrospective analysis was performed;45 PD patients(25 with TD and 20 with nTD),admitted to Department of Neurology,Drum Tower Hospital Affiliated to Medical School of Nanjing University were chosen;and 24 middle-aged and elderly volunteers matched in age,gender and years of education at the same time were chosen as normal controls(NCs).The rs-fMRI data were collected and FCD map of the whole brain was computed.The FCD differences in whole brain and brain regions enjoying different FCD were compared among the 3 groups.ROC curve was used to analyze the differential diagnostic efficacy of FCD in brain regions enjoying different FCD in TD and nTD.Correlations of FCD in brain regions enjoying different FCD with disease course,Hoehn-Yahr(H-Y)grading,unified Parkinson's disease rating scale(UPDRS)III scores,tremor scores and non-tremor scores were analyzed by Pearson or Spearman correlation analyses.Results Brain regions enjoying different FCD among the TD,nTD,and NC groups were the right lingual gyrus,right orbital medial frontal gyrus,right insula,left superior temporal gyrus,left insula,right anterior central gyrus,left posterior central gyrus,right medial and paracingulate gyrus,and left angular gyrus.FCD in the right orbital medial frontal gyrus and left angular gyrus of TD group was significantly higher than that in the nTD group(P<0.05);while FCD in the right insula,right anterior central gyrus,left posterior central gyrus and right medial and paracingulate gyrus of TD group was significantly lower than that in the nTD group(P<0.05).Area under the curve of combined application of FCD in brain regions enjoying different FCD in differentially diagnosing TD and nTD was 0.842,with sensitivity and specificity of 80.0%.FCD in the left superior temporal gyrus and left posterior central gyrus was positively correlated with H-Y grading(P<0.05),while FCD in the left angular gyrus was negatively correlated with H-Y grading(P<0.05).FCD in the left superior temporal gyrus was positively correlated with UPDRS III scores(P<0.05).FCD in the right lingual gyrus,right insula,left insula,right anterior central gyrus,left posterior central gyrus,right medial and paracingulate gyrus was negatively correlated with tremor scores(P<0.05).FCD in the left superior temporal gyrus,right medial and paracingulate gyrus was positively correlated with non-tremor scores(P<0.05),whereas that in the left angular gyrus was negatively correlated with non-tremor scores(P<0.05).Conclusion Abnormalities in FCD exist in certain brain regions of PD patients,with disparities between TD and nTD.Combined application of FCD in brain regions enjoying different FCD can effectively differentiate TD and nTD,and this FCD is also partially correlated with the symptom scores of PD patients.