帕金森病不同亚型的功能连接分析

摘要

目的：寻找不同亚型帕金森病患者之间基于丘脑底核的功能连接差异脑区，分析其在疾病发生中的临床意义。方法收集南京医科大学附属脑科医院老年医学科自2015年9月至2016年5月收治的帕金森病患者23例，包括11例震颤为主型帕金森病患者、12例姿势障碍步态异常（ PIGD）为主型帕金森病患者，同时纳入12名健康对照，基于双侧丘脑底核为种子点，做两两组间差异比较，分析3组之间功能连接差异脑区，计算这些差异连接和临床症状的相关性。结果 PIGD为主型帕金森病患者相对于健康对照组，基于丘脑底核功能连接增强的脑区为右距状裂周围皮质，功能连接下降的脑区位于右楔前叶。震颤为主型帕金森病患者相对于健康对照组，功能连接下降的脑区为楔前叶、右角回和左额中回，且丘脑底核与左额中回的功能连接强度和MMSE评分呈正相关（ r＝0．64， P＝0．034）。 PIGD为主型帕金森病患者相对于震颤为主型帕金森病患者功能连接增加的脑区为左侧距状裂周围皮质。结论不同类型的帕金森病患者中，丘脑底核与楔前叶的功能连接均表现为下降，PIGD为主型患者相对于震颤为主型患者，丘脑底核与距状裂周围皮质功能连接增强。在不同类型的帕金森病患者中，基于丘脑底核的功能连接差异的脑区与认知和情绪调控有关。%Objective To investigate the changed brain areas of functional connectivity ( FC ) patterns of subthalamic nucleus ( STN) between different subtypes of Parkinson′s disease ( PD) and healthy controls and their clinical significance .Methods Twenty-three PD patients and 12 health controls were enrolled, and PD patients were divided into 11 tremor dominant PD patients and 12 postural instability and gait disorder (PIGD) dominant PD patients.The difference of whole-brain resting-state FC with STN among the three groups was investigated and the relationship between the changed areas and clinical symptoms was calculated.Results Compared with healthy controls , PIGD dominant group showed increased FC between STN and right calcarine and decreased FC between STN and right precuneus , and tremor dominant PD patients showed decreased FC between STN and precuneus , right angular gyrus and left middle frontal gyrus , while the FC strength between the STN and left middle frontal gyrus showed positive relationship with MMSE scores ( r=0.64, P=0.034 ) .Compared with tremor dominant PD patients , PIGD dominant patients showed increased FC in the area of left calcarine .Conclusions Decreased FC between STN and precuneus was gained in different subtypes of PD , and PIGD dominant patients showed increased FC between STN and calcarine.Changed areas based on the FC of STN in different subtypes of PD were found related with cognition and mood control .