早期帕金森病患者脑白质损害的扩散张量成像研究

摘要

目的:采用基于纤维束示踪的空间统计方法分析(TBSS)早期帕金森病患者扩散张量成像(DTI)数据,研究早期帕金森病患者脑白质结构损害情况及与运动症状的相关性.方法:18例早期帕金森病(PD)患者(Hoehn-Yahr 1～2级)及22例健康志愿者(对照组)行DTI扫描,采用TBSS技术对两组受试者的DTI数据进行分析,比较两组受试者脑白质纤维的部分各向异性(FA)值的差异,及其与帕金森病评估量表(UPDRS-Ⅲ)评分的相关性,测量并比较先发病侧与对侧大脑白质的FA值.结果:全脑分析显示:与正常对照组相比,PD组双侧额顶部、放射冠、胼胝体和扣带回的脑白质FA值明显减低(P＜0.05),且其范围均与UPDRS-Ⅲ评分呈负相关(r=-0.479～-0.736,P＜0.05);早期PD患者先发病侧大脑与对侧大脑比较,后放射冠、顶叶及颞叶的脑白质FA值的差异有统计学意义(P＜0.05).结论:早期PD患者即可见脑白质纤维结构的改变,大脑白质损害程度与PD患者运动症状有密切联系,PD患者脑白质损害的部位可能存在一定的顺序.%Objective:To observe the change of brain white matter structure and the correlation with motor symptoms in PD,and to evaluate the differences of the fractional anisotropy (FA) within white brain matter between patients with PD and normal control (NC) using TBSS.Methods:DTI data of 18 PD and 22 NC were compared by hypothesis-free whole-brain analysis algorithm (TBSS) focusing on global white matter microstructural deterioration.The areas with reduced FA values were selected and the relevance of FA values in these areas with the scores assessed by the unified Parkinson's disease rating scale (UPDRS-Ⅲ) was analyzed,and the difference of white matter FA values between the first onset and the contralateral side was compared.Results:Compared with NC group,the FA values in the PD group significantly decreased in the white mater,including frontal and parietal region,corona radiate,corpus callosum and cingulated gyrus (P＜0.05);and there was an negative correlation between the FA values and UPDRS-Ⅲ scores.There was statistically significant difference in white matter FA value of corona radiate,lateral parietal lobe and tempral lobe between the involved side and the contralateral side (P＜0.05).Conclusion:In the early stage of PD,there are already microstructual deteriorations of white mater.The brain white matter damage is closely related to PD patients motor symptoms,and PD early cerebral white matter damage may exist a certain order.