CAJ | 학술논문

目的研究不同运动障碍亚型原发性帕金森病(Idiopathic Parkinson's Disease,IPD)壳核和黑质质子磁共振波谱(1H-MRS)变化,探讨1H-MRS在IPD诊断及分型诊断的价值.方法对42例PD患者进行运动障碍评分并进行临床分型,依据主要运动症状分为震颤为主型PD(24例)、姿势异常步态障碍(PIGD)PD(18例)两组,健康对照组20例,对各组双侧壳核、黑质进行1H-MRS检测,计算其双侧N-乙酰基天门冬氨酸(NAA)/肌酸(Cr)和胆碱复合物(Cho)/Cr平均值.结果 PD组双侧壳核、黑质NAA/Cr平均值较健康对照组明显下降(P＜0.01),而Cho/Cr均值略高于健康对照组,但差异无显著性;震颤为主型PD组双侧壳核NAA/Cr均值高于强直少动型PD(P＜0.01),而黑质的NAA/Cr两型间无统计学差异;震颤为主型PD组壳核、黑质区Cho/Cr比值略低于强直少动型PD,但差异无显著性.结论原发性帕金森病壳核、黑质NAA/Cr降低,尤以强直少动型PD壳核NAA/Cr下降明显;1H-MRS有望成为PD诊断及不同运动障碍亚型分型诊断的辅助方法.
목적 연구불동운동장애아형원발성파금삼병(Idiopathic Parkinson's Disease,IPD)각핵화흑질질자자공진파보(1H-MRS)변화,탐토1H-MRS재IPD진단급분형진단적개치.방법 대42례PD환자진행운동장애평분병진행림상분형,의거주요운동증상분위진전위주형PD(24례)、자세이상보태장애(PIGD)PD(18례)량조,건강대조조20례,대각조쌍측각핵、흑질진행1H-MRS검측,계산기쌍측N-을선기천문동안산(NAA)/기산(Cr)화담감복합물(Cho)/Cr평균치.결과 PD조쌍측각핵、흑질NAA/Cr평균치교건강대조조명현하강(P＜0.01),이Cho/Cr균치략고우건강대조조,단차이무현저성;진전위주형PD조쌍측각핵NAA/Cr균치고우강직소동형PD(P＜0.01),이흑질적NAA/Cr량형간무통계학차이;진전위주형PD조각핵、흑질구Cho/Cr비치략저우강직소동형PD,단차이무현저성.결론 원발성파금삼병각핵、흑질NAA/Cr강저,우이강직소동형PD각핵NAA/Cr하강명현;1H-MRS유망성위PD진단급불동운동장애아형분형진단적보조방법.
Objective To investigate the changes of proton magnetic resonance spectroscopy (1H-MRS) on the putamens and nigra of different movement disorder subtypes of Idiopathic Parkinson's disease(IPD) from Southern China population, and explore the diagnostic value of 1H-MRS on different subtypes of IPD according to motor symptoms. Methods 42 cases(male 17, female 25) who have IPD were divided into tremor-dominant PD( 24 ), and postural instability-gait disorder(PIGD)-dominant PD (18). The content of NAA, Cho and Crin putamens and nigra in forty-two patients and twenty age-matched healthy controls were examined with 1H-MRS, the ratios of NAA/Cr and Cho/Cr were calculated. Results The ratios of NAA/Cron putamens and nigra were lower in PD group than that in the control group (P＜0.01),but there was no significant difference between IPD and control group in the average ratios of Cho/Cr;The ratio of NAA/Cr on the putamens in PIGD-dominant PD showed more lower compared to the Tremordominant PD (P＜0.01), however, no significant difference was found in the ratio of NAA/Cr on nigra between tremor-dominant PD and PIGD-dominant PD. Conclusion Our results indicated that there were distinct reduction in the ratios of NAA/Cr on putamens and nigra of IPD,especially in the ratio of NAA/Cr in putamens of PIGD-dominant PD. 1H-MRS is a noninvasive technique that can provide usful information on neuronal loss in the basal ganglia of IPD, which can help diagnose IPD and distinguish from different subtypes of IPD according to motor symptoms.