CAJ | 학술논문

目的:探求原发性帕金森病(PD)触觉功能脑区异常激活程度是否与病情严重度直接相关;对PD触觉脑功能改变与尾状核功能缺陷间的联系提供可能的影像学依据;对前额叶的激活在PD脑功能机制中所起的作用做出可能的解释.方法:21名早期PD患者,平均年龄(60.43±9.65)岁;22名年龄相匹配的正常志愿者,平均年龄(59.23±11.12)岁.所有患者进行统一PD量表(UPDRS)评分,以评价病情严重程度.首先通过触觉任务的fMRI研究,确定PD患者相较于正常人激活增强和减弱的脑区.接着将上述脑区作为感兴趣区(ROI),提取出每个PD患者执行触觉任务时各ROI平均BOLD信号强度,并计算信号变化百分比.将各ROI的信号变化与患者病情严重程度作相关分析,同时作ROI之间相关分析.结果:PD患者右侧初级感觉及运动区,右侧辅助运动区,双侧楔前叶,双侧枕叶视觉皮层,左侧颞中回及双侧尾状核的激活较对照组降低;右侧前额叶及右侧尾状核激活较对照组增高.右侧辅助运动区的信号变化与UPDRS评分呈负相关.双侧尾状核与异常激活脑区的信号变化呈现正相关.右侧前额叶与激活降低脑区的信号变化呈现正相关.结论:早期帕金森患者接受触觉刺激时,辅助运动区的信号改变可以提示病情严重程度.尾状核在PD触觉神经功能改变中应该起着重要作用.前额叶激活增加的原因可能并不是代偿作用,而更可能是PD患者神经功能损害的一种体现.
목적:탐구원발성파금삼병(PD)촉각공능뇌구이상격활정도시부여병정엄중도직접상관;대PD촉각뇌공능개변여미상핵공능결함간적련계제공가능적영상학의거;대전액협적격활재PD뇌공능궤제중소기적작용주출가능적해석.방법:21명조기PD환자,평균년령(60.43±9.65)세;22명년령상필배적정상지원자,평균년령(59.23±11.12)세.소유환자진행통일PD량표(UPDRS)평분,이평개병정엄중정도.수선통과촉각임무적fMRI연구,학정PD환자상교우정상인격활증강화감약적뇌구.접착장상술뇌구작위감흥취구(ROI),제취출매개PD환자집행촉각임무시각ROI평균BOLD신호강도,병계산신호변화백분비.장각ROI적신호변화여환자병정엄중정도작상관분석,동시작ROI지간상관분석.결과:PD환자우측초급감각급운동구,우측보조운동구,쌍측설전협,쌍측침협시각피층,좌측섭중회급쌍측미상핵적격활교대조조강저;우측전액협급우측미상핵격활교대조조증고.우측보조운동구적신호변화여UPDRS평분정부상관.쌍측미상핵여이상격활뇌구적신호변화정현정상관.우측전액협여격활강저뇌구적신호변화정현정상관.결론:조기파금삼환자접수촉각자격시,보조운동구적신호개변가이제시병정엄중정도.미상핵재PD촉각신경공능개변중응해기착중요작용.전액협격활증가적원인가능병불시대상작용,이경가능시PD환자신경공능손해적일충체현.
Objective: To investigate the role of activated brain regions in Parkinson′s disease (PD) during tactile stimulation. Methods: Twenty-one patients with early PD [mean age (60.43±9.65)y] and twenty-two age-matched healthy controls [mean age (59.23±11.12)y] were enrolled in the study.All the patients were tested by the United Parkinson Disease Rating Scale (UPDRS) as the evaluation of the disease severity.A block design was used when the finger tactile stimulation was given to the subjects.The hypoactive and hyperactive regions of PD patients were confirmed first,which were identified as regions of interest (ROI).ROI analysis was performed to quantify BOLD signal changes when subjects were under tactile stimulation.The correlations of signal changes with disease severity,and correlations of hyperactive with hypoactive regions were analyzed. Results: Right primary sensory and motor cortex,right supplementary motor area (SMA),bilateral caudates,bilateral precuneus,bilateral occipital visual cortex and left middle temporal gyrus were hypoactivated in PD,while right prefrontal cortex (PFC) and right caudate were hyperactivated.The hypoactivation of right SMA was negatively correlated with disease severity.All the hypoactive and hyperactive regions were positively correlated with activation of caudates.There was a ositive correlation between hyperactive PFC and hypoactive regions. Conclusions: The signal change of SMA is directly related to disease severity in early PD,and caudates may play a significant role in PD tactile processing.The hyperactivation of PFC may be not a compensation but a pathophysiological change related to PD neural dysfunction.