CAJ | 학술논문

目的：利用质子磁共振波谱（1 H‐M RS ）技术研究不同运动亚型原发性帕金森病（IPD ）患者纹状体、额叶皮质运动区的变化，并比较其认知障碍的发生率，研究帕金森病认知障碍（PD‐CIND ）患者海马区的变化，探讨1 H‐M RS在IPD诊断及分型诊断的价值。方法对70例IPD患者行帕金森病统一评分量表（UPDRS）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IPD 38例、姿势异常、步态障碍（PIGD ）型IPD 32例，同时对各运动亚型行蒙特利尔认知量表评分（MOCA），选出MOCA＜26分的 PD‐CIND患者共27例，无认知障碍IPD（MOCA≥26分）患者43例，健康对照组（HC）30例，对各组双侧纹状体，额叶皮质运动区、海马区行1 H‐MRS检测，计算N‐乙酰天门冬氨酸／肌酸（NAA／CR）和胆碱复合物／肌酸（CHO／CR）的比值。结果震颤为主型IPD伴发认知障碍10例。PIGD型IPD伴发认知障碍17例，2组比较有显著性差异（P＜0.05），IPD组纹状体、额叶皮质运动区NAA／CR比值较 HC组明显下降（P＜0.05），震颤为主型IPD双侧纹状体、额叶皮质运动区NAA／CR比值高于 PIGD型 IPD（P＜0.05），PD‐CIND组海马区 NAA／CR比值低于 IPD组及 HC组（P＜0.05）。而各组CHO／CR比值差异均无统计学意义（P＞0.05）。结论 IPD患者双侧纹状体、额叶皮质运动区 NAA／CR比值降低，尤以PIGD型IPD下降明显，同时震颤为主型PD认知障碍伴发率低于PIGD型，而IPD患者海马区NAA／CR比值降低，尤以PD‐CIND患者下降明显，1 H‐M RS有助于IPD的诊断及分型诊断。
목적：이용질자자공진파보（1 H‐M RS ）기술연구불동운동아형원발성파금삼병（IPD ）환자문상체、액협피질운동구적변화，병비교기인지장애적발생솔，연구파금삼병인지장애（PD‐CIND ）환자해마구적변화，탐토1 H‐M RS재IPD진단급분형진단적개치。방법대70례IPD환자행파금삼병통일평분량표（UPDRS）운동장애평분，병진행림상분형，의거주요운동증상분위진전위주형IPD 38례、자세이상、보태장애（PIGD ）형IPD 32례，동시대각운동아형행몽특리이인지량표평분（MOCA），선출MOCA＜26분적 PD‐CIND환자공27례，무인지장애IPD（MOCA≥26분）환자43례，건강대조조（HC）30례，대각조쌍측문상체，액협피질운동구、해마구행1 H‐MRS검측，계산N‐을선천문동안산／기산（NAA／CR）화담감복합물／기산（CHO／CR）적비치。결과진전위주형IPD반발인지장애10례。PIGD형IPD반발인지장애17례，2조비교유현저성차이（P＜0.05），IPD조문상체、액협피질운동구NAA／CR비치교 HC조명현하강（P＜0.05），진전위주형IPD쌍측문상체、액협피질운동구NAA／CR비치고우 PIGD형 IPD（P＜0.05），PD‐CIND조해마구 NAA／CR비치저우 IPD조급 HC조（P＜0.05）。이각조CHO／CR비치차이균무통계학의의（P＞0.05）。결론 IPD환자쌍측문상체、액협피질운동구 NAA／CR비치강저，우이PIGD형IPD하강명현，동시진전위주형PD인지장애반발솔저우PIGD형，이IPD환자해마구NAA／CR비치강저，우이PD‐CIND환자하강명현，1 H‐M RS유조우IPD적진단급분형진단。
Objective To research the striatum and the change of the frontal cortex movement area in the treatment of idio‐pathic Parkinson's disease (IPD) with different sports subtypes performed by proton magnetic resonance spectrum (1 H‐MRS) technology ,and to compare the prevalence of cognitive impairment and investigate the changes in hippocampus in Parkinson's disease with cognitive impairment(PD‐CIND) so as to testify the value of 1 H‐MRS detection technology in the diagnosis and typed‐diagnosis of IPD .Methods According to the assessment of the movement disorder by UPDRS and the main clinical mani‐festations ,70 cases with IPD were selected and classified into different clinical subtypes :tremor group (38 cases) ,both abnor‐mal posture and gait disorder(PIGD) group (32 cases) ,at the same time all of patients in different subtypes received the as‐sessment of MOCA rating scale ,and a total of 27 IPD patients with PD‐CIND (MOCA<26 points) ,43 IPD patients without cognitive impairment (MOCA≥26 points) ,30 normal cases(HC) as for controls .We detected 1 H‐MRS in bilateral striatum , prefrontal cortex motor area and the hippocampus ,and then calculated the ratio of N‐acetyl aspartate and creatine (NAA/CR) and the ratio of choline compounds and creatine(CHO/CR) .Results There were 10 cases with cognitive impairment in tremor group and 17cases in PIGD group with significant difference (P<0 .05) .Compared with HC group ,NAA/CR ratio in frontal cortex motor area and striatum area in IPD group decreased significantly(P<0 .05);NAA/CR ratio in frontal cortex motor are‐a and bilateral striatum area in tremor group was obviously higher than that in PIGD group (P<0 .05) ,NAA/CR ratio in hip‐pocampus area in PD‐CIND group was lower than that in PD group and HC group(P<0 .05) .The CHO/CR ratio showed no significant difference in all groups (P<0 .05) .Conclusion NAA/CR ratio in bilateral striatum and prefrontal cortex motor area in IPD patients decreases significantly ,especially in the PD‐PIGD PD patients .The occurrence rate of cognitive impairment in tremor subtype shows lower than PIGD subtype .NAA/CR ratio in hippocampus is lower in IPD patients ,especially in PD‐CIND patients .In a word ,1 H‐MRS detection technology has a clinical effect on the diagnosis and typed‐diagnosis of IPD .