基于定量磁敏感图分析初诊早期帕金森病轻度认知障碍的脑深部核团铁沉积特征
The characteristics of subcortical nuclei iron deposition in de novo Parkinson disease with mild cognitive impairment using quantitative sensitivity mapping
-
摘要:目的 采用定量磁敏感图(quantitative susceptibility mapping, QSM)分析初诊未治伴轻度认知障碍(mild cognitive impairment, MCI)的帕金森病(Parkinson disease, PD)患者皮质下脑深部核团铁沉积特征, 以及脑铁沉积与认知变化的相关性。方法 选择2016年10月至2017年12月复旦大学附属中山医院初诊未治的PD患者34例, 分为PD认知正常组(PD with normal cognition, PD-NC, n=22)和PD伴MCI组(PD-MCI, n=12), 选择同时期健康受试者作为对照组(healthy controls, HCs, n=25)。采集所有受试者的临床信息和磁共振图像(包括QSM)。测量各组受试者QSM中黑质(substantia nigra, SN)、红核(red nucleus, RN)、壳核(putamen, PU)、齿状核(dentate nucleus, DN)、苍白球(globus pallidus, GP)和尾状核(caudate nucleus, CN)头的QSM值, 比较各组受试者感兴趣区(region of interests, ROI)的QSM值差异, 进一步分析PD组中各ROI的QSM值与各认知量表之间的相关性。结果 PD-MCI组受试者双侧RN、SN、PU及左侧DN的QSM值较HCs组显著增加(P < 0.05)。PD-MCI组受试者右侧RN和PU的QSM值较PD-NC组显著增加(P < 0.05)。相关性分析显示, PD组双侧GP和PU的QSM值均与连线测试-A正相关(右侧GP: r=0.555, P=0.005;左侧GP: r=0.470, P=0.020;右侧PU: r=0.479, P=0.018;左侧PU: r=0.430, P=0.036), 右侧RN、左侧CN的QSM值与动物流畅性测验负相关(右侧RN: r=﹣0.457, P=0.025;左侧CN: r=﹣0.524, P=0.010), 右侧PU的QSM值与Boston命名测验负相关(r=﹣0.445, P=0.033)。多元回归分析显示: 右侧GP的QSM值对连线测试-A有显著影响(P=0.005)。结论 基于QSM技术发现PD-MCI存在脑深部核团的广泛铁异常沉积, 且PD患者脑内铁异常沉积与注意力、语言功能受损相关, 提示脑铁异常沉积可能参与了PD认知功能障碍的病理生理过程。Abstract:Objective To explore the characteristics of subcortical nuclei iron deposition in de novo Parkinson disease (PD) patients with mild cognitive impairment (MCI) by using quantitative sensitivity mapping (QSM), and the correlation between QSM values (QSMs) and cognitive function in PD patients.Methods From October 2016 to December 2017, 34 de novo PD patients in Zhongshan Hospital, Fudan University were collected.Patients were divided into group PD-MCI (PD with MCI, n=12) and group PD-NC (PD with normal cognition, n=22), and other 25 healthy people were chosen as control group (HCs).The QSMs of substantia nigra (SN), red nucleus (RN), putamen (PU), head of caudate nucleus (CN), globus pallidus (GP) and dentate nucleus (DN) among three groups were compared.Furtherly, the correlations between QSMs in each nucleus and cognitive scales were analyzed.Results The QSMs in the bilateral SN, bilateral RN, bilateral PU, and left DN in group PD-MCI were significantly higher than those in group HCs (P < 0.05).QSMs in the right RN and right PU in group PD-MCI were significantly higher than those in group PD-NC (P < 0.05).Correlation analyses showed that QSMs in the bilateral GP and PU were positively correlated with the Trail Making Test-A (right GP: r=0.555, P=0.005;left GP: r=0.470, P=0.020;right PU: r=0.479, P=0.018;left PU: r=0.430, P=0.036), QSMs in the right RN and left CN were negatively correlated with Animal Fluency Test (right RN: r=﹣0.457, P=0.025;left CN: r=﹣0.524, P=0.010), and QSMs in the right PU were negatively correlated with Boston Naming Test (r=﹣0.445, P=0.033).Multiple linear regression analysis showed that the QSM value of right GP had a significant impact on TMT-A (P=0.005).Conclusions The extensively abnormal iron deposition were found in subcortical nuclei in PD-MCI by using the QSM, and the iron deposition was associated with impaired attention and language functions in PD patients, suggesting that abnormal iron accumulation may participate in the pathophysiological process of cognitive dysfunction in PD.
下载: