摘要
目的 探讨帕金森病（PD）患者不同运动分型局部脑活动的改变及意义.方法 运用静息态功能磁共振成像（RS-fMRI）的脑血氧水平依赖信号（BOLD）观察不同运动类型患者局部脑低频振幅（ALFF）的变化.自2013年1月至2014年3月于宣武医院帕金森病专科门诊采集60例PD及30名健康对照（NC）的RS-fMRI,所有研究对象均签署了知情同意书.PD依照统一帕金森病评定量表（UPDRS）分为震颤为主型（TD）和姿势异常步态障碍为主型（PIGD）各30例.所有研究对象均签署了知情同意书.运用ALFF算法得到每组受检者的脑图,通过单因素方差分析（ANOVA）及验后比较（Post-Hoc）t检验得到3组间差异有统计学意义的脑区.PD组ALFF与相关评分及左旋多巴剂量相关分析,分别得到显著相关脑区.结果 与NC组相比,TD组显著增高的脑区主要分布在小脑（-37,-47,-38）、丘脑（-18,-17,0）、桥脑（-3,-23,-37）、左侧中央前回（-41,-30,46）,活动显著减低的脑区则主要分布在额叶（-13,69,6）、颞叶（-42,18,-21）、左岛叶（-32,22,2）及左前扣带回（-7,32,-5）;PIGD组显著增高的脑区主要分布在右侧中央后回（63,-18,39）,而显著减低的脑区主要分布在壳核（-24,12,3）、前辅助运动区（10,10,58）、额叶（15,-15,57）、颞叶（-39,18,-3）及左岛叶（-29,20,11）.PD组间相比发现TD组颞叶较PIGD组活动增高,而在双侧广泛额叶减低.相关分析发现,TD评分与双侧小脑及额叶正相关,与左中央前回、双侧壳核和颞叶负相关;PIGD评分与双侧额叶和左侧颞叶正相关,与右中央后回及双侧壳核负相关;左旋多巴与TD组颞叶、额叶及PIGD组小脑、顶下小叶正相关.结论 PD两种亚型有特异性脑活动改变,TD主要脑活动改变为小脑-丘脑-皮层环路与基底节-丘脑-皮层运动环路共同作用的结果,而PIGD脑活动改变主要由于基底节-丘脑-皮层运动环路功能损伤.
Objective To explore the changes of local brain activity in motor subtypes of Parkinson＇s disease （PD） with functional magnetic resonance imaging （fMRI）.Methods A total of 60 idiopathic PD and 30 age-and gender-matched normal controls were examined with resting-state fMRI from January 2013 to March 2014.All subjects gave their written informed consent for the study.The amplitude of low-frequency fluctuation （ALFF） was calculated to measure local brain activity.The PD patients were divided into two groups of tremor dominant （TD） and postural instability/gait difficulty （PIGD） （n =30 each）.All subjects gave their written in formed consent for the study.One-way ANOVA and post-hoc t-test were performed to detect the differences of local brain activity between PD and normal subjects.And the correlations were examined between ALFF,scores and levodopa dose.Results Compared with normal subjects,the TD group showed increased activity in bilateral cerebellums （-37,-47,-38）,thalamus （-18,-17,0）,pons （-3,-23,-37） and left precentral gyrus （-41,-30,46） versus decreased activity in bilateral frontal lobes （-13,69,6）,temporal lobes （-42,18,-21）,left insula （-32,22,2）and left anterior cingulated （-7,32,-5）.The PIGD group showed increased activity in right postcentral gyrus （63,-18,39） and decreased activity in bilateral putamens （-24,12,3）,pre-supplementary motor area （10,10,58）,frontal lobes （15,-15,57）,temporal lobes （-39,18,-3） and left insula （-29,20,11）.Compared with PIGD,the TD group showed increased activity in temporal lobes,but decreased activity in frontal lobes.Additionally,ALFF in bilateral cerebellums and frontal lobes was positively correlated with TD scores while ALFF in left precentral gyrus,bilateral putamens and temporal lobes negatively correlated with TD scores.ALFF in bilateral frontal lobes and left temporal lobe was positively correlated with PIGD scores.However,in right postcentral gyrus and bilateral putamens,ALFF was negat
出处
《中华医学杂志》
CAS
CSCD
北大核心
2015年第7期483-488,共6页
National Medical Journal of China
基金
国家自然科学基金（81271429）
关键词
帕金森病
静止性震颤
姿势异常
步态障碍
静息态
Parkinson＇s disease
Resting tremor
Postural instability
Gait difficulty
Resting state
