摘要
目的 借助磁共振图像(MRI)及基于体素的形态学测量(VBM)分析技术研究帕金森病新临床亚型的大脑结构改变,在一定程度上为完善新临床分型可靠性奠定基础.方法 帕金森病患者及正常人对照组的大脑数据均来自帕金森病进展指标计划(PPMI)公开数据库.根据帕金森病新分型标准(综合运动严重程度、快速眼动睡眠行为障碍、自主神经障碍和认知障碍)将帕金森病患者分为三种亚型(轻度运动症状为主型MM、中间型IM、弥漫恶化型DM).应用VBM分析技术计算大脑皮质体积,各亚组与对照组间灰质体积进行t检验探究帕金森各临床亚型大脑皮质体积的异常改变;帕金森各亚型组间进行方差分析、事后(ANOVA)分析探究帕金森各临床亚型间脑皮质体积的差异性.结果 与对照组比较:MM组灰质体积变小的脑区为左侧梭状回/颞下回,体积增大的区域为右侧角回;IM组灰质体积变小的脑区为左侧中央后回/中央前回、左侧颞中回、右侧额下回、右侧央后回/中央前回;DM组灰质体积变小的脑区为右侧中央旁回、左侧杏仁核/海马、左侧距状回.ANOVA分析比较三个亚型间有差异的脑区:IM与MM有差异的脑区为左侧中央前回/中央后回、右楔叶、左颞中回、右中央后回;DM与MM有差异的脑区为左颞中回、右中央后回、右小脑、右楔前叶.结论 基于VBM技术证实了三种帕金森新亚型对大脑结构的损伤是不同的模式,更进一步说明帕金森三种亚型是真实的亚群,而不是同一类型的不同阶段.
Abstract
Objective To study brain structural changes in new clinical subtypes of Parkinson's disease by utilizing MRI and voxel based morphological measurement(VBM)analysis technology,a foundation is laid for improving the reliability of new clinical subtypes to a certain extent.Methods The brain data of Parkinson's disease patients and normal control group were obtained from the Parkinson's Disease Progression Indicator Program(PPMI)public data-base.According to the new classification criteria for Parkinson's disease(comprehensive motor severity,rapid eye move-ment sleep behavior disorder,autonomic nervous disorder,and cognitive impairment),Parkinson's disease patients are di-vided into three subtypes(mild motor symptom dominated type MM,intermediate type IM,and diffuse worsening type DM).On the basis of the new clinical classification of Parkinson's disease,this study applied VBM analysis technology to calculate the volume of the cerebral cortex,and conducted t-tests on the gray matter volume between each subgroup and the control group to explore the abnormal changes in the volume of the cerebral cortex in each clinical subtype of Parkin-son's disease;Conduct analysis of variance and post hoc(ANOVA)analysis among different subtypes of Parkinson's dis-ease to explore the differences in cortical volume among clinical subtypes of Parkinson's disease.Results Compared with the control group,in the MM group,the brain area with reduced gray matter volume was the left fusiform gyrus/infe-rior temporal gyrus,while the area with increased volume was the right angular gyrus;The brain regions with reduced gray matter volume in the IM group were the left posterior/anterior central gyrus,left middle temporal gyrus,right inferior fron-tal gyrus,and right posterior/anterior central gyrus;The brain regions with reduced gray matter volume in the DM group were the right paracentral gyrus,left amygdala/hippocampus,and left talus gyrus.ANOVA analysis compared the brain regions with differences between the three subtypes:the brain regions with differences between IM and MM were the left anterior/posterior central gyrus,right cuneiform lobe,left middle temporal gyrus,and right posterior central gyrus;The brain regions with differences between DM and MM are the left middle temporal gyrus,right posterior central gyrus,right cerebellum,and right anterior cuneiform lobe.Conclusions Based on VBM technology,it has been confirmed that three new subtypes of Parkinson's disease have different patterns of damage to brain structures.In addition,it indicates that the three subtypes of Parkinson's disease are real subgroups,rather than different stages of the same type.
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