基于静息态功能MRI对不同运动亚型帕金森病患者脑功能局部一致性改变的研究
Alterations of brain activity in different motor subtypes of Parkinson disease based on regional homogeneity analysis
目的 探讨不同运动亚型帕金森病(PD)患者静息态fMRI的局部脑功能活动一致性的改变及意义.方法 收集2014年12月至2018年5月间84例PD患者和29名健康对照者(HC)的静息态fMRI数据,PD组根据统一帕金森病评定量表(UPDRS)相关评分分为震颤型(TD)45例和姿势不稳/步态障碍型(PIGD)39例,根据纳入和排除标准最终纳入77例PD患者.所得数据采用基于MATLAB的DPARSF软件和REST V1.8进行数据处理和局部一致性(ReHo)分析,观察各亚型PD患者的脑功能活动改变,通过协方差分析和Post-Hoct检验进行组间比较.采用Pearson相关分析分别计算各运动亚型PD患者差异脑区的ReHo值与TD评分、PIGD评分之间的相关性.结果 与HC组相比,TD组患者右侧额中回、右侧额上回、左侧小脑ReHo增强(体素值13~21,P<0.05);左侧颞叶、左侧壳核、左侧旁中央小叶、双侧丘脑ReHo减低(体素值12~91,P<0.05);PIGD组患者右侧额上回、额中回及扣带回前部ReHo增强(体素值55~92,P<0.05);左侧壳核、左侧苍白球、左侧颞叶、右侧枕叶、双侧丘脑、双侧扣带回中部、双侧辅助运动区ReHo减低(体素值15~78,P<0.05);TD组与PIGD组相比,左侧颞叶、左侧小脑、双侧扣带回中部ReHo增强(体素值19~51,P<0.05);左侧旁中央小叶、双侧楔状叶、右侧额上回、右侧扣带回前部ReHo减低(体素值14~68,P<0.05);Pearson相关分析发现,TD评分与左侧丘脑、左侧壳核ReHo值呈负相关(r值分别为-0.355、-0.498,P均<0.05);PIGD评分与左侧丘脑、右侧丘脑ReHo值呈负相关(r值分别为-0.478、-0.397,P均<0.05).结论 不同运动亚型PD患者存在特异性的脑功能活动改变,TD组患者脑功能活动局部一致性改变主要体现在纹状体-丘脑-皮层环路和小脑-丘脑-皮层环路的相关脑区,而PIGD组患者则主要体现在纹状体-丘脑-皮层环路和视觉网络皮层相关脑区,这为进一步揭示不同运动亚型PD患者的神经病理机制、临床诊断和针对性的治疗提供新的思路.
更多Objective To explore the changes and significance of local brain activity in different motor subtypes of Parkinson disease(PD) using resting-state functional MRI (rs-fMRI) based on regional homogeneity (ReHo) analysis. Methods A total of 84 PD patients and age-and gender-matched 29 healthy controls undergoing rs-fMRI were included. PD patients were divided into two groups of tremor dominant (TD) (n=45) and postural instability gait difficulty(PIGD) (n=39) according to the Unified Parkinson′s Disease Rating Scale (UPDRS) scores. Data processing assistant for resting-state fMRI (DPARSF) and resting-state fMRI data analysis Toolkit (REST) V1.8 based on MATLAB were used to calculate the ReHo which measured brain activity in different motor subtypes of PD. Analysis of covariance and post-hoc t-tests were performed to detect the differences of local brain activity among the three groups.Correlation analyses were performed between ReHo values of the regions showing group differences and TD and PIGD scores respectively. Results Compared to healthy controls, the TD group exhibited increased ReHo in the right superior and middle frontal gyrus, left cerebellum(13 to 21 voxels, P<0.05), while decreased ReHo in the left temporal lobule, left putamen, left paracentral lobule, and bilateral thalamus (12 to 91 voxels, P<0.05). The PIGD group showed increased ReHo in the right superior frontal gyrus, right middle frontal gyrus and anterior cingulate gyrus (ACC) (55 to 92 voxels, P<0.05), while decreased ReHo in the left putamen, left pallidum, left temporal lobule, right occipital lobule, bilateral thalamus, bilateral middle cingulate gyrus, bilateral supplementary motor area (SMA) (15 to 78 voxels, P<0.05). Compared with PIGD, the TD group showed increased ReHo in the left temporal lobule, left cerebellum, bilateral middle cingulate gyrus (19 to 51 voxels, P<0.05), whereas decreased ReHo in the left paracentral lobule, bilateral cuneus, right superior frontal gyrus, and right ACC (14 to 68 voxels, P<0.05). Additionally, ReHo in the left thalamus and left putamen negatively correlated with TD scores (r=-0.355 and -0.498, both P<0.05). ReHo in the left thalamus and right thalamus negatively correlated with PIGD scores (r=-0.478 and-0.397, both P<0.05). Conclusions The changes of brain activity in TD are located in the cerebello-thalamo-cortical (CTC) circuit and the striatal-thalamo-cortical (STC) loop while the changes in PIGD are largely located in the STC loop and visual network cortex. This specific pattern of intrinsic activity in TD and PIGD may provide insights into the neurophysiological mechanisms of PD with different motor subtypes.
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