摘要目的:探究伴睡眠障碍帕金森病(Parkinson disease，PD)患者胆碱能通路高信号与认知功能的相关性。方法:选取2017—2022年住院的PD患者，根据帕金森病睡眠量表(Parkinson's disease sleep scale，PDSS)评分将其分为PD伴睡眠障碍组(PD-SD组)( n＝56)、PD不伴睡眠障碍组(PD-NSD组)( n＝41)。所有被试均行磁共振检查。对两组患者进行PDSS、霍亚分级评估(Hoehn-Yahr，H-Y)、蒙特利尔认知评估量表(Montreal cognitive assessment scale，MoCA)、胆碱能通路高信号量表(cholinergic pathways hyper intensities scale，CHIPS)评估。分析两组患者认知功能的差异及CHIPS与认知功能的相关性。采用SPSS 26.0统计软件对数据进行独立样本 t检验、Spearman相关分析和二元Logistic回归分析。 结果:(1) PD-SD组的MoCA评分[22.00(5.00)分]低于PD-NSD组[26.00(5.00)分]( Z＝－3.830， P<0.05)；PD-SD组CHIPS各层面评分及总分均高于PD-NSD组[低位内囊总分：12.00(8.00)，0(8.00)分；高位内囊总分：12.00(2.00)，6.00(9.00)分；放射冠总分：8.00(0)，4.00(4.00)分；半卵圆中心总分：3.00(4.00)，0(2.00)分；右侧总分：16.00(9.00)，5.00(10.00)分；左侧总分：17.00(6.00)，7.00(9.00)分；CHIPS总分：32.00(14.00)，14.00(20.00)分]( Z＝－5.081，－5.873，－4.933，－3.211，－5.562，－6.232，－5.995，均 P<0.05)。(2)PD-SD组CHIPS量表评分与MoCA总分的相关性分析显示，MoCA总分与低位内囊总分( r＝－0.286)、半卵圆中心总分( r＝－0.307)、右侧总分( r＝－0.376)、左侧总分( r＝－0.284)、CHIPS总分( r＝－0.349)均呈负相关(均 P<0.05)。(3)二元Logistic回归分析结果显示，半卵圆中心、低位内囊、右侧以及左侧脑白质病变均不是认知障碍的影响因素(均 P>0.05)。 结论:PD伴有睡眠障碍比不伴有睡眠障碍患者的认知功能评分更低，CHIPS得分更高，脑白质病变更明显。在伴有睡眠障碍的PD患者中，CHIPS得分越高，认知功能评分越低，其认知障碍发生和发展的速度越显著。

abstractsObjective:To explore the correlation between high cholinergic pathway signaling and cognitive function in patients with Parkinson disease(PD) accompanied with sleep disorder.Methods:PD patients admitted from 2017 to 2022 were divided into PD with sleep disorder group (PD-SD group) ( n=56) and PD without sleep disorder group (PD-NSD group) ( n=41) according to the Parkinson's disease sleep scale (PDSS) score. All participants underwent magnetic resonance imaging examination.All patients were evaluated by the PDSS, Hoehn-Yahr (H-Y), Montreal cognitive assessment scale (MoCA), and cholinergic pathways hyper intensities scale (CHIPS). The difference of cognitive function between the two groups and the correlation between CHIPS and cognitive function were analyzed.Independent sample t-test, Spearman correlation analysis, and binary Logistic regression analysis were performed on the data by SPSS 26.0 statistical software. Results:(1)The MoCA score of the PD-SD group (22.00 (5.00)) was lower than that of the PD-NSD group (26.00 (5.00)) ( Z=-3.830, P<0.05). The total and all aspects scores of CHIPS in PD-SD group were higher than those in PD-NSD group(the total score of the low external capsule: 12.00(8.00), 0(8.00), the total score of the high external capsule: 12.00(2.00), 6.00(9.00), the total score of the radial crown: 8.00(0), 4.00(4.00), the total score of the centrum semiovale: 3.00(4.00), 0(2.00), the total score of the right side: 16.00(9.00), 5.00(10.00), the total score of the left side: 17.00(6.00), 7.00(9.00), the total score of CHIPS: 32.00(14.00), 14.00(20.00))( Z=-5.081, -5.873, -4.933, -3.211, -5.562, -6.232, -5.995, all P<0.05). (2)The correlation analysis between the score of CHIPS and cognitive function in the PD-SD group showed that, the total score of the low external capsule ( r=-0.286), the total score of the centrum semiovale ( r=-0.307), the total score of the right side ( r=-0.376), the total score of the left side ( r=-0.284) and the total score of CHIPS ( r=-0.349) were negatively correlated with MoCA(all P<0.05). (3)Binary Logistic regression analysis showed that white matter lesions in centrum semiovale, low inner capsule, right and left leukodystrophy were not influence factors for cognitive impairment (all P>0.05). Conclusion:PD patients with sleep disorders have lower cognitive function scores, higher CHIPS scores, and significant changes in white matter lesions compared to those without sleep disorders. In PD patients with sleep disorders, the higher the CHIPS score, the lower the cognitive function score, and the more significant the rate of cognitive impairment occurrence and development.