摘要目的:探索多系统萎缩帕金森型（MSA-P）与帕金森病（PD）患者之间的临床鉴别诊断的特异生物学标志物。方法:研究组回顾性分析2016年8月至2019年2月在上海市第一人民医院宝山分院住院或门诊随诊的MSA-P患者10例，PD患者15例，同期健康对照组15名，联合采用基于纤维束示踪的空间统计方法（TBSS）、感兴趣区分析法（ROI），进行扩散张量成像（DTI）的临床分析研究。通过TBSS，对3组间的各向异性（FA）、平均扩散率（MD）进行两两比较的定性分析研究，再将MSA-P组与PD组之间有差异的簇集选作ROI进行深入的定量分析研究。由1名固定的临床医师采用盲法对两种疾病患者行统一帕金森病评定量表（UPDRS）运动评分，采用Spearman相关分析法评价ROI所得定量数据与患者病程以及疾病严重程度的相关性。结果:相较于PD组和健康对照组，MSA-P组在左侧丘脑前辐射（ATR）［ROI检测值分别为0.371（0.287~0.535），0.472（0.390~0.594），0.473（0.388~0.555）； P值分别为0.008，0.008］和左侧上纵束（SLF）［ROI检测值分别为0.397（0.291~0.469），0.456（0.338~0.560），0.473（0.427~0.530）； P值分别为0.013，<0.01］的FA值显著下降，差异有统计学意义。这两种纤维束的FA值与临床严重程度密切相关，分别为 r=-0.807， P=0.005和 r=-0.455， P=0.022。相较于健康对照组，MSA-P的脑白质纤维束存在较多异常。 结论:左侧ATR和左侧SLF脑白质纤维束的异常可作为两种疾病鉴别诊断的特异标志物，且这两种纤维束的FA值可作为疾病严重程度的观测指标。

abstractsObjective:To identify objective markers between the Parkinson variant of multiple system atrophy (MSA-P) and Parkinson′s disease (PD).Methods:Retrospective analysis was performed on 10 patients with MSA-P, 15 patients with PD, and 15 healthy control group during the period from August 2016 to February 2019 in Baoshan Branch of Shanghai First People′s Hospital.We combined the novel tract based spatial statistics (TBSS) and region of interest (ROI) analyses for the first time to investigate three groups with diffusion tensor imaging. By TBSS, we performed pairwise comparisons of mean diffusivity and fractional anisotropy (FA) maps. The clusters with significant differences between MSA-P and PD were used as ROIs for further analyses.Results:FA values in the left anterior thalamic radiation(ATR) (ROI values were 0.371(0.287-0.535), 0.472(0.390-0.594), 0.473(0.388-0.555); P values were 0.008, 0.008) and left superior longitudinal fasciculus (SLF)(ROI values were 0.397(0.291-0.469), 0.456(0.338-0.560), 0.473(0.427-0.530); P values were 0.013,<0.001) were significantly decreased in MSA-P compared with PD or controls, and significantly correlated with clinical data(( r =-0.807, P =0.005),( r =-0.455, P =0.022)). Conclusion:Our findings indicate the abnormalities of left ATR and left SLF as specific biomarkers for differential diagnosis.