脑白质病变与帕金森病患者临床症状的相关性研究

Association between white matter lesion and clinical symptoms in patients with Parkinson's disease

摘要:

目的 探讨脑白质病变（white matter lesions，WML）对帕金森病（Parkinson’s disease，PD）患者运动症状、认知功能和情绪的影响。方法 纳入2018年1月至2023年12月就诊于安徽医科大学第二附属医院神经内科PD患者123例，应用年龄相关的白质改变（age‐related white matter changes，ARWMC）量表评估患者头颅MRI影像学的脑白质病变程度，根据评分结果将患者分为轻度WML组（46例），中重度WML组（77例）；使用帕金森病统一评定量表第三部分、Hoehn & Yahr（H‐Y）分级量表评定运动症状及疾病严重程度，简易精神状态检查（mini‐mental state examination，MMSE）评估PD的认知功能，汉密尔顿抑郁量表，汉密尔顿焦虑量表评定情绪状态，Barthel指数评定患者日常生活功能状态。比较两组患者的运动症状、认知及情绪评分等差异，应用Logistic回归分析PD患者的WML与临床症状的关系。结果 中重度WML组的高血压发生率（41.6% vs. 23.9%，P<0.05）高于轻度WML组。中重度WML组的H‐Y分级高于轻度WML组［2.5（1.5，3.0） vs. 2.0（1.5，2.5），P<0.05］，UPDRS‐Ⅲ评分高于轻度WML组［（34.0±16.5） vs. （24.09±11.04），P<0.01］。此外，中重度WML组的MMSE评分低于轻度WML组［24.0（18.5，27.0） vs. 26.0（23.8，27.0），P<0.01］，Barthel得分亦低于轻度WML组［（77.4±17.4） vs. （83.5±11.7），P<0.05］，差异有统计学意义。相关分析显示，ARWMC总分与HY及UPDRS‐Ⅲ得分呈正相关，与年龄亦呈正相关。ARWMC总分与MMSE得分及Barthel评分呈负相关。Logistic回归分析显示，重度WML损害与认知障碍有相关性（回归系数β=1.072，95%CI=1.078~7.918，P=0.035）。结论 WML与PD运动障碍、认知功能损害及生活质量下降相关。

Abstract:

Objective To investigate the influence of cerebral white matter lesion（WML） on motor symptoms，cognitive function，and mood in patients with Parkinson's disease（PD）.Methods A total of 123 patients with PD who visited the Department of Neurology of the Second Affiliated Hospital of Anhui Medical University from January 2018 to December 2023 were included. Age‐related White Matter Changes（ARWMC） scale was used to evaluate the degree of cerebral WML on cranial MRI imaging，according to the score of the scale，the patients were divided into mild WML group with 46 patients and moderate‐to‐severe WML group with 77 patients. The Unified Parkinson's Disease Rating Scale Part Ⅲ（UPDRS‐Ⅲ） and Hoehn‐Yahr（H‐Y） Rating Scale were used to assess motor symptoms and disease severity； Mini‐Mental State Examination（MMSE） was used to assess cognitive function in PD； Hamilton Depression Scale and Hamilton Anxiety Scale were used to assess the emotion of PD patients； Barthel Index was used to assess the activities of daily living. The scores of motor symptoms，cognitive function，and mood in patients were compared between the two groups， and the relationship between WML and PD patients symptoms was analyzed by Logistic regression.Results The moderate‐to‐severe WML group had a significantly higher incidence rate of hypertension than the mild WML group（41.6% vs. 23.9%，P<0.05）. Compared with the mild WML group，the moderate‐to‐severe WML group had significantly higher H‐Y stage［2.5（1.5，3.0） vs. 2.0（1.5，2.5），P<0.05］ and UPDRS‐Ⅲ score（34.0±16.5 vs. 24.09±11.04，P<0.01）. Compared with the mild WML group，the moderate‐to‐severe WML group had significantly lower MMSE score［24.0（18.5，27.0） vs. 26.0（23.8，27.0），P<0.01］ and Barthel Index［（77.4±17.4） vs.（83.5±11.7），P<0.05］. The correlation analysis showed that total ARWMC score was positively correlated with H‐Y stage，UPDRS‐Ⅲ score，and age，while it was negatively correlated with MMSE score and Barthel Index. The logistic regression analysis showed a significant association between severe WML impairment and cognitive impairment（β=1.072，95% confidence interval：1.078~7.918，P=0.035）.Conclusion WML is associated with dyskinesia，cognitive impairment，and reduction in quality of life in PD.