Zhongguo cuzhong zazhi (Aug 2023)
血管性帕金森综合征与帕金森病的临床特征及脑白质高信号差异性研究 Differences between Clinical Features and White Matter Hyperintensities between Vascular Parkinsonism and Parkinson′s Disease
Abstract
目的 研究血管性帕金森综合征（vascular parkinsonism，VP）与帕金森病（Parkinson’s disease，PD）临床特征及脑白质高信号（white matter hyperintensities，WMH）的差异，为研究VP的发病机制提供一定的依据与思路。 方法 根据临床实际，健康受试者人数以1∶2的比例匹配，回顾性筛选符合入排标准的VP患者和年龄、性别、受教育程度与其相匹配的PD患者、健康志愿者，健康志愿者作为健康对照（healthy control，HC）组。收集一般临床资料及生化指标，评估患者临床症状，采集头颅MRI参数并对3组受试者的资料进行统计分析。 结果 本研究纳入26例VP患者、26例PD患者及13例HC，与PD组相比，VP组的整体认知、精神状态更差：HAMA得分（P=0.025）更高，MMSE得分（P=0.001）、MoCA得分（P=0.008）更低；血管危险因素更多：有高血压病史（P=0.012）和卒中病史（P＜0.001）的患者比例更高；运动相关脑区白质受损更严重：WMH总分（P＜0.001）、深部白质高信号（deep white matter hyperintensities，DWMH）总分（P=0.001）、脑室旁周围白质高信号（periventricular hyperintensities，PVH）总分（P=0.002）、运动相关脑区PVH评分[额角帽状白质高信号评分（P=0.002）、侧脑室带状白质高信号评分（P=0.018）]、运动相关脑区DWMH评分[额叶深部白质高信号评分（P<0.001）、顶叶深部白质高信号评分（P=0.007）]、基底节白质高信号评分（P=0.002）、壳核白质高信号评分（P=0.029）更高，上述差异均具有统计学意义（P＜0.05）。 结论 高血压病史、卒中病史和运动相关脑区白质损伤在VP发病机制中可能有重要作用。 Abstract: Objective The study of the differences in clinical features and white matter hyperintensities (WMH) between vascular parkinsonism (VP) and Parkinson’s disease (PD) can provide some basis and ideas for studying the pathogenesis of VP. Methods According to the clinical practice, the number of healthy subjects was matched at a ratio of 1:2. VP patients meeting the inclusion criteria and PD patients and healthy volunteers matching their age, gender and education level were retrospectively screened, and healthy volunteers were selected as the healthy control (HC) group. Collected their general clinical data and biochemical indicators, evaluated the clinical symptoms of patients, collected head MRI parameters and made statistical analyses of the data of the three groups of subjects. Results A total of 26 VP patients, 26 PD patients and 13 HC were enrolled in this study. Compared with the PD group, VP group had worse overall cognition and mental state: HAMA score was higher (P=0.025), MMSE score (P=0.001) and MoCA score (P=0.008) were lower; more vascular risk factors: a higher proportion of patients had a history of hypertension (P=0.012) and stroke (P<0.001); more severe white matter damage in motion-related brain regions: WMH total score (P<0.001), deep white matter hyperintensities (DWMH) total score (P=0.001), periventricular hyperintensities (PVH) total score (P=0.002), PVH scores in motion-related brain regions [frontal horn cap white matter hyperintensities score (P=0.002), lateral ventricular belt white matter hyperintensities score (P=0.018)], DWMH scores in motion-related brain regions [frontal deep white matter hyperintensities score (P<0.001), parietal deep white matter hyperintensities score (P=0.007)], basal ganglia white matter hyperintensities score (P=0.002), putamen white matter hyperintensities score (P=0.029) were higher. All were statistically significant (all P<0.05). Conclusions A history of hypertension, a history of stroke, and white matter damage in motion-related brain regions may play an important role in the pathogenesis of VP.
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