摘要
目的 采用MRI-磁敏感加权成像(MRI-susceptibility weighted imaging,MRI-SWI)检查老年帕金森病(Parkinson's disease,PD)患者脑微出血(cerebral microbleeds,CMB)灶,并分析老年PD患者CMB与认知障碍的关系。方法 采用前瞻性队列研究方法纳入2020年6月至2024年4月淮安市第三人民医院收治的老年PD患者80例,所有患者均行MRI-SWI检查,并接受认知功能评估。根据MRI-SWI检查结果将纳入的患者分为CMB阳性组17例和CMB阴性组63例;根据PD认知功能评定量表评估结果将患者分为认知障碍组34例和认知正常组46例。比较CMB阳性组和CMB阴性组与认知障碍组和认知正常组的一般临床资料;比较认知障碍组与认知正常组CMB类型和CMB严重程度;采用多因素logistic回归分析老年PD患者CMB与认知障碍的关系。结果 CMB阳性组PD病程、Hoehn-Yahr(H-Y)晚期、统一帕金森病评定量表(unified Parkinson's disease rating scale,UPDRS)Ⅰ评分、认知障碍比例高于CMB阴性组(P<0.05,P<0.01)。脑叶CMB患者的认知障碍比例高于深部-幕下CMB、混合性患者,重度CMB患者认知障碍比例高于轻、中度患者(P<0.05)。多因素logistic回归分析显示,老年PD患者发生认知障碍与PD病程、H-Y中期、H-Y晚期、CMB、UPDRSⅠ评分有关,可能是发生认知障碍的危险因素(OR=1.356,95%CI:1.121~1.640;OR=16.585,95%CI:2.532~108.623;OR=5.786,95%CI:1.073~31.206;OR=6.553,95%CI:1.066~40.281;OR=2.102,95%CI:1.384~3.194)。结论 老年PD患者合并CMB可增加患者认知障碍风险,脑叶CMB、重度CMB认知障碍风险更高,因此早期检出较关键。
Objective To use MRI susceptibility weighted imaging(MRI-SWI) to examine cerebral microbleeds(CMB) in elderly Parkinson’s disease(PD) patients,and analyze the relationship between CMB and cognitive impairment in them.Methods A prospective cohort study was conducted on 80 elderly PD patients admitted to Huai’an No.3 People’s Hospital from June 2020 to April 2024.All patients underwent MRI-SWI examination and PD-Cognitive Rating Scale(PD-CRS).According to the results of MRI-SWI examination,they were divided into a CMB positive group(17 cases) and a CMB negative group(63 cases),and based on the results of PD-CRS,they were also assigned into a cognitive impairment group(34 cases) and a normal cognitive group(46 cases).General clinical data were compared between the CMB positive and negative groups,and between the cognitive impairment group and normal cognitive group.CMB type and severity were compared between the cognitive impairment group and the normal cognitive group.Multivariate logistic regression analysis was applied to investigate the relationship between CMB and cognitive impairment in elderly PD patients.Results The CMB positive group had longer PD course,advanced Hoehn Yahr(H-Y) late stage,higher unified Parkinson’s disease rating scale(UPDRS) Ⅰ score,and larger ratio of cognitive impairment than the CMB negative group(P<0.05,P<0.01).The proportion of cognitive impairment in patients with lobular CMB was higher than that in deep-subtentorial CMB and mixed patients,and the proportion of cognitive impairment in patients with severe CMB was higher than that in patients with mild and moderate CMB(P<0.05).Multivariate logistic regression analysis showed that the occurrence of cognitive impairment in elderly PD patients was related to the course of disease,H-Y mid stage,H-Y late stage,CMB,and UPDRS Ⅰ score,which may be risk factors for cognitive impairment(OR=1.356,95%CI:1.121-1.640;OR=16.585,95%CI:2.532-108.623;OR=5.786,95%CI:1.073-31.206;OR=6.553,95%CI:1.066-40.281;OR=2.102,95%CI:1.384-3.194).Conclusion The coexistence of CMB in elderly PD patients can increase the risk of cognitive impairment,with a higher risk of cognitive impairment in cerebral lobe CMB and severe CMB.Therefore,early detection is crucial.
作者
王前香
吴雪峰
徐华
邵宝富
潘合跃
徐鹏
Wang Qianxiang;Wu Xuefeng;Xu Hua;Shao Baofu;Pan Heyue;Xu Peng(Department of Radiology,Huai'an Second Clinical Medical College of Xuzhou Medical University,Huaian No.3 People's Hospital,Huaian 223001,Jiangsu Province,China)
出处
《中华老年心脑血管病杂志》
CAS
北大核心
2024年第10期1173-1177,共5页
Chinese Journal of Geriatric Heart,Brain and Vessel Diseases
基金
淮安市基础研究计划项目(HABL2023085)。
关键词
帕金森病
磁共振成像
脑微出血
认知障碍
Parkinson disease
magnetic resonance imaging
cerebral microbleeds
cognition disorders
作者简介
通信作者:徐鹏,Email:xupeng_doc@163.com。
