Lu Sa,1 Shan Li,2 Linyu Chen,3 Jin Wang,4 Yijin Wang,1 Changxin Cheng,1 Changyuan Xin,1 Shuni Zhang,1 Fan Ding,1 Bo Wang1 

1Department of MRI, the First People’s Hospital of Yunnan Province, the Affiliated Hospital of Kunming University of Science and Technology, Kunming, Yunnan, 650032, People’s Republic of China; 2Department of Neurology, the First People’s Hospital of Yunnan Province, the Affiliated Hospital of Kunming University of Science and Technology, Kunming, Yunnan, 650032, People’s Republic of China; 3Department of Medical Imaging, the Third People’s Hospital of Honghe State, Gejiu, Yunnan, 661000, People’s Republic of China; 4Department of Medical Imaging, Southern Central Hospital of Yunnan Province (The First People’s Hospital of Honghe State), Mengzi, Yunnan, 661100, People’s Republic of China

Correspondence: Bo Wang, Department of MRI, the First People’s Hospital of Yunnan Province, the Affiliated Hospital of Kunming University of Science and Technology, Kunming, Yunnan, 650032, People’s Republic of China, Email wb13888564672@163.com
摘要

目的：利用沿血管周围间隙的扩散张量成像分析（Diffusion tensor image analysis along the perivascular space，DTI-ALPS）、扩大的血管周围间隙（Enlarged perivascular space，EPVS）及脉络丛体积（Choroid plexus volume，CPV）的多模态成像技术探究帕金森病（Parkinson’s Disease，PD）伴焦虑患者脑类淋巴系统功能。

方法：前瞻性纳入64例PD患者和42例健康对照组（healthy controls，HC），对所有参与者的焦虑、抑郁、认知和运动障碍等症状进行临床评估。根据汉密尔顿焦虑评定量表（Hamilton Anxiety Rating Scale，HAM-A）将PD患者分为34例PD伴焦虑组（Parkinson’s disease with anxiety，PD-A）和30例PD不伴焦虑组（Parkinson’s disease without anxiety，PD-NA），比较3组间DTI-ALPS指数、EPVS数和CPV的差异，并开发了整合前述多模态指标的综合模型。此外，控制年龄、性别、受教育程度进行偏相关分析，以探究上述三个影像学指标与PD-A临床特征之间的关系。

结果：与PD-NA组相比，PD-A组的DTI-ALPSr（P=0.047）和DTI-ALPSb（P=0.01）指数降低，CPVl（P=0.046）增大。PD患者的DTI-ALPS指数与CPV呈负相关。基于受试者工作特征曲线（receiver operating curve，ROC）分析，最佳单指标联合模型在区分帕金森病与健康对照方面表现出优越的效能（area under the curve，AUC=0.847）。此外，结合DTI-ALPSb、CPVl的复合模型对帕金森病患者的焦虑具有预测价值（AUC=0.748）。在控制年龄、性别和教育程度后，CPV与HAM-A（r=0.657，P=0.031）和非运动症状量表（Non-Motor Symptom Scale，NMSS）（r=0.617，P=0.041）呈正相关。标准化的CPV与蒙特利尔认知评估（Montreal Cognitive Assessment，MoCA）（r=-0.640，P=0.034）和统一帕金森病评定量表第3部分（Unified Parkinson’s Disease Rating Scale III，UPDRS III）（r=0.659，P=0.03）呈负相关。

结论：PD患者存在脑类淋巴功能障碍，且伴焦虑的PD患者损害更严重。CPV增大与PD伴焦虑患者的焦虑、认知能力下降和运动功能障碍有关。多模态MRI指标模型评估脑类淋巴功能具有临床应用的潜能。