Walter Uwe, Hoeppner Jacqueline, Prudente-Morrissey Lara, Horowski Sebastian, Herpertz Sabine C, Benecke Reiner
Department of Neurology, University of Rostock, Gehlsheimer Strasse 20, D-18147 Rostock, Germany.
Brain. 2007 Jul;130(Pt 7):1799-807. doi: 10.1093/brain/awm017. Epub 2007 Feb 28.
Substantia nigra (SN) hyperechogenicity is a characteristic transcranial sonography (TCS) finding in idiopathic Parkinson's disease. SN hyperechogenicity, found also in approximately 10% of healthy adults, was related to a subclinical malfunction of the nigrostriatal dopaminergic system on PET studies and is, therefore, thought to represent a risk marker for Parkinson's disease. Epidemiological findings suggest an increased risk in subjects with depression. To find out whether frequency of SN hyperechogenicity is increased in depression, we performed TCS of brainstem and basal ganglia in 200 subjects: 55 controls without depression and without Parkinson's disease, 55 subjects with depression without Parkinson's disease (D+ PD-), 45 Parkinson's disease patients without depression (D- PD+) and 45 Parkinson's disease patients with depression (D+ PD+). Marked SN hyperechogenicity was found in 13% of controls, 40% of D+ PD- (chi2 test, P = 0.001), 69% of D- PD+ (vs D+ PD-, P = 0.004) and 87% of D+ PD+ patients (vs D- PD+, P = 0.04). Reduced echogenicity of brainstem raphe, thought to reflect alteration of the serotonergic system, was more frequent in depressed than in non-depressed subjects, irrespective of presence of Parkinson's disease, confirming earlier reports. The combined finding of marked SN hyperechogenicity and reduced raphe echogenicity in Parkinson's disease patients, however, was clearly associated with a history of depression prior to Parkinson's disease onset, whereas in D+ PD- patients this combined TCS abnormality was related to motor asymmetry. In D+ PD+ patients with depression prior to Parkinson's disease onset (n = 12), larger SN echogenic sizes correlated with younger age at Parkinson's disease onset (Spearman test, r = -0.607, P = 0.036). TCS findings of other basal ganglia did not differ between the groups studied. Data suggest that in subjects with depression nigrostriatal vulnerability is frequent, and that TCS might be useful to detect individuals at risk for developing Parkinson's disease.
黑质高回声是特发性帕金森病经颅超声检查（TCS）的一项特征性表现。在约10%的健康成年人中也发现有黑质高回声，在PET研究中它与黑质纹状体多巴胺能系统的亚临床功能障碍有关，因此被认为是帕金森病的一个风险标志物。流行病学研究结果表明，抑郁症患者患帕金森病的风险增加。为了确定抑郁症患者中黑质高回声的发生率是否增加，我们对200名受试者进行了脑干和基底节的TCS检查：55名无抑郁症且无帕金森病的对照者、55名无帕金森病的抑郁症患者（D+ PD-）、45名无抑郁症的帕金森病患者（D- PD+）和45名有抑郁症的帕金森病患者（D+ PD+）。在13%的对照者、40%的D+ PD-患者（卡方检验，P = 0.001）、69%的D- PD+患者（与D+ PD-相比，P = 0.004）和87%的D+ PD+患者（与D- PD+相比，P = 0.04）中发现有明显的黑质高回声。脑干中缝核回声降低被认为反映了血清素能系统的改变，在抑郁症患者中比非抑郁症患者更常见，无论是否存在帕金森病，这证实了早期报道。然而，帕金森病患者中黑质明显高回声和中缝核回声降低的联合发现，显然与帕金森病发病前的抑郁症病史有关，而在D+ PD-患者中，这种联合的TCS异常与运动不对称有关。在帕金森病发病前有抑郁症的D+ PD+患者（n = 12）中，黑质回声大小越大与帕金森病发病年龄越小相关（斯皮尔曼检验，r = -0.607，P = 0.036）。所研究的其他基底节的TCS检查结果在各研究组之间没有差异。数据表明，抑郁症患者中黑质纹状体易损性很常见，并且TCS可能有助于检测有患帕金森病风险的个体。
