Hatate Jun, Miwa Kaori, Matsumoto Mari, Sasaki Tsutomu, Yagita Yoshiki, Sakaguchi Manabu, Kitagawa Kazuo, Mochizuki Hideki
Department of Neurology, Osaka University Graduate School of Medicine, Osaka, Japan.
Department of Neurology and Stroke Center, Kinki University Graduate School of Medicine, Osaka, Japan.
Parkinsonism Relat Disord. 2016 May;26:29-34. doi: 10.1016/j.parkreldis.2016.02.011. Epub 2016 Feb 13.
The aim of this study was to examine the association between mild parkinsonian signs (MPS), cerebral small-vessel disease (SVD), and total SVD burden in patients with vascular risk factors.
We performed a cross-sectional study among 268 patients with vascular risk factors but without parkinsonism or dementia (71.0 ± 7.8 years, 63% male). MPS was evaluated via Unified Parkinson's Disease Rating Scale Part III. Brain MRI was used to determine SVD (cerebral microbleeds [CMBs], lacunar infarctions [LIs], and white matter hyperintensities [WMH]). The presence of each SVD feature was indicated by the total SVD score. Logistic regression analyses were performed adjusting for age, sex, history of stroke, hypertension, diabetes mellitus, and dyslipidemia.
In a multivariate analysis, we found that the presence of CMBs, deep CMBs, mixed (in the basal ganglia and thalamus) LIs, periventricular hyperintensities (PVH), and deep WMH (DWMH), and total SVD score were significantly associated with MPS, whereas strictly lobar CMBs and other LIs (in strictly basal ganglia or strictly thalamus) were not. We also found a significant association between mixed LIs, PVH, DWMH and total SVD score and gait/balance function, between PVH and rigidity, and between mixed LIs and bradykinesia. Among elderly participants (≥73years), the association of total SVD score, deep CMBs, mixed LIs, and PVH, with MPS remained significant.
Our results provide additional evidence that SVD including CMBs, and especially total SVD burden, might be a surrogate marker for MPS and support the contribution of hypertensive microangiopathy as the underlying etiology.
本研究旨在探讨血管危险因素患者中轻度帕金森氏征（MPS）、脑小血管病（SVD）与总SVD负担之间的关联。
我们对268例有血管危险因素但无帕金森症或痴呆的患者进行了横断面研究（年龄71.0±7.8岁，男性占63%）。通过统一帕金森病评定量表第三部分评估MPS。采用脑部磁共振成像（MRI）确定SVD（脑微出血[CMB]、腔隙性脑梗死[LI]和白质高信号[WMH]）。每个SVD特征的存在情况用总SVD评分表示。进行逻辑回归分析，并对年龄、性别、中风史、高血压、糖尿病和血脂异常进行校正。
在多变量分析中，我们发现CMB、深部CMB、混合性（基底节和丘脑）LI、脑室周围高信号（PVH）、深部WMH（DWMH）以及总SVD评分与MPS显著相关，而单纯叶性CMB和其他LI（仅在基底节或仅在丘脑）则不然。我们还发现混合性LI、PVH、DWMH和总SVD评分与步态/平衡功能之间、PVH与僵硬之间以及混合性LI与运动迟缓之间存在显著关联。在老年参与者（≥73岁）中，总SVD评分、深部CMB、混合性LI和PVH与MPS之间的关联仍然显著。
我们的结果提供了更多证据，表明包括CMB在内的SVD，尤其是总SVD负担，可能是MPS的替代标志物，并支持高血压微血管病作为潜在病因的作用。
