Department of Neurology, Movement Disorder Clinic, Rabin Medical Center - Beilinson Hospital, Petach Tikva 4941492, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Beit Berl Academic College, Kfar Saba 44905, Israel.
J Neurol Sci. 2018 Jul 15;390:255-260. doi: 10.1016/j.jns.2018.05.006. Epub 2018 May 7.
The role of nuclear imaging in predicting Parkinson's disease (PD) progression is unclear. This study investigated whether the degree of reduced striatal dopamine transporter binding at diagnosis of PD predicts later motor complications and time to disease progression.
We retrospectively studied 41 patients with early PD who underwent I-FP-CIT SPECT and were followed thereafter with a mean disease duration of 9.51 ± 3.18 years. The association of quantitatively analyzed I-FP-CIT binding in striatal subregions with the development of motor fluctuations, dyskinesias, freezing of gait (FOG) and falls as well as the time to Hoehn and Yahr (H&Y) stage 3 was evaluated.
Logistic regression models controlling for age at diagnosis, sex, disease duration, and L-dopa dose revealed that I-FP-CIT binding in the putamen and striatum significantly predicted FOG (OR = 0.02, p = 0.03; OR = 0.01, p = 0.04; respectively) but not falls. Cox proportional hazard analysis did not reveal significant relationship between I-FP-CIT binding and motor fluctuations, dyskinesias, or H&Y stage 3.
Our results suggest that a more severe depletion of presynaptic dopamine in early PD is a bad prognostic sign in terms of FOG development. These findings, if replicated, may point to dopaminergic transmission as part of the mechanism underlying FOG in PD.
核成像在预测帕金森病（PD）进展中的作用尚不清楚。本研究旨在探讨 PD 诊断时纹状体多巴胺转运体结合程度的降低是否预测后期运动并发症和疾病进展时间。
我们回顾性研究了 41 例早期 PD 患者，这些患者接受了 I-FP-CIT SPECT 检查，此后平均随访 9.51±3.18 年。评估定量分析纹状体亚区 I-FP-CIT 结合与运动波动、运动障碍、冻结步态（FOG）和跌倒的发展以及 Hoehn 和 Yahr（H&Y）分期 3 的时间之间的关联。
在控制诊断时年龄、性别、病程和左旋多巴剂量后，逻辑回归模型显示，壳核和纹状体中的 I-FP-CIT 结合显著预测 FOG（OR=0.02，p=0.03；OR=0.01，p=0.04；分别），但不预测跌倒。Cox 比例风险分析并未显示 I-FP-CIT 结合与运动波动、运动障碍或 H&Y 分期 3 之间存在显著关系。
我们的研究结果表明，早期 PD 中突触前多巴胺的更严重耗竭是 FOG 发展的不良预后标志。如果这些发现得到证实，可能表明多巴胺能传递是 PD 中 FOG 机制的一部分。
