视网膜变薄与新诊断帕金森病中的黑质多巴胺能神经元丧失有关。

Retinal thinning associates with nigral dopaminergic loss in de novo Parkinson disease.

机构信息

From the Departments of Ophthalmology (J.A., T.W.K.), Neurology (J.-Y.L.), Nuclear Medicine (E.J.Y., Y.K.K.), and Biomedical Statistics (S.O.), Seoul Metropolitan Government-Seoul National University Boramae Medical Center and Seoul National University College of Medicine; Departments of Neurology (J.M.K.), Ophthalmology (S.J.W.), and Psychiatry (K.W.K.), Seoul National University Bundang Hospital and Seoul National University College of Medicine; and Department of Neurology (B.J.), Seoul National University Hospital and Seoul National University College of Medicine, South Korea.

出版信息

Neurology. 2018 Sep 11;91(11):e1003-e1012. doi: 10.1212/WNL.0000000000006157. Epub 2018 Aug 15.

DOI:10.1212/WNL.0000000000006157

PMID:30111550

Abstract

OBJECTIVE

To analyze the relationship between retinal thinning and nigral dopaminergic loss in de novo Parkinson disease (PD).

METHODS

Forty-nine patients with PD and 54 age-matched controls were analyzed. Ophthalmologic examination and macula optical coherence tomography scans were performed with additional microperimetry, -(3-[F]fluoropropyl)-2-carbomethoxy-3-(4-iodophenyl) nortropane PET, and 3T MRI scans were done in patients with PD only. Retinal layer thickness and volume were measured in subfields of the 1-, 2.22-, and 3.45-mm Early Treatment of Diabetic Retinopathy Study circle and compared in patients with PD and controls. Correlation of inner retinal layer thinning with microperimetric response was examined in patients with PD, and the relationships between retinal layer thickness and dopamine transporter densities in the ipsilateral caudate, anterior and posterior putamen, and substantia nigra were analyzed.

RESULTS

Retinal layer thinning was observed in the temporal and inferior 2.22-mm sectors (false discovery rate-adjusted < 0.05) of drug-naive patients with PD, particularly the inner plexiform and ganglion cell layers. The thickness of these layers in the inferior 2.22-mm sector showed a negative correlation with the Hoehn and Yahr stage ( = 0.032 and 0.014, respectively). There was positive correlation between macular sensitivity and retinal layer thickness in all 3.45-mm sectors, the superior 2.22-mm sector, and 1-mm circle ( < 0.05 for all). There was an association between retinal thinning and dopaminergic loss in the left substantia nigra (false discovery rate-adjusted < 0.001).

CONCLUSION

Retinal thinning is present in the early stages of PD, correlates with disease severity, and may be linked to nigral dopaminergic degeneration. Retinal imaging may be useful for detection of pathologic changes occurring in early PD.

摘要

目的

分析初发帕金森病（PD）患者视网膜变薄与黑质多巴胺能丧失之间的关系。

方法

分析了 49 例 PD 患者和 54 名年龄匹配的对照者。对所有 PD 患者进行眼科检查和黄斑光学相干断层扫描（OCT）检查，并进行微视野计、[~~(3)F]氟丙基-2-羧基-3-(4-碘苯基)去甲托烷（~~(3)F]FP-CIT）正电子发射断层扫描（PET）和 3T MRI 扫描。在 1、2.22 和 3.45mm 早期糖尿病视网膜病变研究（ETDRS）圆的亚区测量 PD 患者和对照者的视网膜层厚度和容积。在 PD 患者中检查内层视网膜变薄与微视野计反应之间的相关性，并分析视网膜层厚度与对侧尾状核、前和后壳核及黑质中多巴胺转运体密度之间的关系。

结果

在未经药物治疗的 PD 患者的颞侧和下 2.22mm 扇形区（经假发现率校正，<0.05）观察到视网膜层变薄，尤其是内丛状层和节细胞层。这些层在下 2.22mm 扇形区的厚度与 Hoehn 和 Yahr 分期呈负相关（分别为=0.032 和 0.014）。所有 3.45mm 扇形区、上 2.22mm 扇形区和 1mm 环的黄斑敏感性与视网膜层厚度呈正相关（均<0.05）。视网膜变薄与左侧黑质多巴胺能丧失之间存在相关性（经假发现率校正，<0.001）。