基底节区血管周围间隙与新发帕金森病的长期运动预后

Perivascular Spaces in the Basal Ganglia and Long-term Motor Prognosis in Newly Diagnosed Parkinson Disease.

机构信息

From the Departments of Neurology (S.J.C., H.S.Y., J.-M.H., Y.J.K., P.H.L., Y.H.S.) and Radiology (Y.W.P., S.-K.L.) and Biostatistics Collaboration Unit (H.S.L.), Yonsei University College of Medicine, Seoul; Department of Neurology (S.J.C., J.-M.H., Y.J.K.), Yongin Severance Hospital, Yonsei University Health System, Yongin; and Department of Radiology (N.-Y.S.), Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea.

出版信息

Neurology. 2021 Apr 20;96(16):e2121-e2131. doi: 10.1212/WNL.0000000000011797. Epub 2021 Mar 2.

DOI:10.1212/WNL.0000000000011797

PMID:33653906

Abstract

OBJECTIVE

To investigate the association between enlarged perivascular spaces (PVS) in the basal ganglia (BG-PVS) and long-term motor outcomes in Parkinson disease (PD).

METHODS

We reviewed the medical records of 248 patients with drug-naive early-stage PD (follow-up >3 years, mean age 67.44 ± 8.46 years, 130 female) who underwent brain MRI and dopamine transporter (DAT) scans at initial assessment. The number of baseline enlarged BG-PVS was counted on axial T2-weighted images. Then, patients were divided into 2 groups: a PD group with a low number (0-10) of enlarged PVS (PD-EPVS-; n = 156) and a PD group with a high number (>10) of enlarged PVS (PD-EPVS+; n = 92). We used Cox regression models to compare the levodopa-induced dyskinesia (LID)-, wearing-off-, and freezing of gait (FOG)-free times between groups. We also compared longitudinal increases in levodopa-equivalent dose per body weight between groups using a linear mixed model.

RESULTS

Patients in the PD-EPVS+ group were older (72.28 ± 6.07 years) and had greater small vessel disease burden than those in the PD-EPVS- group (64.58 ± 8.38 years). The PD-EPVS+ group exhibited more severely decreased DAT availability in all striatal subregions except the ventral striatum. The risk of FOG was higher in the PD-EPVS+ group, but the risk of LID or wearing-off was comparable between groups. The PD-EPVS+ group required higher doses of dopaminergic medications for effective symptom control compared to the PD-EPVS- group.

CONCLUSION

This study suggests that baseline enlarged BG-PVS can be an indicator of the progression of motor disability in PD.

摘要

目的

探讨基底节区（BG）血管周围间隙扩大（PVS）与帕金森病（PD）患者长期运动预后的关系。

方法

我们回顾了 248 例初诊为药物未治疗的早期 PD 患者（随访时间＞3 年，平均年龄 67.44±8.46 岁，女性 130 例）的病历资料，这些患者在初始评估时均接受了脑部 MRI 和多巴胺转运体（DAT）扫描。在轴位 T2 加权图像上计算基线时增大的 BG-PVS 数量。然后，将患者分为 2 组：PVS 数量较少（0-10）的 PD 组（PD-EPVS-；n=156）和 PVS 数量较多（＞10）的 PD 组（PD-EPVS+；n=92）。我们使用 Cox 回归模型比较两组间左旋多巴诱导的运动障碍（LID）、开-关现象和冻结步态（FOG）无发作时间。我们还使用线性混合模型比较了两组间左旋多巴等效剂量与体重的纵向增加。

结果

PD-EPVS+组患者年龄较大（72.28±6.07 岁），小血管疾病负担较 PD-EPVS-组重（64.58±8.38 岁）。除了腹侧纹状体以外，PD-EPVS+组患者所有纹状体亚区的 DAT 可用性均显著降低。PD-EPVS+组发生 FOG 的风险更高，但 LID 或开-关现象的风险在两组间无差异。与 PD-EPVS-组相比，PD-EPVS+组需要更高剂量的多巴胺能药物来有效控制症状。