Department of Ultrasound, The Second Affiliated Hospital of Soochow University, 1055, Road Sanxiang, Suzhou, 215004, Jiangsu, China.
Department of Neurology and Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, Suzhou, China.
Neurol Sci. 2024 Dec;45(12):5739-5747. doi: 10.1007/s10072-024-07697-0. Epub 2024 Aug 2.
It is debatable whether the area of substantia nigra hyperechogenicity (SN+) in transcranial sonography (TCS) is related to Parkinson's disease (PD) severity. Iron deposition, which is associated with the formation of SN+, may have different effects on dopamine nerve function as PD progresses. However, little research has explored the association between the SN + area and disease severity of PD in stages.
612 PD patients with sufficient bone window were retrospectively included from a PD database, and disease severity was assessed by the Unified Parkinson's Disease Rating Scale (UPDRS) scores. Based on the Hoehn and Yahr (H-Y) scale, we classified the patients into seven groups (H-Y stage 1, 1.5, 2, 2.5, 3, 4, and 5) and then analyzed the correlations between the SN + area and the UPDRS scores separately.
Our results indicated a U-shaped relationship between the initial-SN + area and disease severity in PD: In the H-Y stage 1 group, the initial-SN + area was negatively correlated with the UPDRS total score (r = - 0.456, p < 0.001) and UPDRS-III score (r = - 0.497, p < 0.001). No correlation was observed in the groups of H-Y stages 1.5, 2, and 2.5. In the groups of H-Y stage ≥ 3, the initial-SN + area was positively correlated with the UPDRS total score and UPDRS-III score, with strongest correlation in the H-Y stage 5 group (all p values < 0.05). Moreover, the larger SN + area and average SN + area showed a similar evolutionary trend of correlation with UPDRS total score and UPDRS-III score.
Our study indicated a U-shaped correlation between the SN + area with the UPDRS total score and UPDRS-III score as H-Y stage progressed. The evolution of the correlation may reflect the evolution of underlying pathological mechanisms related to iron deposition in the substantia nigra.
经颅超声（TCS）中黑质高回声（SN+）面积是否与帕金森病（PD）的严重程度有关仍存在争议。铁沉积与 SN+的形成有关，随着 PD 的进展，它可能对多巴胺神经功能产生不同的影响。然而，很少有研究探讨 SN+面积与 PD 不同阶段疾病严重程度之间的关系。
从 PD 数据库中回顾性纳入 612 名具有足够骨窗的 PD 患者，采用统一帕金森病评定量表（UPDRS）评分评估疾病严重程度。根据 Hoehn 和 Yahr（H-Y）量表，我们将患者分为七个组（H-Y 分期 1、1.5、2、2.5、3、4 和 5），然后分别分析 SN+面积与 UPDRS 评分之间的相关性。
我们的结果表明，PD 中初始 SN+面积与疾病严重程度之间呈 U 型关系：在 H-Y 分期 1 组中，初始 SN+面积与 UPDRS 总分（r=-0.456，p<0.001）和 UPDRS-III 评分（r=-0.497，p<0.001）呈负相关。在 H-Y 分期 1.5、2 和 2.5 组中未观察到相关性。在 H-Y 分期≥3 的组中，初始 SN+面积与 UPDRS 总分和 UPDRS-III 评分呈正相关，在 H-Y 分期 5 组中相关性最强（均 p 值<0.05）。此外，较大的 SN+面积和平均 SN+面积与 UPDRS 总分和 UPDRS-III 评分的相关性呈相似的演变趋势。
我们的研究表明，随着 H-Y 分期的进展，SN+面积与 UPDRS 总分和 UPDRS-III 评分之间呈 U 型相关。相关性的演变可能反映了与黑质铁沉积有关的潜在病理机制的演变。
