以皮层和皮层下形态学改变鉴别帕金森病伴或不伴抑郁

目的 观察皮层及皮层下核团形态学改变鉴别诊断帕金森病伴抑郁(PDD)与不伴抑郁(PDND)的价值。方法 回顾性纳入40例PDD患者(PDD组)和26例PDND患者(PDND组),并前瞻性招募33名健康对照者(HC组);对比3组间及两两组间皮层厚度及皮层下核团体积,并分析其用于鉴别诊断PDD与PDND的效能。结果 相比HC组,PDD组双侧额上回、左侧颞中回、右侧颞上回和右侧岛叶皮层厚度,PDND组左侧额上回、右侧前扣带回和右侧颞上回皮层厚度均显著下降(P均＜0.05);相比PDND组,PDD组左侧外侧眶额回皮层厚度显著下降(P＜0.05)。相比HC组,PDD组双侧海马、双侧杏仁核、左侧丘脑和右侧伏隔核体积显著缩小(P均＜0.05),PDD组和PDND组双侧尾状核和壳核体积均显著增加(P均＜0.05);相比PDND组,PDD组双侧丘脑、左侧杏仁核和右侧伏隔核体积显著缩小(P均＜0.05)。以PDND组为对照,病程、左侧外侧眶额回皮层厚度、左侧丘脑体积及右侧伏隔核体积均为PDD的独立预测因素,其鉴别PDD与PDND的曲线下面积(AUC)分别为0.662、0.682、0.742及0.706;各参数联合的AUC为0.881,均高于单一参数(P均＜0.05)。结论 左侧外侧眶额回皮层厚度、左侧丘脑体积及右侧伏隔核体积结合病程有助于鉴别诊断PDD与PDND。

Morphological changes of cortical and subcortical nuclei for differentiating Parkinson disease with or without depression

Objective To observe the value of morphological changes of cortical and subcortical nuclei for differentiating Parkinson disease with depression (PDD) or with non-depressed (PDND). Methods Forty PDD patients (PDD group) and 26 PDND patients (PDND group) were retrospectively enrolled, and 33 healthy controls (HC group) were prospectively recruited. The cortical thickness and subcortical nuclei volume were compared among 3 groups and between each 2 groups, respectively, and the value of the above parameters for differentiating PDD and PDND were analyzed. Results Compared with HC group, the cortical thickness of bilateral superior frontal gyrus, left middle temporal gyrus, right superior temporal gyrus and right insular decreased in PDD group (all P＜0.05), so did that of left superior frontal gyrus, right rostral anterior cingulate and right superior temporal gyrus in PDND group (all P＜0.05). Compared with PDND group, the thickness of left lateral orbitofrontal cortex decreased in PDD group (P＜0.05). Compared with HC group, the volume of bilateral hippocampus, bilateral amygdala, left thalamus and right nucleus accumbens decreased in PDD group (all P＜0.05), while of bilateral caudate and putamen increased in PDD group and PDND group (all P＜0.05). Compared with PDND group, the volume of bilateral thalamus, left amygdala and right nucleus accumbens decreased in PDD group (all P＜0.05). Taken PDND group as the controls, the course of disease, thickness of left lateral orbitofrontal cortex, volume of left thalamus and right nucleus accumbens were all independent predictors of PDD, with the area under the curve (AUC) for differentiating PDD and PDND of 0.662, 0.682, 0.742 and 0.706, respectively. The AUC of the combination of the above parameters was 0.881, significantly higher than each index alone (all P＜0.05). Conclusion The thickness of left lateral orbitofrontal cortex, volume of left thalamus and right nucleus accumbens combined with the course of disease were helpful for differentiating PDD and PDND.