纹状体梗死患者黑质弥散变化的弥散张量研究

目的 观察纹状体梗死后黑质的弥散变化,探讨纹状体梗死后黑质的继发性损害及其意义.方法 收集首次发病、单侧纹状体梗死、非纹状体梗死、病程在3个月以上的患者各20例分别作试验组和临床对照组,募集健康志愿者20名作对照研究.研究对象均进行1次弥散张量成像(DTI),试验组与临床对照组进行改良Rankin量表(mRS)、Barthol指数(BI)的评分,评估患者脑梗死的预后以及日常生活能力,同时对部分有类似帕金森病症状的患者采用统一帕金森病综合评分量表(Unified Parkinson's Disease Rating Scale,UPDRS)的第Ⅲ分量表评价其严重程度.结果 DTI的参数分析显示:分别与临床对照及健康对照比较,试验组梗死灶同侧黑质的平均弥散量(mean diffusion,MD)值分别升高30.86%(t=40.07,P=0.000)及31.42%(t=42.64,P=0.000),临床对照组梗死灶同侧黑质的MD值与健康对照组比较差异无统计学意义.与没有帕金森病样症状的患者比较,试验组患者中4例出现帕金森病样症状患者梗死灶同侧黑质的MD值升高22%(t=18.03,P=0.01),同时患侧黑质的MD值的上升与其帕金森病样症状的严重程度呈正相关(r=0.97,P=0.03).结论 纹状体梗死可以导致同侧黑质的继发性损害,而且这种继发性损害可能是部分帕金森综合征的发病原因.

Diffusion changes in substantia nigra following striatum infarction with diffusion tensor imaging

Objective To investigate the diffusion changes in ipsilateral substantia nigra after a chronic striatum infarction with diffusion tensor imaging ( DTI ) and its connotation for clinical lecture.Methods Participators underwent a DTI scan and were divided into three groups. The striatum infarction (SI) group consisted of twenty patients with chronic basal ganglia infarction with striatum involved, while the non striatum infarction (NSI) group consisted of another twenty patients with chronic basal ganglia infarctions without striatum involved. The control group consisted of twenty healthy volunteers. Before the DTI scan all patients underwent a clinical evaluation with Modified Rankin Scale (mRS) and Barthol Index,and the four patients of SI group with symptoms like Parkinson disease underwent an additional evaluation with the third subscale of Unified Parkinson' s Disease Rating Scale ( UPDRS Ⅲ ). Results Compared with NSI and control groups, the infarct side substantia nigra MD of SI group increased by 30. 86 percent (t =40.07,P=0.000) and 31.42 percent (t =42. 64,P =0.000). The FA values from the three groups were not different. There were four patients with some symptoms like Parkinson disease in SI group. Compared with those patients without symptom like Parkinson disease in SI group, the infarct side substantia nigra MD of these four patients increased by 22 percent(t = 18.03, P =0. 01 ). Moreover, the infarct side substantia nigra MD of these four patients was correlated with their UPDRS Ⅲ positively ( r = 0. 97, P = 0. 03 ).Conclusions The secondary degeneration in the ipsilateral side substantia nigra after striatum infarction could be detested quantitatively with diffusion tensor imaging. The secondary degeneration in substantia nigra may be responsible for the symptoms like Parkinson disease in striatum infarction patients.