磁共振弥散张量研究纹状体梗死后黑质继发性损害及其临床意义

项目名称： 磁共振弥散张量研究纹状体梗死后黑质继发性损害及其临床意义

项目编号： No.30860088

项目类型： 地区科学基金项目

立项/批准年度： 2009

项目学科： 电工技术

项目作者： 梁志坚

作者单位： 广西医科大学

项目金额： 25万元

中文摘要： 目的：纹状体梗死后黑质发生的继发性损害是否参与血管性帕金森的发病过程尚不清楚。本研究采用常规磁共(MRI)和弥散张量（DTI）探讨纹状体梗死后黑质继发性损害的发生发展过程及其潜在意义。方法：连续收录初次发病、纹状体明显受累的脑梗死患者11例。招募年龄性别相匹配健康志愿者11名作对照研究。患者分别在发病的第1周（W1）、第4周和第12周（W12）进行常规MRI和DTI检测，以及美国国立卫生研究院卒中评分（NIHSS）、Barthel生活指数(Barthel Index, BI)评定，在W12对部分有类似于帕金森氏病症状的患者采用帕金森氏病综合评分量表（UPDRS）的第Ⅲ#20998;量表评价其严重程度。对照组于相同时间间隔进行DTI检测。结果：与对照组比较，患者梗死灶同侧黑质的平均弥散量（MD）在各个时间点均明显升高， 患者组而且随时间延长有逐步升高的趋势。有1例患者出现类似于帕金森氏病的症状，UPDRS的第Ⅲ#20998;量表评分为18分。结论：DTI可以检测到纹状体梗死后黑质继发性损害的程度及其发展过程；黑质的继发性损害可能参与血管性帕金森发病过程。

中文关键词： 脑梗死; 纹状体；黑质；继发性损害；弥散张量成像

英文摘要： The secondary degeneration in substantia nigra following a recently striatum infarct if or not playing a role in vascular parkinsonism remained unknown. This aim was to investigate the secondary degeneration in substantia nigra following a recently cerebral infarct involved striatum with diffusion tensor imaging(DTI), as well as its potential clinical significance. Methods: 11 patients with a focal cerebral infract at unilateral basal ganglia with striatum involved underwent DTI and evaluations with the NIH Stroke Scale (NIHSS) and the barthel index (BI) 3 times at the first week (W1), the fourth (W4) and twelfth week (W12) after stroke onset respectively. For those who had symptoms similar to Pakinson's disease, an evaluation was mad with the Ⅲubscale of UPDRS at W12. 11 gender and age match healthy volunteers underwent DTI three times at same time points. The DTI parameters of Mean diffusivity (MD) and fractional anisotropy (FA value) were measured at substantia nigra. The comparisons of DTI parameters between patient groud and controls were used t test, and the comprision of DTI parameters of patient group from the three time pionts were used competed data analysis of variance. Results: From W1 to W12, The patients' NIHSS decreased and BI increased gradually. Compared to the controls, the MD of ipsilateral substantia nigra in patients significantly increased at every time point repectively；and increased gradually from W1 to W12. There was a patient with symptoms similar to Pinkinson's disease, with 18 point evaluated by the Ⅲsubscale of UPDRS. Conclusions: DTI can detect the secondary degeneration in ipsilateral substantia nigra following a cerebral infarct with striatum involved. The secondary degeneration in ipsilateral substantia nigra may exist and progress at lest three months, and may be responsible for the symptoms of vascular parkinsonism.

英文关键词： cerebral infarction; striatum; substantia nigra; secondary degeneration; diffusion tensor imaging