目的:探讨路易体痴呆(DLB)和帕金森病(PD)早期至中期的黑质纹状体多巴胺能神经元变性的差异。
方法:使用3-Tesla神经黑色素敏感MRI和123I-FP-CIT多巴胺转运蛋白SPECT进行了综合神经影像学分析,以及三个变量的关系和侧向性,包括黑质(NRCSN)和蓝斑(NRCLC)中的神经黑色素相关对比以及纹状体中的特异性结合比(SBR),进行了详细的检查。纳入患有DLB和PD的患者和对照受试者(分别为n=29、52和18)。
结果:在DLB中观察到双侧半球SBR的下降明显大于PD。在使用Z评分调整神经黑色素相关MRI对比的半球间不对称性后,NRCSN和SBR之间的线性回归是针对半球受影响最大/受影响最小的侧进行的,如每个变量的半球间差异所定义的(SBR,NRCSN,标准化的[SBR+NRCSN])。在DLB中,最高的,尽管统计学上不显著,在基于SBR的系统中观察到相关性,受影响最大的一面。在警察局,在(SBR+NRCSN)基础上观察到最高的相关性,受影响最严重的一方,接近临床定义的值,受影响最大的一面。仅在基于(SBR+NRCSN)或临床定义的受影响最小的一面。
结论:在DLB中,体细胞和突触前末端的丢失可能独立发生,而突触前末端的减少很大。观察到的体细胞变性与突触前末端之间的密切关系表明,轴突变性可能在PD中占主导地位。
To investigate differences in nigrostriatal dopaminergic neuron degeneration between dementia with Lewy bodies (DLB) and Parkinson\'s disease (PD) in the early to intermediate stage of these diseases.
An integrative neuroimaging analysis was developed using 3-Tesla neuromelanin-sensitive MRI and 123I-FP-CIT dopamine transporter SPECT, and the relationship and laterality of three variables, including neuromelanin-related contrast in the substantia nigra (NRCSN) and locus coeruleus (NRCLC) and the specific binding ratio (SBR) in the striatum, were examined in detail. Patients with DLB and PD and control subjects (n = 29, 52, and 18, respectively) were enrolled.
A significantly greater decrease in the SBR in the bilateral hemispheres was observed in DLB than in PD. After adjusting for the interhemispheric asymmetry in neuromelanin-related MRI contrast by using the Z-score, linear regression between the NRCSN and SBR was performed for the most-affected/least-affected sides of the hemispheres as defined by the interhemispheric differences in each variable (SBR, NRCSN, standardized [SBR + NRCSN]). In DLB, the highest, albeit statistically non-significant, correlation was observed in the SBR-based, most-affected side. In PD, the highest correlation was observed in the (SBR + NRCSN)-based, most-affected side, which approximated the value of the clinically-defined, most-affected side. A non-significant correlation was observed only in the (SBR + NRCSN)-based or clinically-defined, least-affected side.
Loss of the soma and presynaptic terminals may occur independently in DLB with a large decrease in the presynaptic terminals. The close relationship observed between the degeneration of the soma and presynaptic terminals suggested that axon degeneration may dominate in PD.