贵州医科大学学报

目的 探讨早发型及晚发型早中期帕金森病(PD)患者的颅脑超声(TCS)特征差异。方法 选取确诊为PD且Hoehn-Yahr(H-Y)分期为1.0～3.0期的患者为PD组(n=66),同期健康体检者为对照组(n=64),并以50岁为界将PD组患者分为早发型组(≤50岁，n=30)和晚发型组(>50岁，n=36);收集各组患者一般资料包括年龄、性别、病程等，比较各组患者黑质强回声面积、第三脑室宽度、双侧大脑中动脉(MCA)流速及阻力指数(RI)的差异性，Spearman检验分析黑质强回声分级和面积与性别、年龄、病程、H-Y分期、第三脑室宽度、MCA流速和RI的相关性。结果 PD组患者第三脑室宽度更宽、黑质强回声面积及强回声面积与中脑面积比值(S/M)高于对照组，右侧MCA收缩期与舒张期血流速度及左侧MCA RI值低于对照组(P<0.05);PD组患者性别、年龄、病程与黑质强回声分级呈正相关(r=0.274、0.280、0.262,P<0.05)、与黑质强回声面积呈正相关(r=0.330、0.344、0.332,P<0.05);第三脑室宽度、右侧MCA RI与黑质强回声面积呈正相关(r=0.259、0.256;P<0.05);右侧MCA舒张期血流速度与黑质强回声面积呈负相关(r=-0.246,P<0.05);晚发型组患者第三脑室宽度、强回声面积、S/M高于早发型组，双侧MCA的RI更高，左侧MCA的舒张期流速更低(P<0.05);多因素分析结果显示第三脑室宽度和左侧MCA RI是影响PD患者发病早晚的独立危险因素。结论 与早发型PD比较，晚发型PD的第三脑室更宽，黑质强回声分级级别更高，MCA血流速度更低，RI更高，可以更好地用于PD的筛查。

Objective To explore the differences in transcranial sonographic(TCS) features between early-onset and late-onset patients with early to mid-stage Parkinson's disease(PD). Methods Patients diagnosed with PD and with Hoehn-Yahr(H-Y) stage 1.0-3.0 were selected as the PD group(n=66). Healthy individuals undergoing physical examination were selected as the control group(n=64). The PD group was further divided into the early-onset group(≤50 years, n=30) and the late-onset group(>50 years, n=36) based on the 50-year-old boundary. General information of each group, including age, gender, and disease duration, was collected. Differences in the areas of the substantia nigra strong echo, the width of the third ventricle, the flow velocity and resistance index(RI) of the bilateral middle cerebral arteries(MCA) were compared between the groups. Spearman test was used to analyze the correlations between the grades and areas of the substantia nigra strong echo and gender, age, disease duration, H-Y stage, width of the third ventricle, MCA flow velocity, and RI. Results The third ventricle width in the PD group was wider, and the areas of the substantia nigra with strong echoes and the ratio of the strong echo area to the midbrain area(S/M) were higher than those in the control group. The systolic and diastolic blood flow velocities of the right MCA and the RI value of the left MCA in the PD group were lower than those in the control group(P<0.05). Gender, age, and disease duration of patients in the PD group were positively correlated with the grade of hyperintense signal in the substantia nigra(r=0.274, r=0.280, and r=0.262, respectively, all P<0.05), and positively correlated with the area of hyperintense signal in the substantia nigra(r=0.330, r=0.344, and r=0.332, respectively, all P<0.05). The width of the third ventricle, and the right MCA RI were positively correlated with the area of hyperintense signal in the substantia nigra(r=0.259 and r=0.256, respectively, all P<0.05). The diastolic blood flow velocity of the right MCA and the area of the strong echo in the substantia nigra were negatively correlated(r=-0.246, P<0.05). The third ventricle width, the strong echo area, and S/M in the late-onset group were higher than those in the early-onset group, and the RI of the bilateral MCA was higher, while the diastolic flow velocity of the left MCA was lower(P<0.05). The multivariate analysis results showed that the third ventricle width and the RI of the left MCA were independent risk factors for the early or late onset of PD. Conclusion Compared with early-onset PD, the third ventricle in late-onset PD is wider, the grade of the dark matter hypoechoic area is higher, the blood flow velocity of the MCA is lower, and the RI is higher. This makes it more suitable for the screening of PD.