帕金森病躯干姿势异常神经网络演化机制的多模态磁共振成像研究

Postural deformities are frequent and disabling complications of Parkinson’s disease(PD). The pathophysiology of postural deformities is not well understood. More and more evidences showed that the specific micro gray matter and white matter and neural network may play an important role in the regulation of posture in PD patients. The current study will include PD patients with camptocormia, antecollis, Pisa syndrome, and scoliosis, and gender, age matched healthy controls. Motor disability matched PD patients without postural deformities will also include in. The differences in gray and white matter as well as neural network changes between PD patients with and without postural deformities and healthy controls will be explored. The associations between the potential changes in neural network and severity of postural deformities will also studied. We will also study the changes of abnormal neural network occurred in PD patients with postural deformities in a 24-months follow up. The outcome of the study may provide more evidences on developing new targets for therapeutic approach of postural deformities.

躯干姿势异常是帕金森病（Parkinson’s disease, PD）十分常见并且严重致残的运动症状，其确切的病理生理机制尚不明确，多巴胺能药物和脑深部电刺激疗法对其改善十分有限。既往大量的结构和功能MRI研究发现脑微观结构异常及神经网络功能改变在PD姿势步态的维持和调控中发挥重要作用，可能是促进PD躯干姿势异常发生和进展的关键环节。本课题创新性的纳入不同类型躯干姿势异常的PD患者（躯干前屈组、颈项前屈组、Pisa综合征组及脊柱侧弯畸形组），并纳入运动残疾与其相匹配的不伴躯干姿势异常的PD患者、健康对照者等进行多模态MRI扫描,深入探讨这些躯干姿势异常相关的脑灰质萎缩、脑白质纤维束结构异常和神经网络功能连接改变, 通过纵向随访，探讨这些异常改变随躯干姿势异常进展的演化规律。本研究有望发现调控PD躯干姿势异常发生和进展的特异性影像学生物标记物，为开发有效的干预靶点提供理论依据。

帕金森病（Parkinson’s disease, PD）患者合并躯干姿势异常的处理非常困难，本课题纳入不同类型躯干姿势异常的PD患者，并纳入运动残疾与其相匹配的不伴躯干姿势异常的PD患者、健康对照者等进行多模态MRI扫描，发现伴躯干姿势异常的PD患者与不伴姿势异常的PD患者相比，多处脑功能连接异常改变，如基底节区功能连接（双侧壳核、尾状核、丘脑）以及小脑与丘脑功能连接增强；其尾状核-前额叶环路和默认网络模式功能连接减弱。而躯干前屈PD患者和不伴躯干姿势异常的PD患者相比，右侧丘脑与颞叶功能连接减弱，Pisa综合征的PD患者与健康对照相比，双侧丘脑的功能连接增强。提示基底节区功能连接增强可能是对躯干姿势异常的一种代偿性反应，而尾状核-前额叶环路、基底节-皮层环路功能连接可能在PD躯干姿势的调节中发挥重要作用。这些研究结果对开发改善PD患者严重躯干姿势异常的新疗法提供了新的视角。