The Study Of Hemo-biological Indices And Cerebral Metabolism PET In Patients With Parkinson's Disease

Objective:To analyze the epidemiology of Parkinson's disease?PD?in the Grade?A hospital.To analyze the correlation between the blood homocysteine,?-amyloid 1-42,?-synuclein,cystatin C and Parkinson's disease.To discuss the diagnostic evaluation value of ¹⁸F-FDG PET,¹¹C-CFT PET and ¹¹C-Raclopride PET brain imaging in Parkinson's disease.Methods:?1?Participants were 2427 individuals diagnosed with idiopathic PD for the first time in our hospital from 2002 to 2017.Statistical analysis:we analysed the basic information of the above patients with general statistical methods,and forecasted the incidence of PD in the future with Autoregressive Integrated Moving Average Model?ARIMA?and GM?1,1?model.?2?261 PD patients and 238 healthy controls were measured blood homocysteine and?-synuclein,serum?-amyloid 1-42 and cystatin C.The participants were divided into groups according to H&Y staging,Mo CA scores,gender difference and ethnic difference.And they were compared with each other.Drew the receiver-operating characteristic curve?ROC curve?,and calculated the area under curve?AUC?of biological indicators in diagnosing Parkinson's disease and its 95%confidence interval,critical value,sensitivity and specificity.Analyzed the correlation between the level of plasma Hcy and?-Syn,serum A?1-42 and Cys C levels,and motor symptoms or non-motor symptoms of Parkinson's disease with Spearman rank correlation analysis and Pearson correlation analysis.Analyzed the risk factors of PD patients,the risk factors of cognitive impairment and the risk factors of advanced PD with multivariate Logistic regression.?3?117 PD patients underwent ¹⁸F-FDG PET brain scan,83 PD patients underwent ¹¹C-?-CFT PET brain scan,and 18 PD patients underwent ¹¹C-Raclopride PET brain scan.We processed the¹⁸F-FDG PET images with SPM software to analyse the part of cerebral glucose metabolism difference in healthy controls and PD patients,which were divided into groups according to H&Y staging and MoCA scores.With region of interest?ROI?we measured the mean radio counting in caudate nucleus,anterior putamin,middle putamin and posterior putamin of PD patients and controls.The retio of ROI-CB/CB was used as representing the intake index of ¹¹C-?-CFT and ¹¹C-Raclopride.Compared and analyzed the uptake index of PD patients and controls according to different H&Y staging,age of disease onset and Mo CA scores.Analyzed the connection between uptake index of¹¹C-?-CFT or ¹¹C-Raclopride and motor symptoms of PD with Spearman rank correlation analysis and Pearson correlation analysis.Results:?1?Among the 2,427 PD patients,57.7%were males and 42.3%were females.The early-onset PD proportion was 8.86%,and the late-onset PD proportion was 91.14%.The number of retired people was 1316,accounting for 54.22%.The han population was the largest,followed by uyghur,kazak,hui,etc.The ARIMA?1,1,2?and GM?1,1?model of Parkinson's disease in the Grade?A hospital was successfully established,with high fitting precision and good forecasting performance.?2?There was a statistical difference in plasma Hcy,?-synuclein,serum Cys C and A?1-42 levels between PD groups and controls?P<0.05?.Hcy,?-synuclein and Cys C levels were higher than controls,while A?1-42 levels were lower than contrasts.The ROC analysis showed that plasma Hcy levels for diagnose of PD with an area under the ROC curve=0.694?95%CI:0.648⁰.740,P<0.001?,with72.8%diagnostic sensitivity and 57.6 diagnostic specificity.The ROC analysis showed that plasma?-synuclein levels for diagnose of PD with an area under the ROC curve=0.617?95%CI:0.566⁰.740,P<0.001?,with 55.6%diagnostic sensitivity and70.8%diagnostic specificity.The ROC analysis showed that serum Cys C levels for diagnose of PD with an area under the ROC curve=0.706?95%CI:0.661⁰.751,P<0.001?,with 70.1%diagnostic sensitivity and 60.5%diagnostic specificity.There were statistical differences in plasma Hcy and serum Cys C levels between advanced PD and ealy PD,the former was higher than the latter?P<0.05?.There was difference in serum Cys C levels between PD-MCI group,PDD group and PD-NC group,the former is higher than the latter?P<0.05?.There was statistical difference in serum Cys C and A?1-42 levels between han PD group and ughur PD group?P<0.05?.There were statistical differences in plasma Hcy,serum Cys C and serum A?1-42 levels between male and female?P<0.05?.The study showed that there was a positive correlation between plasma Hcy levels and UPDRS,UPDRSI,UPDRSII,UPDRSIII,UPDRSIV and UPDRSV scores.There was a positive correlation between serum?-Syn levels and UPDRS,UPDRSI,UPDRSII,UPDRSIII,UPDRSIV and UPDRSV scores.There was a positive correlation between serum Cys C levels and UPDRS,UPDRSII and UPDRSV scores.There was a negative correlation between serum?-Syn levels and visual spatial execution,language ability,abstract thinking and directional ability.There was a negative correlation between serum Cys C and MoCA scores,visual spatial execution,attention.delayed recall and orientation.There was a negative correlation between serum A?1-42and naming skills?P<0.05?.Multivariate Logistic regression showed that high level of plasma Hcy and high level of Cys C were risk factors of PD in occuring and aggravating.Advanced age and high level of Cys C were the risk factors of cognitive dysfunction.Serum A?1-42 was protective factor of PD.?3?¹⁸F-FDG PET brain imaging shows that there was dramatic difference in the part of cerebral glucose metabolism between healthy controls and PD group.?P<0.001?.The metabolism in partial premotor area,parietal lobe,left occipital lobe and posterior lobe of cerebellum was reduced,while the metabolism in bilatera putamen,thalamus,parahippocampal gyrus,right anterior central gyrus and posterior central gyrus was incrased compared to healthy controls in early PD group.The metabolism in premotor area,parietal lobe,bilateral occipital lobe and caudate nucleus was reduced,while the metabolism in bilateral putamen,thalamus,marginal lobe,inferior frontal gyrus,bilateral parietal lobule,right posterior central gyrus and left anterior lobe of cerebellum was incrased compared to healthy controls in advanced PD.In the PD-NC group compared to healthy controls,the metabolism in local parietal lobe,left occipital lobe,bilateral posterior lobe of cerebellum was reduced,while the metabolism in bilateral partial motor anterior,middle temporal gyrus,hippocampus/parahippocampal gyrus,right occipital lobe,bilateral thalamus and putamen was increased.In the PD-MCI group,the metabolism in partial premotor area,motor area,superior temporal gyrus,middle temporal gyrus,parietal lobe and occipital lobe,left thalamus?intraperitoneal nucleus?,caudate nucleus and bilateral cerebellar posterior lobe was reduced,while the metabolism in bilateral parietal lobules,posterior central gyrus,hippocampus/parahippocampal gyrus,bilateral cingulate gyrus was increased.In the PDD group,the metabolism in bilateral premotor area,left anterior central gyrus,partial parietal lobe,left occipital lobe,bilateral cingulate gyrus,caudate nucleus,thalamus?intraperitoneal nucleus?,posterior lobe of cerebellum was reduced,while the metabolism in bilateral parietal lobules,right hippocampus/left parahippocampal gyrus and right posterior central gyrus was incresed.¹¹C-?-CFT PET showed that uptake of ¹¹C-CFT was reduced in bilateral caudatum,fronterior putamen,middle putamen and posterior putamen successively,especially in the middle and posterior of the putamen in comparision with normal controls?P<0.001?.Uptake index of ¹¹C-CFT in posterior of the putamen was different between early PD group and advanced PD group?P<0.05?.There was no difference in the bilateral caudatum,fronterior putamen and middle putamen?P>0.05?.In early PD,there was obvious difference of uptake index of ¹¹C-CFT in fronterior,middile and posteria putamen between different site of onset symptoms?P<0.05?.It was evidently different in lateralized PD patients that the uptake index of ¹¹C-CFT in middile and posterior putamen?P<0.05?.In advanced PD,there were obvious differences of uptake index of¹¹C-CFT in posterior putamen between different site of onset symptoms?P<0.05?.There was no difference between YOPD and LOPD groups of uptake index of ¹¹C-CFT in putamen and caudatum?P>0.05?.There was no connection between uptake index of¹¹C-CFT in putamen and caudatum and UPDRSIII,static tremor,rigidity and bradykinesia?P>0.05?.There was negative correlation between rigidity scores and uptake index of ¹¹C-CFT in froterior and middle putamen?P<0.05?.There was negative correlation between index of ¹¹C-CFT in middle putamen and bradykinasia scores?r=-0.499,P=0.049?.¹¹C-Raclopride PET brain imaging indicated that uptake index of¹¹C-Raclopride was increased inordinately in caudatum,fronterior putamen,middle putamen and posterior putamen,especially in middle and posterior putamen.In comparision with healthy controls,uptake index of ¹¹C-Raclopride in middle and posterior putamen was increased distinctly in early PD group?P<0.05?.Conclusion:?1?The number of PD in the Grade?A hospital was high among the populations above the50 years old?91.14%?,male was more than female.ARIMA model and GM?1,1?model could predict the number of PD patients of every month and every year in the future on the hospital.?2?Plasma Hcy,?-Syn and serum A?1-42,Cys C are helpful for the diagnosis of PD.Plasma Hcy and?-Syn could be as the evaluation index of severity of the disease.Serum A?1-42,Cys C and plasma?-Syn might be related to the cognitve impairment of PD.Serum Cys C could be as an assesmment index of different level of cognitive dysfunction.There was difference in serum A?1-42 levels between han PD group and uyghur PD group,which implies the race difference of PD.?3?¹⁸F-FDG PET brain imaging is helpful for the diagnosis of PD,which may assess the severity of disease comprehensively,and also reflect the extenct of cognitive impairment of PD objectively.¹¹C-?-CFT PET brain imaging has the definite diagnostic value for PD,espetially the early diagnostic value.11C-?-CFT PET brain imaging showed that the damage was from posterior putamin,medium putamin,froterior putamin to caudate nucleus.Rigidity and bradykinesia was related to putamen,tremor was not related to caudate nucleus and putamen,and motor symptoms were not related to caudate nucleus.¹¹C-Raclopride PET brain imaging is possibly helpful for the early diagnosis of PD,which showed that dopamine D2 receptor in putamen had the up-regulation trend.