| Objective:To investigate the changes of metabolites in bilateral midbrain,basal ganglia and frontal lobe of patients with early Parkinson’s disease(PD)under proton magnetic resonance spectroscopy(proton magnetic resonance spectroscopy),whether there is asymmetry consistent with symptoms,and to further analyze its correlation with clinical data,so as to find potential biomarkers for PD.To provide a scientific basis for the detection of early Parkinson’s disease.Methods:1.Thirty-three patients with early Parkinson’s disease diagnosed in The First Affiliated Hospital of Gannan Medical College from December 2020 to December 2022 were selected as the early PD group;During the same period,22 healthy people in The First Affiliated Hospital of Gannan Medical College were selected as the control group.The gender,age and years of education of all subjects were collected.History of hypertension and diabetes;Whether they had a history of smoking or drinking,Mini-mental State Examination(MMSE)was performed.2.The history of present illness,Unified Parkinson’s Disease Rating Scale(UPDRS)part Ⅲscore and Hoehn-Yahr stage were recorded.3.All patients underwent conventional MRI scan and 1H-MRS spectroscopy on a 3TMRI scanner after admission.The parameter maps were obtained by the own software,and the images were read by at least two radiologists using a double-blind method.The regions of interest in the bilateral substantia nigra,red nucleus,caudate nucleus,lenticular nucleus,thalamus and prefrontal lobe were symmetrically selected from the images and the relevant parameters were measured.The differences of related parameters of different metabolites in each region of interest between the early PD group and the control group were analyzed and compared.The correlation between metabolite parameters in different regions of interest and clinical symptoms of PD was analyzed.Results:1.In the nigra,the ratios of NAA/Cr,NAA/(Cho+Cr),NAA/ml,Cho/Cr in early PD group were significantly lower than those in control group(PNAA/Cr=0.017,PNAA/(Cho+Cr)<0.001,PNAA/ml<0.001,PCho/cr=0.042).The ratios of NAA/Cho and NAA/ml in the region of interest of red nucleus in early PD group were significantly lower than those in control group(PNAA/Cho=0.025,P NAA/ml=0.001).The ratios of NAA/Cr and NAA/(Cho+Cr)in the region of interest of the caudate nucleus in early PD group were significantly lower than those in the control group(PNAN/Cr=0.006,PNAA/(Cho+Cr)=0.022).The ratios of NAA/Cr in the region of interest of lenticular nucleus in PD group were significantly lower than that in control group(P=0.020).In the region of interest(ROI)of the prefrontal lobe,the Cho/Cr ratio of early PD group was significantly higher than that of the control group,and the difference was statistically significant(PCho/Cr=0.041).The ratios of NAA/Cr,NAA(Cho+Cr),Cho/Cr in the red nucleus,NAA/Cho,NAA/ml,Cho/Cr in the caudate nucleus,NAA/Cho,NAA/(Cho+Cr),NAA/ml,Cho/Cr in the lenticular nucleus,The ratios of NAA/Cho,NAA/Cr,NAA/(Cho+Cr),NAA/ml,Cho/Cr in the region of interest of thalamus,NAA/Cho,NAA/Cr,NAA/(Cho+Cr),NAA/ml in the region of interest of prefrontal lobe were not significantly different from those in the control group(P>0.05).2.In the substantia nigra region of interest,the ratios of NAA/Cr,NAA/(Cho+Cr),NAA/ml,and Cho/Cr in the affected side of early PD patients were significantly lower than those in the contralateral side(PNAA/Cr<0.001,PNAA/(Cho+Cr)=0.003,PNAA/ml=0.026,PCho/Cr=0.008).The Cho/Cr ratio in the region of interest of the red nucleus was significantly higher than that of the contralateral group(PCho/Cr=0.015).In the caudate nucleus,lenticular nucleus and thalamus,the NAA/Cr ratio of the affected side was lower than that of the contralateral group,and the NAA/ml of the caudate nucleus was significantly lower than that of the contralateral group,the diflferences were statistically significant(P caudate nucleusNAA/Cr=0.005,Pleticular nucleusNAA/Cr=0.002,P thalamusNAA/Cr=0.033;Plenticular nucleusNAA/ml=0.005);In the region of interest(ROI)of the prefrontal lobe,Cho/Cr on the affected side of early PD was significantly higher than that on the contralateral side(P=0.001).But NAA/Cho,NAA/Cr,NAA/(Cho+Cr),NAA/ml in bilateral red nucleus,NAA/Cho,NAA/(Cho+Cr),Cho/Cr in bilateral caudate nucleus,NAA/Cho,NAA/ml,Cho/Cr in bilateral lenticular nucleus,NAA/Cho,NAA/(Cho+Cr),NAA/mL,Cho/Cr in bilateral lenticular nucleus.There were no significant differences in NAA/Cho,NAA/(Cho+Cr),NAA/ml,Cho/Cr in bilateral thalamus and NAA/Cho,NAA/Cr,NAA/(Cho+Cr),NAA/ml in bilateral prefrontal lobe(P>0.05).In the control group,there was no significant difference in the metabolites related parameters of bilateral substantia nigra,red nucleus,caudate nucleus,lenticular nucleus,thalamus and prefrontal region of interest(P>0.05).3.The MRS Results of metabolites in the region of interest on the affected side with statistical differences in patients with different grades of early PD were compared.The ratios of NAA/Cr,NAA/(Cho+Cr),NAA/ml in the substantia nigra and NAA/Cr in the thalamus were significantly different(Psubstantia nigra NAA/Cr=0.001,Psubstantia nigra NAA/(Cho+Cr)<0.001,Psubstantia nigra NAA/ml=0.002,Pthalmus NAA/Cr=0.008,Pprefrontal NAA/Cr=0.003)4.The correlation between the metabolite MRS Results of substantia nigra,red nucleus,lenticular nucleus,thalamus,caudate nucleus,prefrontal region of interest and UPDRS part Ⅲ score,and the correlation between the significant MRS Results of prefrontal region of interest and MMSE score were analyzed.The results showed that in the nigra,the ratio of NAA/Cr on the affected side was highly negatively correlated with UPDRS part Ⅲ score,and the ratio of NAA/(Cho+Cr)on the affected side was highly negatively correlated with UPDRS part Ⅲ score.Bilateral NAA/Cho,NAA/ml,The ratios of NAA/Cr and NAA/(Cho+Cr)on the contralateral side were moderately negatively correlated with the UPDRS part Ⅲ score,and the ratios of Cho/Cr on the affected side were low negatively correlated with the UPDRS part Ⅲ score,and the correlations were statistically significant(PAnterior substantia nigra NAA/Cr<0.001,PAntarior substantia nigra NAA/(Cho+Cr)=0.001,PAnterior substantia nigra NAA/Cho=0.005,PContralatemal subslantia nigra NAA/Cho=-0.002,PAnerio substantia nigra NAA/ml=0.002,PContralateral substantia nigra NAA/ml=0.008,PContralateral substantia vigra NAA/Cr=0.010,Contralateral substantia nigra NAA/(Cho+Cr)=0.002,PContralateral substania nigra Cho/Cr=0.041).In the region of interest of the red nucleus,there was a negative correlation between NAA/ml and low degree(PNAA/ml=0.039).In the region of interest of the caudate nucleus,the bilateral NAA/Cr ratio was negatively correlated with UPDRS part Ⅲ score,and the correlation was statistically significant(PAnterior caudate nucleus NAA/Cr=0.011,PCaudate check side NAA/Cr=0.002).In the region of interest(ROI)of the prefrontal lobe,the Cho/Cr ratio of the prefrontal lobe on the affected side was moderately negatively correlated with the UPDRS part Ⅲ score,and the correlation was statistically significant(Pcho/Cr=0.003).The ratio of Cho/Cr in the ipsilateral prefrontal lobe was negatively correlated with MMSE score at moderate intensity(PStating side=0.005),and the ratio of Cho/Cr in the contralateral prefrontal lobe was negatively correlated with MMSE score at low intensity(Pcontralateral=0.044).There was no correlation between the ratio of Cho/Cr in the contralateral substantia nigra,the ratio of NAA/ml in the lateral red nucleus,the ratio of Cho/Cr in the bilateral red nucleus,the ratio of NAA/(Cho+Cr)in the bilateral caudate nucleus,the ratio of NAA/Cr in the bilateral lenticular nucleus,the ratio of Cho/Cr in the contralateral prefrontal lobe and the UPDRS part Ⅲ score(P>0.05).Conclusion:1.The ratios of NAA/Cr,NAA/(Cho+Cr),NAA/ml,Cho/Cr in substantia nigra,NAA/Cho,NAA/ml in red nucleus,NAA/Cr,NAA/(Cho+Cr)in caudate nucleus and NAA/Cr in lenticular nucleus decreased.The increased Cho/Cr ratio in the prefrontal lobe may be useful for early detection of PD patients with atypical symptoms.2.The asymmetry of MRS Results of bilateral metabolites in early PD patients is consistent with the asymmetry of clinical symptoms in PD patients.3.There were significant differences in NAA/Cr,NAA/(Cho+Cr),NAA/ml in the substantia nigra and NAA/Cr in the thalamus between the groups with different H-Y grades in the early stage of PD,indicating that there were also significant differences in the degree of neuronal dysfunction among different grades in the early stage of PD.4.The ratios of NAA/Cr and NAA/(Cho+Cr)in SN and caudate nucleus of PD patients were highly negatively correlated with UPDRS part Ⅲ score.The ratio of Cho/Cr in frontal lobe was negatively correlated with MMSE score in PD patients.The changes of intracranial metabolites in early PD patients are related to the severity of clinical symptoms,and the increase of Cho/Cr ratio in the frontal lobe has a suggestive significance for the risk of dementia in PD patients.5.To detect and analyze the metabolites in substantia nigra,red nucleus,striatum and prefrontal lobe of suspected PD patients in vitro by 1H-MRS technology,calculate the ratio,and compare the results of metabolites MRS Detection,so as to provide objective imaging indicators for early detection of Parkinson’s disease,individualized evaluation and early intervention. |
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