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Article(id=1322210872861249718, tenantId=1146029695717560320, journalId=1319373162502258839, issueId=1322210840242139234, articleNumber=null, orderNo=null, doi=10.16016/j.2097-0927.202409094, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1726156800000, receivedDateStr=2024-09-13, revisedDate=1739462400000, revisedDateStr=2025-02-14, acceptedDate=null, acceptedDateStr=null, onlineDate=1793169237580, onlineDateStr=2026-10-28, pubDate=1744646400000, pubDateStr=2025-04-15, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1793169237580, onlineIssueDateStr=2026-10-28, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1793169237580, creator=13701087609, updateTime=1793169237580, updator=13701087609, issue=Issue{id=1322210840242139234, tenantId=1146029695717560320, journalId=1319373162502258839, year='2025', volume='47', issue='7', pageStart='629', pageEnd='748', issueExtLink='null', onlineDate='null', pubDate='1744646400000', pubDateStr='2025-04-15', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1793169229803, creator='13701087609', updateTime=1793325214855, updator='13701087609', preIssue=null, nextIssue=null, articleTotal=null, ext={EN=IssueExt(id=1322865089049383299, tenantId=1146029695717560320, journalId=1319373162502258839, issueId=1322210840242139234, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1322865089049383300, tenantId=1146029695717560320, journalId=1319373162502258839, issueId=1322210840242139234, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null, downloadFileDto=null}, startPage=649, endPage=655, ext={EN=ArticleExt(id=1322210873054187703, articleId=1322210872861249718, tenantId=1146029695717560320, journalId=1319373162502258839, language=EN, title=Correlation between change in choroid plexus volume and cognitive function in patients with Parkinson’s disease, columnId=1320435149808980440, journalTitle=Journal of Army Medical University, columnName=Neuroscience, runingTitle=null, highlight=null, articleAbstract=
Objective‍

To investigate the change in choroid plexus (CP) volume in Parkinson’s disease (PD) patients with different cognitive states and its correlation with structural volumes of other brain regions.

Methods‍

A cross-sectional study was conducted on 48 PD patients admitted in Department of Neurosurgery of the First Affiliated Hospital of Army Medical University between May 2023 and April 2024, and on 35 healthy controls (HC) recruited through a physical exam center. According to the results of Mini-Mental State Examination (MMSE), the patients were divided into PD with cognitive impairment (PD-CI) group (n=27) and PD with normal cognitive function (PD-NC) group (n=21). 3.0T magnetic resonance imaging (MRI) was performed using MPRAGE sequences, and CP volume and volumes of other brain regions were obtained using FreeSurfer 6.0 software. The CP volume was adjusted by calculating the ratio of its volume to estimated total intracranial volume (eTIV). After controlling for confounders, partial correlation analysis was used to assess the relationship between the CPV/eTIV ratio and the volumes of other brain regions as well as cognitive scale scores. Additionally, multiple linear regression analysis was performed to further explore the relationship between CPV and cognitive function in the PD-CI group.

Results‍

Compared to the HC group, the CPV in the PD-CI group was significantly larger (P=0.029). In the PD-CI group, the CPV/eTIV ratio showed significant positive correlations with the volume of the lateral ventricles (r=0.689, P=0.001), the volume of the third ventricle (r=0.592, P=0.006), the volume of cerebrospinal fluid (CSF) (r=0.508, P=0.022), and white matter hyperintensities (WMH) (r=0.486, P=0.030), but was negatively correlated with the volume of the caudate nucleus (r=-0.530, P=0.016), the volume of the thalamus (r=-0.477, P=0.033), and the MMSE scores (r=-0.483, P=0.031). But in the PD-NC group, the CPV/eTIV ratio was only positively correlated with CSF volume (r=0.571, P=0.021). Multiple linear regression analysis indicated that the CPV/eTIV ratio and MMSE scores remained significantly negatively correlated in the PD-CI group (β=-0.388, P=0.046).

Conclusion‍

Cognitive impairment in PD patients may be closely associated with the change in CP volume, suggesting that the volume can serve as a potential imaging marker in assessment of cognitive impairment in PD patients.

, authors=Suyi ZHOU1, Zhiming ZHEN1, Huilin PANG1, Zhi LIU2, Yanhui LIU3, Wei CHEN4, Wei CHEN1, authorsList=Suyi ZHOU, Zhiming ZHEN, Huilin PANG, Zhi LIU, Yanhui LIU, Wei CHEN, Wei CHEN, authorCompany=null, correspAuthors=Wei CHEN, authorNote=null, correspAuthorsNote=null, copyrightStatement=© 2025 Journal of Army Medical University, copyrightOwner=Editorial Office of Journal of Army Medical University, extLink=null, articleAbsUrl=null, sourceXml=null, magXml=null, pdfUrl=null, pdf=null, pdfFileSize=null, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=null, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=null, mapNumber=null, fund=null), CN=ArticleExt(id=1322210873658167482, articleId=1322210872861249718, tenantId=1146029695717560320, journalId=1319373162502258839, language=CN, title=帕金森病患者脉络丛体积改变与认知功能的相关性研究, columnId=1322185530771619910, journalTitle=陆军军医大学学报, columnName=神经科学, runingTitle=null, highlight=null, articleAbstract=
目的

探讨帕金森病（Parkinson’s disease，PD）患者不同认知状态下脉络丛（choroid plexus，CP）体积变化及其与其他脑区结构体积的相关性。

方法

本研究为横断面研究，纳入2023年5月至2024年4月期间就诊于陆军军医大学第一附属医院神经外科的48例PD患者及从健康体检中心招募的35例健康对照（healthy controls，HC），基于简易精神状态检查量表（Mini-Mental State Examination，MMSE）评估结果，将PD患者分为帕金森病伴认知功能障碍组（Parkinson’s disease with cognitive impairment，PD-CI）27例和帕金森病认知功能正常组（Parkinson’s disease with normal cognitive function，PD-NC）21例。采用3.0T磁共振成像（magnetic resonance imaging，MRI）进行MPRAGE序列扫描，并使用FreeSurfer 6.0软件获得脉络丛体积（choroid plexus volume，CPV）与其他脑区结构的体积。对CPV进行校正，计算其与估算的总颅内体积（estimated total intracranial volume，eTIV）的比值。调整混杂因素后，通过偏相关分析评估CPV/eTIV比值与其他脑区结构体积及认知量表评分之间的关系。使用多元线性回归分析进一步探究PD-CI组中CPV与认知功能之间的关系。

结果

与HC组相比，PD-CI组的CPV显著增大（P=0.029）。PD-CI组中，CPV/eTIV比值与侧脑室体积（r=0.689，P=0.001）、第三脑室体积（r=0.592，P=0.006）、脑脊液（cerebrospinal fluid，CSF）体积（r=0.508，P=0.022）、脑白质高信号（white matter hyperintensities，WMH）体积（r=0.486， P=0.030）呈显著正相关，同时与尾状核体积（r=-0.530，P=0.016）、丘脑体积（r=-0.477，P=0.033）及MMSE评分呈显著负相关（r=-0.483，P=0.031）。而PD-NC组中，CPV/eTIV比值仅与CSF体积（r=0.571，P=0.021）呈显著正相关；在PD-CI组中，CPV/eTIV比值与MMSE评分行多元线性回归分析，结果显示两者仍呈显著负相关（β=-0.388，P=0.046）。

结论

PD患者的认知功能障碍可能与CPV变化密切相关，提示CPV可作为评估PD认知损伤的潜在影像学标志物。

, authors=周素伊1, 甄志铭1, 庞慧琳1, 刘智2, 刘艳辉3, 陈炜4, 陈伟1, authorsList=周素伊, 甄志铭, 庞慧琳, 刘智, 刘艳辉, 陈炜, 陈伟, authorCompany=null, correspAuthors=陈伟, authorNote=null, correspAuthorsNote=
陈 伟，E-mail：
CHEN Wei，E-mail：
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J Neuroinflamm，2022，19（1）：163., articleTitle=NLRP3 inflammasome-mediated choroid plexus hypersecretion contributes to Hydrocephalus after intraventricular hemorrhage via phosphorylated NKCC1 channels, refAbstract=null)], funds=null, companyList=[AuthorCompany(id=1322210873914020027, tenantId=1146029695717560320, journalId=1319373162502258839, articleId=1322210872861249718, xref=1, ext=[AuthorCompanyExt(id=1322210873922408636, tenantId=1146029695717560320, journalId=1319373162502258839, articleId=1322210872861249718, companyId=1322210873914020027, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=1Department of Radiology，), AuthorCompanyExt(id=1322210873930797245, tenantId=1146029695717560320, journalId=1319373162502258839, articleId=1322210872861249718, companyId=1322210873914020027, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=1陆军军医大学（第三军医大学）第一附属医院：放射科，重庆)]), AuthorCompany(id=1322210873993711806, tenantId=1146029695717560320, journalId=1319373162502258839, articleId=1322210872861249718, xref=2, ext=[AuthorCompanyExt(id=1322210874006294719, tenantId=1146029695717560320, journalId=1319373162502258839, articleId=1322210872861249718, companyId=1322210873993711806, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=2Department of Neurosurgery，First Affiliated Hospital，Army Medical University （Third Military Medical University），Chongqing), AuthorCompanyExt(id=1322210874048237760, tenantId=1146029695717560320, journalId=1319373162502258839, articleId=1322210872861249718, companyId=1322210873993711806, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=2陆军军医大学（第三军医大学）第一附属医院：神经外科，重庆)]), AuthorCompany(id=1322210874123735233, tenantId=1146029695717560320, journalId=1319373162502258839, articleId=1322210872861249718, xref=3, ext=[AuthorCompanyExt(id=1322210874132123842, tenantId=1146029695717560320, journalId=1319373162502258839, articleId=1322210872861249718, companyId=1322210874123735233, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=3Department of Neurosurgery，West China Hospital，Sichuan University，Chengdu，Sichuan), AuthorCompanyExt(id=1322210874140512451, tenantId=1146029695717560320, journalId=1319373162502258839, articleId=1322210872861249718, companyId=1322210874123735233, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=3四川大学华西医院神经外科，四川成都)]), AuthorCompany(id=1322210874211815620, tenantId=1146029695717560320, journalId=1319373162502258839, articleId=1322210872861249718, xref=4, ext=[AuthorCompanyExt(id=1322210874224398533, tenantId=1146029695717560320, journalId=1319373162502258839, articleId=1322210872861249718, companyId=1322210874211815620, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=4Guangzhou Branch of Siemens Healthineers Ltd，Guangzhou，Guangdong，China), AuthorCompanyExt(id=1322210874232787142, tenantId=1146029695717560320, journalId=1319373162502258839, articleId=1322210872861249718, companyId=1322210874211815620, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=4西门子数字医疗科技（上海）有限公司广州分公司，广东广州)])], figs=[ArticleFig(id=1322210886253662451, tenantId=1146029695717560320, journalId=1319373162502258839, articleId=1322210872861249718, language=EN, label=null, caption=null, figureFileSmall=39IcYwI/8FVLffh3bvVbBQ==, figureFileBig=6L03aZHIg3xwqfxvu16M1w==, tableContent=null), ArticleFig(id=1322210886631149812, tenantId=1146029695717560320, journalId=1319373162502258839, articleId=1322210872861249718, language=CN, label=图1, caption=PD-CI组（A）与HC组（B）相关性脑区示意图, figureFileSmall=39IcYwI/8FVLffh3bvVbBQ==, figureFileBig=6L03aZHIg3xwqfxvu16M1w==, tableContent=null), ArticleFig(id=1322210887054774517, tenantId=1146029695717560320, journalId=1319373162502258839, articleId=1322210872861249718, language=EN, label=null, caption=null, figureFileSmall=null, figureFileBig=null, tableContent=
指标HC组（n=35）PD-NC组（n=21）PD-CI组（n=27）F/H/χ2/t值P值校正后P值
HC vs PD-NCHC vs PD-CIPD-NC vs PD-CI
年龄/岁62.77±5.1261.24±5.6464.19±8.681.0620.3540.6780.8400.413
性别1.7690.4130.720>0.9990.690
男性16（45.70）13（61.90）12（44.40）-----
女性19（54.30）8（38.10）15（55.60）-----
病程/年-6.62±5.235.85±5.050.4950.623---
受教育年限/年14.0（11，15）9.0（9.0，13.5）7.0（6，9）32.902<0.0010.083<0.0010.009
H-Y 分期-2.41±1.132.54±1.07-0.5320.599---
MMSE评分30.00（29.00，30.00）29.00（28.00，30.00）23.00（19.00，24.00）58.970<0.0010.488<0.001<0.001
CPV/mL1.29±0.291.47±0.381.64±0.624.5460.0160.1930.0290.602
CPV/eTIV/×10-30.90±0.181.00±0.191.12±0.374.0260.0250.3810.0290.304
侧脑室/eTIV/×10-313.88±3.7417.55±6.8918.28±7.855.2570.0100.0950.0330.981
第三脑室/eTIV/×10-30.88±0.211.00±0.321.26±0.448.1060.0010.4140.0010.067
CSF/eTIV/×10-30.74±0.130.80±0.190.92±0.159.863<0.0010.475<0.0010.039
WMH/eTIV/×10-31.10±0.751.34±0.691.63±0.684.1910.0190.7280.0150.468
尾状核/eTIV/×10-34.71±0.444.38±0.544.27±0.457.3920.0010.0420.001>0.999
丘脑/eTIV/×10-310.21±0.879.56±0.969.56±1.014.6800.0120.0480.290>0.999
eTIV/mL1 416.71±121.521 482.41±158.941 451.2±128.711.6240.2040.2390.956>0.999
), ArticleFig(id=1322210887402901750, tenantId=1146029695717560320, journalId=1319373162502258839, articleId=1322210872861249718, language=CN, label=表1, caption=

PD组与HC组一般资料情况比较［x¯±s，例（％），M（P25，P75）］

, figureFileSmall=null, figureFileBig=null, tableContent=
指标HC组（n=35）PD-NC组（n=21）PD-CI组（n=27）F/H/χ2/t值P值校正后P值
HC vs PD-NCHC vs PD-CIPD-NC vs PD-CI
年龄/岁62.77±5.1261.24±5.6464.19±8.681.0620.3540.6780.8400.413
性别1.7690.4130.720>0.9990.690
男性16（45.70）13（61.90）12（44.40）-----
女性19（54.30）8（38.10）15（55.60）-----
病程/年-6.62±5.235.85±5.050.4950.623---
受教育年限/年14.0（11，15）9.0（9.0，13.5）7.0（6，9）32.902<0.0010.083<0.0010.009
H-Y 分期-2.41±1.132.54±1.07-0.5320.599---
MMSE评分30.00（29.00，30.00）29.00（28.00，30.00）23.00（19.00，24.00）58.970<0.0010.488<0.001<0.001
CPV/mL1.29±0.291.47±0.381.64±0.624.5460.0160.1930.0290.602
CPV/eTIV/×10-30.90±0.181.00±0.191.12±0.374.0260.0250.3810.0290.304
侧脑室/eTIV/×10-313.88±3.7417.55±6.8918.28±7.855.2570.0100.0950.0330.981
第三脑室/eTIV/×10-30.88±0.211.00±0.321.26±0.448.1060.0010.4140.0010.067
CSF/eTIV/×10-30.74±0.130.80±0.190.92±0.159.863<0.0010.475<0.0010.039
WMH/eTIV/×10-31.10±0.751.34±0.691.63±0.684.1910.0190.7280.0150.468
尾状核/eTIV/×10-34.71±0.444.38±0.544.27±0.457.3920.0010.0420.001>0.999
丘脑/eTIV/×10-310.21±0.879.56±0.969.56±1.014.6800.0120.0480.290>0.999
eTIV/mL1 416.71±121.521 482.41±158.941 451.2±128.711.6240.2040.2390.956>0.999
), ArticleFig(id=1322210887545508087, tenantId=1146029695717560320, journalId=1319373162502258839, articleId=1322210872861249718, language=EN, label=null, caption=null, figureFileSmall=null, figureFileBig=null, tableContent=
HC组PD-NC组PD-CI组
r值P值r值P值r值P值
侧脑室0.3520.0480.1930.4730.6890.001
第三脑室0.590<0.0010.3180.2300.5920.006
CSF0.3830.0310.5710.0210.5080.022
WMH0.3960.025-0.1500.5800.4860.030
尾状核0.2180.2310.3230.222-0.5300.016
丘脑0.0400.8280.0910.738-0.4770.033
MMSE评分-0.1180.5220.3060.250-0.4830.031
), ArticleFig(id=1322210887621005560, tenantId=1146029695717560320, journalId=1319373162502258839, articleId=1322210872861249718, language=CN, label=表2, caption=

CPV/eTIV比值与其他脑区影像参数的关系

, figureFileSmall=null, figureFileBig=null, tableContent=
HC组PD-NC组PD-CI组
r值P值r值P值r值P值
侧脑室0.3520.0480.1930.4730.6890.001
第三脑室0.590<0.0010.3180.2300.5920.006
CSF0.3830.0310.5710.0210.5080.022
WMH0.3960.025-0.1500.5800.4860.030
尾状核0.2180.2310.3230.222-0.5300.016
丘脑0.0400.8280.0910.738-0.4770.033
MMSE评分-0.1180.5220.3060.250-0.4830.031
), ArticleFig(id=1322210887822332153, tenantId=1146029695717560320, journalId=1319373162502258839, articleId=1322210872861249718, language=EN, label=null, caption=null, figureFileSmall=null, figureFileBig=null, tableContent=
变量回顾系数B标准误β值95％CIP值
年龄0.1160.0870.266-0.066~0.2970.198
性别-1.0721.502-0.147-4.227~2.0830.484
受教育年限0.7670.2300.6230.285~1.2500.004
病程-0.2780.143-0.383-0.577~0.0220.067
CPV/eTIV比值-3.620×10-30.970×10-3-0.388-7.160×10-3~-0.076×10-30.046
), ArticleFig(id=1322210889491665146, tenantId=1146029695717560320, journalId=1319373162502258839, articleId=1322210872861249718, language=CN, label=表3, caption=

PD-CI组中CPV/eTIV比值与MMSE评分多元线性回归分析

, figureFileSmall=null, figureFileBig=null, tableContent=
变量回顾系数B标准误β值95％CIP值
年龄0.1160.0870.266-0.066~0.2970.198
性别-1.0721.502-0.147-4.227~2.0830.484
受教育年限0.7670.2300.6230.285~1.2500.004
病程-0.2780.143-0.383-0.577~0.0220.067
CPV/eTIV比值-3.620×10-30.970×10-3-0.388-7.160×10-3~-0.076×10-30.046
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帕金森病患者脉络丛体积改变与认知功能的相关性研究
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周素伊 1 , 甄志铭 1 , 庞慧琳 1 , 刘智 2 , 刘艳辉 3 , 陈炜 4 , 陈伟 1
陆军军医大学学报 | 神经科学 2025,47(7): 649-655
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陆军军医大学学报 |神经科学 2025 , 47 (7) : 649 -655
帕金森病患者脉络丛体积改变与认知功能的相关性研究
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周素伊1, 甄志铭1, 庞慧琳1, 刘智2, 刘艳辉3, 陈炜4, 陈伟1
作者信息
  • 1陆军军医大学（第三军医大学）第一附属医院：放射科，重庆
  • 2陆军军医大学（第三军医大学）第一附属医院：神经外科，重庆
  • 3四川大学华西医院神经外科，四川成都
  • 4西门子数字医疗科技（上海）有限公司广州分公司，广东广州
通讯作者:
陈 伟，E-mail：
CHEN Wei，E-mail：
Correlation between change in choroid plexus volume and cognitive function in patients with Parkinson’s disease
Suyi ZHOU1, Zhiming ZHEN1, Huilin PANG1, Zhi LIU2, Yanhui LIU3, Wei CHEN4, Wei CHEN1
Affiliations
  • 1Department of Radiology，
  • 2Department of Neurosurgery，First Affiliated Hospital，Army Medical University （Third Military Medical University），Chongqing
  • 3Department of Neurosurgery，West China Hospital，Sichuan University，Chengdu，Sichuan
  • 4Guangzhou Branch of Siemens Healthineers Ltd，Guangzhou，Guangdong，China
出版时间: 2025-04-15 doi: 10.16016/j.2097-0927.202409094
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摘要
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目的

探讨帕金森病（Parkinson’s disease，PD）患者不同认知状态下脉络丛（choroid plexus，CP）体积变化及其与其他脑区结构体积的相关性。

方法

本研究为横断面研究，纳入2023年5月至2024年4月期间就诊于陆军军医大学第一附属医院神经外科的48例PD患者及从健康体检中心招募的35例健康对照（healthy controls，HC），基于简易精神状态检查量表（Mini-Mental State Examination，MMSE）评估结果，将PD患者分为帕金森病伴认知功能障碍组（Parkinson’s disease with cognitive impairment，PD-CI）27例和帕金森病认知功能正常组（Parkinson’s disease with normal cognitive function，PD-NC）21例。采用3.0T磁共振成像（magnetic resonance imaging，MRI）进行MPRAGE序列扫描，并使用FreeSurfer 6.0软件获得脉络丛体积（choroid plexus volume，CPV）与其他脑区结构的体积。对CPV进行校正，计算其与估算的总颅内体积（estimated total intracranial volume，eTIV）的比值。调整混杂因素后，通过偏相关分析评估CPV/eTIV比值与其他脑区结构体积及认知量表评分之间的关系。使用多元线性回归分析进一步探究PD-CI组中CPV与认知功能之间的关系。

结果

与HC组相比，PD-CI组的CPV显著增大（P=0.029）。PD-CI组中，CPV/eTIV比值与侧脑室体积（r=0.689，P=0.001）、第三脑室体积（r=0.592，P=0.006）、脑脊液（cerebrospinal fluid，CSF）体积（r=0.508，P=0.022）、脑白质高信号（white matter hyperintensities，WMH）体积（r=0.486， P=0.030）呈显著正相关，同时与尾状核体积（r=-0.530，P=0.016）、丘脑体积（r=-0.477，P=0.033）及MMSE评分呈显著负相关（r=-0.483，P=0.031）。而PD-NC组中，CPV/eTIV比值仅与CSF体积（r=0.571，P=0.021）呈显著正相关；在PD-CI组中，CPV/eTIV比值与MMSE评分行多元线性回归分析，结果显示两者仍呈显著负相关（β=-0.388，P=0.046）。

结论

PD患者的认知功能障碍可能与CPV变化密切相关，提示CPV可作为评估PD认知损伤的潜在影像学标志物。

脉络丛  /  帕金森病  /  磁共振  /  认知功能障碍
Objective‍

To investigate the change in choroid plexus (CP) volume in Parkinson’s disease (PD) patients with different cognitive states and its correlation with structural volumes of other brain regions.

Methods‍

A cross-sectional study was conducted on 48 PD patients admitted in Department of Neurosurgery of the First Affiliated Hospital of Army Medical University between May 2023 and April 2024, and on 35 healthy controls (HC) recruited through a physical exam center. According to the results of Mini-Mental State Examination (MMSE), the patients were divided into PD with cognitive impairment (PD-CI) group (n=27) and PD with normal cognitive function (PD-NC) group (n=21). 3.0T magnetic resonance imaging (MRI) was performed using MPRAGE sequences, and CP volume and volumes of other brain regions were obtained using FreeSurfer 6.0 software. The CP volume was adjusted by calculating the ratio of its volume to estimated total intracranial volume (eTIV). After controlling for confounders, partial correlation analysis was used to assess the relationship between the CPV/eTIV ratio and the volumes of other brain regions as well as cognitive scale scores. Additionally, multiple linear regression analysis was performed to further explore the relationship between CPV and cognitive function in the PD-CI group.

Results‍

Compared to the HC group, the CPV in the PD-CI group was significantly larger (P=0.029). In the PD-CI group, the CPV/eTIV ratio showed significant positive correlations with the volume of the lateral ventricles (r=0.689, P=0.001), the volume of the third ventricle (r=0.592, P=0.006), the volume of cerebrospinal fluid (CSF) (r=0.508, P=0.022), and white matter hyperintensities (WMH) (r=0.486, P=0.030), but was negatively correlated with the volume of the caudate nucleus (r=-0.530, P=0.016), the volume of the thalamus (r=-0.477, P=0.033), and the MMSE scores (r=-0.483, P=0.031). But in the PD-NC group, the CPV/eTIV ratio was only positively correlated with CSF volume (r=0.571, P=0.021). Multiple linear regression analysis indicated that the CPV/eTIV ratio and MMSE scores remained significantly negatively correlated in the PD-CI group (β=-0.388, P=0.046).

Conclusion‍

Cognitive impairment in PD patients may be closely associated with the change in CP volume, suggesting that the volume can serve as a potential imaging marker in assessment of cognitive impairment in PD patients.

choroid plexus  /  Parkinson’s disease  /  magnetic resonance imaging  /  cognitive impairment
周素伊, 甄志铭, 庞慧琳, 刘智, 刘艳辉, 陈炜, 陈伟. 帕金森病患者脉络丛体积改变与认知功能的相关性研究. 陆军军医大学学报, 2025 , 47 (7) : 649 -655 . DOI: 10.16016/j.2097-0927.202409094
Suyi ZHOU, Zhiming ZHEN, Huilin PANG, Zhi LIU, Yanhui LIU, Wei CHEN, Wei CHEN. Correlation between change in choroid plexus volume and cognitive function in patients with Parkinson’s disease[J]. Journal of Army Medical University, 2025 , 47 (7) : 649 -655 . DOI: 10.16016/j.2097-0927.202409094
正文
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帕金森病（Parkinson’s disease，PD）是最常见的神经退行性疾病之一。近年来，认知功能障碍作为PD常见的非运动症状逐渐受到重视。PD患者发展成为帕金森病痴呆（Parkinson’s disease dementia，PDD）的风险是正常人的4~6倍［1］。一项为期3年的随访研究发现，部分PD患者的认知功能显著下降［2］。此外，另一项研究显示，在疾病进展至10年后，PDD的发病率增加至46%［3］。PD的认知功能下降涉及灰质核团、脑皮层与脑白质的改变。有研究发现，伴有认知功能障碍的PD患者存在额叶皮层、壳核和尾状核等区域的萎缩［4-5］，纹状体-苍白球-丘脑网络到背外侧前额叶皮层的回路中断被认为是PD发生认知障碍的基础［6］。然而，上述脑区病理改变与PD认知功能障碍的具体作用机制尚未完全阐明。
脉络丛（choroid plexus，CP）作为脑类淋巴系统的重要组成部分，近年来因其在脑营养供应及稳态维持方面的重要作用，在神经退行性疾病病理生理学机制研究中受到广泛关注。CP功能障碍已被认为是阿尔茨海默病（Alzheimer’s disease，AD）的一种独立亚型［7］，且脉络丛体积（choroid plexus，CPV）增大通过影响类淋巴循环及β淀粉样蛋白（amyloid-β，Aβ）清除加速患者认知障碍恶化［8］。神经退行性疾病通常具有相似的病理过程，α-突触核蛋白（α-synuclein，α-syn）的聚集及病理性传播与PD的进展密切相关，这一过程伴随着免疫激活、神经炎症、线粒体功能障碍以及血管周围间隙的扩张等改变［9］。CPV与脑实质功能区密切相关，JEONG等［10］发现，PD患者CPV增大通过影响基线额叶的执行功能促进早期痴呆转化。
目前，关于PD患者不同认知状态下CP变化的研究较少。本研究以CP为核心，结合脑类淋巴循环的视角，探索PD患者CP与认知功能障碍之间的关系，为深入理解PD相关神经认知损伤的机制提供新思路。
1　资料与方法
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1.1　研究对象
本研究为横断面研究，纳入2023年5月至2024年4月就诊于陆军军医大学第一附属医院神经外科54例PD患者及通过健康体检中心招募的37例健康对照（healthy controls，HC）。PD组纳入标准：①由2名神经外科医生参照中国帕金森病的诊断标准（2016版）［11］诊断为PD的患者；②年龄>40岁；③可配合完成磁共振及相关量表检查；④右利手；⑤对本研究内容知情同意。HC组纳入标准：①年龄>40岁；②常规头颅MRI检查无颅内占位性病变、脑软化灶、脑萎缩；③无精神疾病及相关药物服用史；④简易精神状态检查量表（Mini-Mental State Examination，MMSE）评分正常 （≥27分）；⑤右利手；⑥对本研究内容知情同意。
PD和HC组排除标准：①曾接受颅内手术者；②合并颅内占位性病变、正常压力脑积水、出血或缺血性脑血管病变；③存在其他会导致或可能影响认知功能改变的疾病，如小脑性共济失调、额颞叶痴呆、原发性失语等；④继发性帕金森综合征和帕金森叠加综合征；⑤有晚期、严重或不稳定的内科系统疾病；⑥因主观或客观原因不能完成磁共振检查者。其中PD组中6例由于检查过程中依从性欠佳导致图像质量较差，HC组中2例由于存在幽闭恐惧被排除。本研究已通过陆军军医大学第一附属医院伦理委员会审批［（A）KY2023060］，并获得所有受试者知情同意。
1.2　研究工具及方法
1.2.1　一般资料
收集所有入选者的年龄、性别及受教育年限。PD患者另收集发病年龄、病程。
1.2.2　量表评估与分组
1.2.2.1　认知功能评估
采用简易精神状态检查量表（Mini-Mental State Examination，MMSE）评估研究对象的认知功能。MMSE评分标准［12］根据受教育程度进行分组：①对于文盲患者，MMSE评分14~17分为轻度痴呆，10~13分为中度痴呆，≤9分为重度痴呆；②对于受教育程度为小学的患者，MMSE评分14~20分为轻度痴呆，10~13分为中度痴呆，≤9分为重度痴呆；③对于受教育程度为初中及以上的患者，MMSE评分20~26分为轻度痴呆，10~19分为中度痴呆，≤9分为重度痴呆。根据MMSE评分，PD患者被分为2个亚组：帕金森病伴认知功能障碍（Parkinson’s disease with cognitive impairment，PD-CI）组及帕金森病认知功能正常（Parkinson’s disease with normal cognitive function，PD-NC） 组。
1.2.2.2　Hoehn-Yahr（H-Y）分期
采用H-Y分期评估量表评估PD患者疾病分期。
1.2.3　仪器与方法
所有受试者进行Trio-3.0T MRI（Siemens）头颅MPRAGE序列扫描。扫描参数：TR=1 900 ms，TE=2.52 ms，Slices=176，Voxel size=1 mm×1 mm×1 mm，翻转角=9º。
由2名放射科医师（分别具有5年和10年颅脑影像诊断经验）评估了所有MRI图像，以识别图像伪影并排除形态学病变（无症状大体脑损伤）的存在。将DICOM格式的原始MR图像转换为FSL、SPM和Mricron等软件使用的NIfTI格式（http://people.cas.sc.edu/rorden/mricron/dcm2nii.html）。
1.2.4　图像处理与数据分析
基于所有受试者的MPRAGE结构像，在全脑水平上，使用FreeSurfer 6.0软件，采用高斯混合模型分割方法对全脑各脑区和侧脑室中的CP进行了自动分割。将FreeSurfer软件分割提取的估算的总颅内体积（estimated total intracranial volume，eTIV）、全脑白质、全脑灰质、CP、丘脑、尾状核、苍白球、壳核、海马、杏仁核、脑脊液（cerebrospinal fluid，CSF）和白质高信号（white matter hyperintensities，WMH）等体积作为感兴趣的区域，每个区域的总体积等于左侧和右侧脑区的体积和，并由FreeSurfer软件自动计算获得。最终的自动分割结果均由1名具有10年经验的神经影像学研究人员进行核对和校正。
1.3　统计学分析
所有统计分析均使用SPSS 26.0软件进行。定量资料的统计描述方法如下：若数据符合正态分布，采用x¯±s表示；若数据不符合正态分布，采用M（P25，P75）表示。定性资料以例（％）表示。两组间符合正态分布且方差齐性的计量资料比较使用独立样本t检验；正态分布的计量资料多组间比较采用单因素方差分析，非正态分布的计量资料多组间比较采用Kruskal-Wallis H检验，并进行Bonferroni多重比较校正。对CPV进行校正，计算CPV与eTIV的比值。在控制年龄、性别、受教育年限和病程的影响后，通过偏相关分析评估CPV/eTIV比值与其他脑区结构体积及认知量表评分之间的关系。使用多元线性回归分析进一步探讨CPV/eTIV比值与认知功能之间的关系。P<0.05表示差异具有统计学意义。
2　结果
收起
2.1　一般资料情况及认知功能的评估
83例研究对象均为右利手，其中PD-NC组21例（男13例，女8例），平均年龄（61.24±5.64）岁，PD-CI组27例（男12例，女15例），平均年龄（64.19±8.68）岁；HC组35例（男16例，女19例），平均年龄（62.77±5.12）岁。统计结果显示，HC组、PD-NC组和PD-CI组在受教育年限及MMSE评分方面差异具有统计学意义（P<0.05），而在年龄、性别、病程和H-Y分期差异无统计学意义（表1）。
2.2　PD组与HC组CPV差异
PD-CI组与HC组相比，CPV显著更高［（1.64±0.62）vs（1.29±0.29）mL，P=0.029］。虽然没有显著的统计学差异，但HC组、PD-NC组及PD-CI组的CPV［（1.29±0.29） mL、（1.47±0.38） mL、（1.64±0.62） mL］具有依次增大的趋势。对CPV进行校正后，CPV/eTIV比值在PD-CI组与HC组中仍有显著性差异（1.12×10-3±0.37×10-3 vs 0.90×10-3±0.18×10-3，P =0.029，表1、图1）。
2.3　CPV/eTIV比值与其他脑区结构体积相关性分析
对CPV进行校正后，控制年龄、性别、病程和受教育年限因素的影响后，进行CPV/eTIV比值与其他脑区结构体积的偏相关分析。在PD-CI组中，CPV/eTIV比值与侧脑室体积（r=0.689，P=0.001）、第三脑室体积（r=0.592，P=0.006）、CSF体积（r=0.508，P=0.022）、WMH体积（r=0.486，P=0.030）呈显著正相关，同时与尾状核体积（r=-0.530，P=0.016）、丘脑体积（r=-0.477，P=0.033）。在PD-NC组中，CPV/eTIV比值仅与CSF体积（r=0.571，P=0.021）呈显著正相关。在HC组中，CPV/eTIV比值与侧脑室体积（r=0.352，P=0.048）、第三脑室体积（r=0.590，P<0.001）、CSF体积（r=0.383，P=0.031）呈显著正相关（表2）。
2.4　PD-CI组中CPV/eTIV比值与认知量表的关系
在控制了年龄、性别、受教育年限和病程的影响后，偏相关分析显示PD-CI组中CPV/eTIV比值与MMSE评分呈显著负相关（r=-0.483，P=0.031，表2）。进一步使用多元线性回归分析显示，二者相关水平仍显著（β=-0.388，P=0.046，表3）。
3　讨论
收起
CP作为脑类淋巴系统的重要组成部分，CPV增大已被证明与多种神经退行性疾病的进程密切相关［8，13-14］。PD是由蛋白质错误折叠引起的第二大神经退行性疾病，类淋巴障碍在PD的病理过程中起到重要作用［15］。然而，目前关于PD患者不同认知状态下CPV变化的研究仍较有限。本研究发现，PD患者在不同认知状态下的CPV变化，为探索PD认知障碍的机制提供了新的视角。
3.1　PD-CI组患者CPV（CPV/eTIV比值）较HC组显著增大
PD患者的病理特征为黑质致密区多巴胺能神经元大量变性丢失和以α-syn为主的蛋白质异常聚集［16］。α-syn积累产生氧化应激，促进中枢神经系统（central nervous system，CNS）炎症反应［9］。CP处于血液脑脊液屏障（blood-cerebrospinal fluid barrier，BCSFB）的关键位置，有许多重要的炎症途径汇聚或穿过［17］。CNS炎症往往伴随CP和CSF中的免疫细胞数量增加［18-20］。例如，在精神病患者中，CPV增大被认为与神经炎症增加及BCSFB通透性降低有关［21］。α-syn的集聚可能会激活以小胶质细胞为代表的巨噬细胞，并促使它们在CP驻留［17］。这可能是CPV增大的原因之一。除此之外，CP作为高度血管化的结构，炎症反应导致的血管损伤、上皮细胞肿胀等［22］也可能共同促进CPV增大。本研究虽然未发现PD-NC组与PD-CI组及HC组的CPV存在显著差异，但CPV以及CPV/eTIV比值呈逐步增大的趋势。HE等［14］发现CPV的增大可预测早期PD患者认知能力的加速下降。他们还发现，基线时CSF中的Aβ1-42/α-syn比率降低，可能在5年后通过CP的变化，介导认知能力的进一步下降。因此，PD中的CPV变化可能作为连接上游病理改变与下游认知障碍表现的重要中介，为深入探究PD相关认知障碍的病理机制提供了重要的影像学支持。
3.2　CPV增大与脑结构变化及认知功能的相关性
CP作为CSF循环的起点，CPV的增大可能广泛影响脑类淋巴系统的下游结构。CP功能障碍可能导致CSF循环异常［23］，进而影响脑室体积变化。已有研究发现，AD患者中侧脑室扩大可能反映CSF循环异常的差异［24］。此外，CP功能障碍会破坏CSF稳态，影响类淋巴系统对脑废物（如错误折叠的α-syn）的清除，从而推动神经退行性疾病的病理进展［25］。LI等［26］的研究表明，CPV的增大通过类淋巴系统的损伤加剧了WMH体积的增长。在PD中，WMH体积增大被认为是从帕金森病患者伴轻度认知功能障碍（Parkinson’s disease-mild cognitive impairment，PD-MCI）转换为PDD的重要预测因子，并与额叶认知功能的持续下降有关［27］。此外，基线时的WMH负担可预测早期至中期PD的认知能力下降［28］。因此，对CP的深入探究，可从类淋巴循环与WMH的关系角度，为PD认知功能下降机制的探索提供新的研究视角。
CP具有产生和分泌生长因子的作用，并表达许多激素的受体，参与脑的营养支持和神经调节［29］。尾状核参与背外侧前额叶回路的一部分［30］，由尾状核异常改变导致回路的破坏可能导致认知缺陷和记忆受损［31］。APOSTOLOVA等［5］发现认知能力下降的PD患者表现出尾状核的萎缩。丘脑是众多广泛大脑网络的核心部分，在传递、调节和整合感觉和（亚）皮层输入方面发挥着关键作用。因此，丘脑几乎参与了认知功能和行为的所有方面［32］。边缘环路相关丘脑核团的损伤可能介导PD患者的认知功能障碍、情绪异常及自主神经症状［33］。本研究结果提示，PD患者中CP与尾状核和丘脑的关联可能在一定程度上解释了PD患者认知功能下降的病理机制。调控CP功能的治疗技术在近年来被认为是脑出血后脑积水等疾病新的治疗方向［34］。因此，这为进一步阐明PD认知障碍病理生理学提供了新的方向及治疗靶点。
然而，本研究也存在一些局限性。首先，本研究每组的样本量较少；其次，本研究缺乏纵向随访数据，限制了对PD患者认知功能变化过程的深入理解。因此，未来的研究应当开展多中心的纵向研究，以验证CPV作为认知功能障碍的预测指标的可靠性和稳定性。
综上所述，本研究发现PD-CI患者CPV增大且与类淋巴系统障碍、尾状核和丘脑萎缩及WMH增大相关。本研究的发现为PD认知障碍的临床诊断提供影像学依据，并揭示了CP变化与认知损伤之间的潜在关联。

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doi: 10.16016/j.2097-0927.202409094
  • 接收时间：2024-09-13
  • 首发时间：2026-10-28
  • 出版时间：2025-04-15
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  • 收稿日期：2024-09-13
  • 修回日期：2025-02-14
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    1陆军军医大学（第三军医大学）第一附属医院：放射科，重庆
    2陆军军医大学（第三军医大学）第一附属医院：神经外科，重庆
    3四川大学华西医院神经外科，四川成都
    4西门子数字医疗科技（上海）有限公司广州分公司，广东广州

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