The Characteristics Of Hemoglobin And Transcranial Ultrasonography In Parkinson's Disease

Background and ObjectiveParkinson's disease(PD)is the second most common neurodegenerative disorder after Alzheimer's disease.Because there is no recognized biomarker,the diagnosis of PD is still based on clinical symptoms.Therefore,it still remains a great challenge for experienced neurologists to make a definite diagnosis of PD at the early stage of the disease.Pathological studies have shown that abnormal iron deposition in specific intracranial tissues plays an important role in the pathogenesis of PD,especially in substantia nigra.Transcranial sonography(TCS)can detect abnormal strong echo signals in substantia nigra.Iron is an important cofactor of various metabolic enzymes and an important component of hemoglobin.Studies have shown that the hemoglobin level of PD patients has changed after the onset stage of the disease and is correlated with iron metabolism.At present,there are few studies on the relationship between hemoglobin,hyperechoic changes in substantia nigra and the severity of the disease in PD patients,and their value in assistant diagnosis of PD is still unclear.Therefore,we will study the characteristics of strong echo changes of hemoglobin and substantia nigra in patients with PD after onset,analyze the relationship between these changes and the severity of the disease,and explore their application value in the diagnosis of PD,so as to find biomarkers for assistant diagnosis of PD.MethodsFrom January 2017 to January 2018,38 patients with primary PD,as well as 42 healthy people,were enrolled in the Department of Neurology of the Fifth Affiliated Hospital of Zhengzhou University.Their clinical data,Hoehn-Yahr classification,blood routine and serum ferritin results were strictly evaluated.Meanwhile,TCS was performed and the echo intensity of substantia nigra was graded.The echo intensity of substantia nigra which is equal to or greater than grade III will be diagnosed as positive in substantia nigra.Statistical analysis was made on these results.Comparison of the counting data will be conducted by?2,while that of the measurement data will be done by t test.At the same time,the accuracy of the grading on the basis of echo positiveness and the echo intensity of substantia nigra will be explored.The relationship between hemoglobin,the intensive echo area of substantia nigra and the severity of the disease will be analyzed and compared.That P is less than 0.05 is statistically significant.Results1.This study has found that the erythrocyte count,hemoglobin level and ferritin of PD patients are lower than those of healthy control group,and the difference was statistically significant(P < 0.05).2.Among the 38 patients in this study,28 of them are diagnosed positive in substantia nigra,while 3 of the 42 healthy people are diagnosed positive in substantia nigra echo test.The proportion of the echo positive patients in substantia nigra,the area of substantia nigra echo enhancement,the area of substantia nigra echo enhancement and the area of midbrain in patients with PD are higher than those in healthy controls(P < 0.05).3.This study has found that the positive echo of substantia nigra is correlated with sex,course of disease and serum ferritin level in patients with PD(P < 0.05),but not with age,onset age and onset form(P > 0.05).4.This study regards clinical diagnosis as the gold standard,regards the patients with positive substantia nigra echo as true positive,those with negative substantia nigra echo as false negative,those with positive substantia nigra echo as false positive,those with negative substantia nigra echo as true negative,and those with negative substantia nigra echo as true negative.It is found that the sensitivity and specificity of positive substantia nigra echo for the diagnosis of PD are 73.68% and 92.86% respectively.The area under ROC curve of graded diagnostic PD was 0.918,and the 95% confidence interval was(0.854,0.982),(P < 0.001).5.Spearman correlation analysis is used to analyze the relationship between hemoglobin level,strong echo area of substantia nigra and severity of disease.We have found that hemoglobin level is negatively correlated with Hoehn-Yahr classification(r=-0.477,P=0.02),while strong echo area of substantia nigra is positively correlated with Hoehn-Yahr classification(r=0.469,P=0.003).Conclusion1.The level of hemoglobin in patients with PD decreases after onset,and the level of hemoglobin is negatively correlated with the severity of the disease.Dynamic follow-up of the level of hemoglobin has certain referential value for the clinical diagnosis of PD.2.The positive echo of substantia nigra in patients with PD is related to gender,course of disease and serum ferritin level.The area of enhanced echo of substantia nigra in colleagues is positively related to the severity of the disease.The positive echo of substantia nigra has high sensitivity and specificity for the diagnosis of PD.TCS can be used as a biomarker for assistant diagnosis of PD.