Objective To detect the echogenicity of substantia nigra (SN) by transcranial sonography (TCS) and investigate it's relationships with motor symptoms (MS) and non-motor symptoms (NMS) in patients with Parkinson's disease (PD). Methods (1)122 PD patients in Department of Neurology, Beijing Tiantan Hospital and 46 age and gender-matched healthy individuals were recruited from January 2012 to December 2012. (2) Echogenicity and hyperechogenicity area of SN and ratio of hyper-SN over ipsilateral midbrain (S/M) were detected by TCS; PD patients with echogenicity of gradeⅠ-Ⅱ and gradeⅢ-Ⅳ were included in PDSN- and PDSN+ groups, respectively. (3)MS was evaluated by Hoehn-Yahr Stage and Unified Parkinson's Disease Rating ScaleⅢ (UPDRS Ⅲ), and NMS was assessed by Non-motor Symptoms Questionnaire (NMSQ), Mini-Mental Status Examination (MMSE), Montreal Cognitive Assessment Scale (MoCA), Hamilton Anxiety Scale (HAMA), Hamilton Depression Scale (HAMD), Pittsburgh Sleep Quality Index Scale (PSQI), Epworth Sleepiness Scale (ESS), Scale For Outcomes in PD For Autonomic Symptoms (SCOPA-AUT), Fatigue Scale-14 (FS-14) and Restless Legs Syndrome Severity Rating Scale (RLSRS).(4)The relationships between echogenicity of SN and MS and NMS were analyzed. Results (1) In 122 PD patients, there (was) were 0, 31, 57, 32 and 2 case (s) for gradeⅠ-Ⅴof SN echogenicity,respectively,and 91 cases(74.6%)and 31 cases(25.4%)were in SN- and SN+ groups, respectively;In 40 cases normal subjects(6 cases were not detected due to poor temporal window condition), there (was) were 11, 26, 3, 0 and 0 case (s) for gradeⅠ-Ⅴof SN echogenicity,respectively,and 3 cases(7.5%)and 31case(92.5%)were in SN+and SN- groups, respectively;the incidence of SN hyperechogenicity in PD group was significantly higher than that in control group(P<0.05);The hyperechogenicity area of SN and S/M ratio in PD patients with different grade of echogenicity were all significantly higher than that in control group(P<0.05).(2)The incidence of PDSN (+) in male was significantly higher than that of female(P<0.05). The age and age onset of PDSN+group were notably older than that of PDSN- group,(62.0±9.6) years vs. (54.3±11.1)years, (57.9 ±11.0) years vs. (51.1±10.9)years, P<0.05. (3) H-Y stage in PDSN+group was prominently severe compare with PDSN- group,(2.06±0.77)stage vs.(1.68±0.63)stage, P<0.05, and tremor score of UPDRSⅢ in PDSN+group was significantly higher than that in PDSN- group(P<0.05);Onset side in 72 out of 92 cases(79.1%)in PDSN+group was in the opposite side of SN hyperechogenicity or the side with larger area of SN hyperechogenicity if both sides involved, 19 cases(20.9%)was in the same side with SN hyperechogenicity or the side with larger area of SN hyperechogenicity if both sides involved.(4)MoCA score in PDSN+group was significantly declined compared with SN- group,(20.1±5.4) points vs. (22.7±5.8)points,P<0.05, the incidences of PD with mild cognitive impairment in PDSN+group were remarkably higher than that in PDSN+group,63.74% vs. 32.26%, P<0.05; SCOPA-AUT score in PDSN+group was significantly higher than that in PDSN- group,(36.8±9.0) points vs. (33.5±7.7)points, P<0.05;The incidences and scores of other NMS in two groups were not different(P>0.05). Conclusions PD patients have high incidences of SN hyperechogenicity detected by TCS. Echogenicity, hyperechogenicity area of SN and S/M ration all reflect SN echogenicity;factors relating higher incidences of SN hyperechogenicity in PD patients include male, older age and older onset age;PD patients present the onset symptoms in the opposite side of SN hyperechogenicity, show a higher H-Y stage, severer tremor and significantly impaired cognitive and autonomic functions.%目的：采用经颅超声（TCS）技术检测帕金森病患者黑质（SN）回声的变化及其与运动症状（MS）及非运动症状（NMS）的关系。方法（1）收集2012年1月至2012年12月就诊于北京天坛医院神经内科的122例帕金森病患者和46名年龄、性别相当的健康对照者，记录人口学资料。（2）采用经颅超声技术检测帕金森病患者SN回声强度、面积及高回声面积/中脑面积（S/M）比值，将SN回声强度Ⅰ、Ⅱ级为正常（PDSN-组），≥Ⅲ级为异常（PDSN＋组）。（3）采用Hoehn-Yahr分期、帕金森病统一评定量表第Ⅲ部分（UPDRSⅢ）于开期评价MS。（4）采用以下量表评价NMS：非运动症状筛查量表（NMSQ）、简易精神状态量表（MMSE）、蒙特利尔认知评估量表（MoCA）、汉密尔顿焦虑量表（HAMA）、汉密尔顿抑郁量表（HAMD）、匹茨堡睡眠质量指数量表（PSQI）、爱泼沃斯思睡量表（ESS）、帕金森病自主神经症状量表（SCOPA-AUT）、疲劳量表（FS-14）及不宁腿综合征严重程度评定量表（RLSRS）。（5）分析帕金森病患者SN回声的变化与MS及NMS的关系。结果（1）122例帕金森病患者SN回声Ⅰ～Ⅴ级分别为0、31、57、32及2例，SN＋组91例（74.6%），SN-组31例（25.4%）；40例对照者（6例因颞窗条件不佳而无法探测）分别为11、26、3、0及0例，SN＋组3例（7.5%），SN-组37例（92.5%），帕金森病组SN高回声的发生率明显高于正常对照组（P＜0.05）；帕金森病组SN不同回声级别患者高回声面积、高回声面积/中脑面积比值均具有显著差异（P＜0.05）。（2）男性PDSN＋的发生率明显高于女性（70.33%vs.29.67%， P＜0.05），PDSN＋组年龄及发病年龄均明显高于 PDSN-组[（62.0±9.6）岁 vs.（54.3±11.1）岁，（57.9±11.0）岁vs.（51.1±10.9）岁，P＜0.05]。（3）PDSN＋组H-Y分期明显高于PDSN-组[（2.06±0.77）期 vs.（1.68±0.63）期，P＜0.05]；UPDRSⅢ震颤评分明显高于PDSN-组[（2（1～5）分vs.4（2～8）分，P＜0.05]；PDSN＋组91例患者中的72例（79.1%）起病侧别位于高回声的对侧（单侧SN出现高回声）或更大面积高回声的对侧（双侧 SN 出现高回声），19例（20.9%）起病侧别位于高回声的同侧（单侧 SN出现高回声）或更大面积高回声的同侧（双侧SN出现高回声）。（4）PDSN＋组MoCA评分明显低于PDSN-组[（20.1±5.4）分vs.（22.7±5.8）分，P＜0.05]，伴发轻度认知障碍的发生率明显高于PDSN-组（63.74%vs.32.26%，P＜0.05）；PDSN＋组SCOPA-AUT评分明显高于PDSN-组[（36.8±9.0）分vs.（33.5±7.7）分，P＜0.05]；两组其他NMS的发生率及评分均无显著差异（P＞0.05）。结论采用经颅超声技术检测帕金森病患者SN高回声的发生率高，SN回声强度、高回声面积及S/M比值均可反映SN回声的变化；男性、年龄及发病年龄大的帕金森病患者SN高回声的发生率更高；帕金森病伴SN高回声患者起病多在高回声对侧，H-Y分期更重，震颤明显，轻度认知功能障碍及自主神经症状明显。
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