手写笔在帕金森病诊断及早中期运动障碍评估中的作用研究

摘要

Objective To study the role of electronic pen in diagnosis of Parkinson's disease (PD) and its movement symptoms according to the movement parameters collected with electronic pen.Methods Thirty-nine PD patients (4 at prodromal statge,28 at Hoehn-Yahr 1.0-2.5 stage and 7 at Hoehn-Yahr 3.0 intermediate stage) served as a PD group,40 education-,sex-and agematched healthy subjects served as control group in this study.Their clinical data collected with electronic pen were compared with the movement parameters collected with computer (movement velocity,movement acceleration,movement time,tremor amplitude and tremor frequency).Results The mean movement velocity,movement acceleration,tremor frequency of upper extremities were significantly lower while the movement time and tremor amplitude of upper extremities were significantly higher in PD group than in control group (2.3±0.4 vs 3.0±0.8,1.4±0.2 vs 1.7± 0.2,4.2±1.7 vs 5.8±1.1,P=0.000;16.9±3.3 vs 13.7±2.4,4.3±1.8 vs 2.4±0.5,P=0.000).The parameters of bradykinesia and tremor were positively related with the MDS-UDPRS ]Ⅲ score and Hoehn-Yahr stage in PD group (r=0.8131,0.7809,P＜0.05).Conclusion Quantitative analysis of electronic pen trajectory can effectively detect dyskinesia and predict the severity of prodromal,early and intermediate PD,and is thus a more rapid,sensitive,simple,objective and promising tool than MDS-UPDRS for diagnosis of dyskinesia and PD.%目的 利用手写笔采集手写时的运动参数,探讨各参数在帕金森病(Parkinson's disease,PD)诊断的作用及其对运动症状的量化价值.方法 选取解放军总医院PD专病门诊的PD患者39例为PD组,其中前驱期4例、Hoehn-Yahr(HY) 1.0～2.5级的早期PD 28例、HY 3.0级的中期PD 7例,同期选择教育水平、性别、年龄相匹配的健康者40例为对照组,收集临床资料,并用手写笔在数位屏上依次完成阿基米德曲线、米字图形临摹及定腕划弧3个手写任务,与之相连的计算机采集手写的运动参数包括完成任务时间(MT)、峰值加速度(PA)、运动速度中位数(MV)、震颤幅度(AT)、震颤频率(FT),比较2组各参数差异,并将PD组的各参数值与MDS-UPDRSⅢ总分、HY分级、病程做相关性分析.结果 PD组的上肢MV、PA、FT均显著降低于对照组(2.3±0.4 vs3.0±0.8、1.4±0.2 vs1.7±0.2、4.2±1.7 vs5.8±1.1,P=0.000);MT、AT均高于对照组(16.9±3.3 vs 13.7±2.4、4.3±1.8 vs2.4±0.5,P=0.000);PD组运动迟缓和震颤各参数值与MDS-UDPRSⅢ、HY分级均呈正相关(r=0.8131、0.7809,P＜0.05).结论 手写轨迹的量化分析可有效检测出前驱期及早中期PD运动障碍,可定量评估不同严重程度的PD,比传统MDS-UPDRS快捷、敏感、简单、更客观,有望成为前驱期诊断的手段.