帕金森病与原发性震颤患者的经颅超声研究

摘要

Objective To determine the validity of transcranial sonography (TCS) in the differential diagnosis of Parkinson's disease (PD) and essential tremor (ET). Methods TCS was performed in 100 patients with PD, 33 patients with ET and 100 normal controls in a blind manner. The echo signal intensity of the substantia nigra was classified into grade Ⅰ-Ⅴ for semi-quantitative analysis. When the echo intensity was grade Ⅲ or more, it was deemed as abnormal and the area of the substantia nigra hyperechogenicity would be measured and its ratio to the area of the whole midbrain ( S/M ) would be calculated. Results ( 1 ) Semi-quantitative analysis: the ratio of the persons whose echo intensity of the substantia nigra was grade Ⅲ or more was greater (76. 00％ ,76/100) in PD than ET (9. 09％, 3/33) and normal controls ( 13.00％, 13/100; x2 = 130. 622, P ＜0. 01 ). However, there was no difference between ET and controls. (2) Quantitative analysis: the median and quartile range of the area of substantia nigra hyperechogenicity and S/M were greater in PD patients ( O. 54 ( 0. 57 ), 11.03 ( 9. 00 ) ) than ET ( 0. 00(0.04), 0.00(1.55),H= 42.39,42.19, both P＜0. 01, respectively) and normal controls (0.00(0. 00), 0. 00 (0. 00 ), H = 121.86,121.47, both P ＜ 0. 01, respectively), and there was no difference between ET and controls. (3) Using the area of hyperechogenicity ≥0. 20 cm2 or S/M ≥ 7％ as a cut off for predicting PD, the sensitivity, specificity and accuracy were 85.39％, 78. 38％ and 81.50％ or 86. 02％,81.31％ and 83.50％ ,respectively. But there was no significant difference for the accuracy (Z = 0. 683,P ＞ 0. 05). Conclusion TCS might find the specific hyperechogenicity of substantia nigra in PD patients,providing useful information to distinguish PD from ET.%目的 评价经颅超声(TCS)图像对辅助鉴别帕金森病(PD)和原发性震颤(ET)的临床价值。方法 对100例PD、33例ET及100名健康对照进行TCS检查，黑质回声强度分为Ⅰ～Ⅴ级进行半定量分析，当单侧黑质强回声≥Ⅲ级时测量强回声面积、计算双侧强回声总面积与中脑总面积比值(S/M)，进行定量分析。结果 (1)半定量分析：PD组黑质强回声≥Ⅲ级比例(76.00％，76/100)明显高于ET组(9.09％，3/33)及对照组(13.00％，13/100)，差异有统计学意义(x2=130.622，P＜O.01)。(2)定量分析：PD组黑质强回声面积及S/M比值的中位数和四分位数间距[0.54(0.57)、11.02(9.00)]明显高于ET组[0.00(0.04)、0.00(1.55)，H=42.39、42.19，均P＜0.01]及对照组[0.00(0.00)、0.00(0.00)，H=121.86、121.47，均P＜0.01]，ET组和对照组比较差异无统计学意义。(3)利用单侧黑质强回声面积≥0.2 cm2或S/M比值≥7％对判断PD的敏感度、特异度、诊断符合率分别为：85.39％、78.73％、81.50％和86.02％、81.13％、83.50％，但诊断符合率之间差异无统计学意义。结论 TCS检查可发现部分PD患者中脑黑质内特异性强回声，从而为鉴别PD与ET提供一定的信息。