血管性帕金森综合征的临床、影像学特征及嗅觉功能的研究  

Investigation of clinical,imaging features and olfactory function of vascular parkinsonism

作　　者：谈世东[1] 陈先文[1] 龚亮[1] 

机构地区：[1]安徽医科大学第一附属医院神经内科,合肥230022

出　　处：《临床神经病学杂志》2010年第3期181-184,共4页Journal of Clinical Neurology

基　　金：安徽省教育厅基金资助项目(2006kj364b)

摘　　要：目的研究血管性帕金森综合征(VP)患者的临床、影像学特征及嗅觉功能。方法对37例VP患者的临床资料进行分析,进行统一帕金森病(PD)评分量表(UPDRS)、美国国立卫生研究院卒中量表(NIHSS)评分和头颅MRI检查;并与46例PD患者比较。采用康涅狄格州化学感觉临床研究中心(CCCRC)试验对31例VP患者、40例PD患者及40名正常对照者进行嗅觉功能检查。结果与PD组比较,VP组发病年龄及脑卒中危险因素、脑卒中病史、铅管样肌张力增高、姿势性震颤、阔基步态和智能障碍的比率明显增高,静止性震颤、屈曲体姿和症状两侧不对称的比率显著降低(P<0.05～0.001);NIHSS评分显著增高(P<0.001)。两组UPDRS评分的差异无统计学意义。VP组患者MRI示基底节区和脑室周围多发性脑梗死,伴脑叶萎缩及白质疏松。VP组CCCRC评分(56.97±12.86)与正常对照组的差异无统计学意义,而明显高于PD组(36.43±23.04)(P<0.001)。结论 VP患者的临床特点为有锥体外系和锥体束损害表现的非典型帕金森综合征,影像学特点为脑缺血改变,嗅觉功能无异常。嗅觉功能测试可作为鉴别VP与PD的方法 。Objective To investigate the clinical,imaging features and olfactory function in patients with vascular parkinsonism（VP）.Methods Clinical data were collected and analyzed,Unified Parkinson＇s disease （PD） rating scale（UPDRS）,National Institutes of Health Stroke Scale（NIHSS）score and cranium MRI were carried out in 37 patients with VP,which were compared with 46 patients with PD. The Connecticut Chemosensory Clinical Research Center（CCCRC） test was carried out in 31 patients with VP,40 patients with PD and 40 normal controls for olfactory function testing.Results Compared to PD group,the onset age,and rate of cerebral stroke risk factor,cerebral stroke history,lead-pipe myotonia,postural tremor,wide-based step gait,intelligence impairment were significantly increased,and the rate of aplanetism tremor,buckling body attitude,symptoms asymmetry were significantly decreased（P0.05-0.001）,and NIHSS score was significantly increased in the VP group（P0.001）. While the UPDRS scores were not significantly different between two groups.MRI in VP group mainly displayed multiple infarcts in basal ganglia and periventricular cerebral white matter,frequently accompanied with cerebral atrophy or leukoaraiosis. CCCRC score in VP group（56.97±12.86） was significantly higher than that in PD group（36.43±23.04）（P0.001）,but was not significantly different with the normal control group.Conclusions Clinical features of VP are mainly atypical parkinsonism caused by damage of both of pyramidal and extra pyramidal system,with cerebral ischemic changes in imaging investigation. The olfactory function was normal in VP. Olfactory function testing may be helpful in differentiating VP from PD.

关 键 词：血管性帕金森综合征 原发性帕金森病 临床表现 磁共振成像 嗅觉功能 

分 类 号：R742.5[医药卫生—神经病学与精神病学]