经颅超声联合嗅觉测试在帕金森病鉴别诊断中的应用  

Combination of substantia nigra transcranial sonopraphy and olfactory test in the differential diagnosis of Parldnson＇ s disease

作　　者：马端兰 李振光[2] 张建忠[1] 于占彩[2] 邹佳霖[1] 包卫方[3] 张江山[2] 张金彪[2] 

机构地区：[1]山东省威海市立医院超声诊断科,264200 [2]山东省威海市立医院神经内科,264200 [3]威海市文登中心医院

出　　处：《中国实用医刊》2016年第11期27-30,共4页Chinese Journal of Practical Medicine

摘　　要：目的探讨黑质（SN）经颅超声（TCS）检查联合嗅觉测试在帕金森病（PD）鉴别诊断中的价值。方法选择符合入选标准的58例PD及60例特发性震颤（ET）患者，嗅觉功能评价采用Sniffin’Sticks法。比较两组间嗅觉减退、SN强回声（SN＋）阳性率，分析两种标记物对PD鉴别诊断的敏感性、特异性、阳性预测值（PPV）及阴性预测值（NPV）。结果PD组Sniffin’Sticks法嗅觉评分（20．7±4．3）显著低于ET组（26．6±5．5，t=-5．720，P=0．003），PD组嗅觉减退或丧失阳性率（60．3％）显著高于ET组（8．3％，X^2=29．156，P=0．002），PD组SN＋阳性率（53．4％）显著高于ET组（16．7％，X^2=16．925，P=0．005）。嗅觉测试联合SN＋若两者中有一项阳性，则敏感性为81．2％，若两项同时阳性则敏感性为32．2％，特异性分别为84．3％和100％；PPV分别为86．6％和100％，NPV分别为74．3％和52．0％。结论黑质经颅超声检查联合嗅觉测试对于PD与ET的鉴别诊断具有重要意义。Objective To investigate whether the combination of olfactory test and TCS of SN could enhance the differential diagnostic power in patients with Parkinson＇ s disease （PD）. Methods Fifty-eight patients with PD and 60 patients with essential tremor （ET） were evaluated on Sniffin＇ Sticks odor identification test and TCS of SN. The frequency of hyposmia and SN hyperechogenicity in each group was compared. The sensitivity, specificity, positive predictive value （PPV） and negative predictive value （NPV） of the two clinical biomarkers were analyzed. Results The frequency of hyposmia in patients with PD （60.3%） was significantly higher than that in patients with ET （ 8.3% , X^2 = 29. 156, P = 0. 002）. The frequency of SN hyperechogenicity in patients with PD （ 53.4% ） was significantly higher than that in ET subjects （16.7% , X^2 = 16. 925, P = 0. 005 ）. The combination of hyposmia and SN hyperechogenicity （ if either one or both present） discriminated patients with PD from ET with a sensitivity of 81.2% and 32.2% , specificity of 84.3% and 100% , PPV of 86.6% and 100% , and NPV of 74.3% and 52.0% , respectively. Conclusions Our preliminary data suggested that the combination of hyposmia and SN hyperechogenicity can improve the diagnostic potential for discriminating patients with PD from ET.

关 键 词：帕金森病 嗅觉减退 经颅超声 特发性震颤 

分 类 号：R742.5[医药卫生—神经病学与精神病学]