嗅觉评估联合经颅黑质超声检查早期诊断帕金森病的临床价值分析  

Olfactory assessment and substantia nigra ultrasonography in early diagnosis of Parkinson＇s disease

作　　者：王黎萍[1] 李星云[1] 桂小红[1] 吴承龙[1] 孙新芳[1] Wang Liping;Li Xingyun;Gui Xiaohong;Wu Chenglong;Sun Xinfang(Department of Neurology,Shaoxing People＇s Hospital,Shaoxing 312000,China)

机构地区：[1]绍兴市人民医院神经内科,312000

出　　处：《中华神经医学杂志》2018年第10期1028-1032,共5页Chinese Journal of Neuromedicine

基　　金：绍兴市科技计划项目（2014870062）

摘　　要：目的探讨嗅觉评估联合经颅黑质超声检查在帕金森病（PD）早期诊断中的意义。方法选择自2015年3月至2017年3月在绍兴市人民医院神经内科就诊的PD患者30例（PD组）和嗅觉正常的门诊体检老年人30例（对照组）。采用嗅觉评估工具16种气味识别（SS-16）试验进行嗅觉评估，采用经颅黑质超声（TCS）检测2组成员中脑部位黑质回声情况。计算嗅觉评估、经颅黑质超声及两者联合诊断PD的敏感性、特异性及阳性预测值，同时分析PD组患者年龄、性别、病程及帕金森病统一评定量表第Ⅲ部分（UPDRSⅢ）评分与嗅觉评估得分及黑质超声面积的相关性。结果PD组中SS-16气味识别得分≤10分的有25例，对照组SS-16气味识别得分≤10分的有8例。与对照组比较，PD组嗅觉功能评分明显降低，嗅觉障碍发生率明显升高，差异有统计学意义（P〈0.05）。PD组经颅黑质超声面积≥0.20 cm2有23例，对照组经颅黑质超声面积≥0.20 cm2有4例。PD组黑质高回声面积明显增大，病理性黑质高回声发生率明显升高，差异均有统计学意义（P〈 0.05）。嗅觉评估、经颅黑质超声以及两者联合检查诊断PD的敏感性依次为83.33%、76.67%、86.67%，联合检查诊敏感性明显增加，差异有统计学意义（P〈0.05）。PD组患者年龄、性别、病程及UPDRSⅢ评分与嗅觉评估得分及黑质超声面积均无相关性（P〉0.05）。结论嗅觉评估与经颅黑质超声联合检测可提高PD早期诊断的敏感性。ObjectiveTo explore the application of olfactory assessment and substantia nigra ultrasonography in early diagnosis of Parkinson＇s disease （PD）.MethodsThirty PD patients, admitted to our hospital from March 2015 to March 2017, were served as PD group and 30 healthy subjects were served as control group. Olfactory assessment tool Sniffin Sticks-16 and substantia nigra ultrasonography were performed; the sensitivity, specificity and positive predictive value of olfactory assessment, transcranial ultrasonography, and combined measurement for diagnosis of PD were calculated, respectively. Correlations of results of olfactory assessment, transcranial ultrasonography with age, gender, course of disease, and Unified Parkinson＇s Disease Rating Scale III （UPDRS III） scores were analyzed.ResultsThere were 25 PD patients with olfactory test （SS-16） scores≤10 and 22 control subjects; the olfactory test （SS-16） scores in PD patients were 7.83±2.23, which were significantly lower as compared with those in control subjects （12.03±1.96, P〈0.05）; the incidence of olfactory dysfunction in PD group was 83.33% and that in control group was 26.67%, with statistical significance （P〈0.05）. There were 23 PD patients with area of substantia nigra hyperecho≥0.20 cm2 and 26 control subjects; area of substantia nigra hyperecho was （0.22±0.06） cm2 in PD group, which was signfciantly increased as compared with control group （[0.11±0.07] cm2, P〈0.05）; the incidence of pathological substantia nigra hyperecho in PD group was 76.67% and that in control group was 13.33%, with significant difference （P〈0.05）. The sensitivity of olfactory assessment, transcranial ultrasonography, and combined measurement for diagnosis of PD was 83.33%, 76.67%, 86.67%, indicating that combined measurement had significantly higher sensitivity that the other two method （P〈0.05）. SS-16 scores and area of substantia nigra hyperecho were unrelated with gender, age, duration and UPDRS III scores （P〉0.05）.

关 键 词：帕金森病 经颅黑质超声 嗅觉评估 早期诊断 

分 类 号：R742.5[医药卫生—神经病学与精神病学]