心率变异及皮肤交感反应对帕金森病的鉴别诊断价值  

Value of heart rate variability and sympathetic skin response in differential diagnosis of Parkinson's disease

作　　者：张萌[1] 张娟利[1] 党亮君 邓永宁[1] 曹红梅[1] 屈秋民[1] ZHANG Meng;ZHANG Juan-li;DANG Liang-jun;DENG Yong-ning;CAO Hong-mei;QU Qiu-min(Department of Neurology,the First Affiliated Hospital of Xi'an Jiaotong University,Xi'an 710061,China)

机构地区：[1]西安交通大学第一附属医院神经内科,陕西西安710061

出　　处：《西安交通大学学报（医学版）》2018年第1期93-96,共4页Journal of Xi’an Jiaotong University（Medical Sciences）

基　　金：国家自然科学基金资助项目(No.81301097)~~

摘　　要：目的探讨心率变异(heart rate variability,HRV)和皮肤交感反应(sympathetic skin response,SSR)对于帕金森病(Parkinson’s disease,PD)鉴别诊断的价值。方法选取西安交通大学第一附属医院神经内科门诊及住院临床确诊的36例PD、17例特发性震颤(essential tremor,ET)及59例非典型帕金森症(Parkinsonism-Plus,PD-plus)患者,测定平静呼吸、深呼吸、Vasaval动作时HRV指数及四肢的SSR潜伏期。结果 (1)平静呼吸时PD组较ET组HRV指数降低,HRV异常率高,差异具有统计学意义(P<0.05),PD组与PD-plus组间HRV差异无统计学意义,深呼吸及Vasaval动作时三组间差异无统计学意义;(2)上肢、下肢SSR潜伏期均值及异常率在PD组、PD-plus组及ET组间差异无统计学意义;(3)HRV指数区别PD和PD-plus的灵敏度为82.6%、特异度为22.8%;区别PD和ET的灵敏度为82.6%、特异度为66.9%。测定SSR潜伏期区别PD和PD-plus的灵敏度为52.6%、特异度为39.0%;区别PD和ET的灵敏度为52.6%、特异度为29.4%。结论 PD患者较ET患者HRV降低,HRV异常率高;测定HRV指数有助于鉴别PD和ET,但是对于鉴别PD和PD-plus价值不大;测定SSR潜伏期对于鉴别PD、PD-plus及ET价值不大。Objective To evaluate the value of heart rate variability(HRV)and sympathetic skin response(SSR)in differential diagnosis of Parkinson’s disease(PD).Methods We selected36PD,17essential tremor(ET)and59Parkinsonism Plus(PD-plus)patients diagnosed in our department.We recorded HRV during the period of quiet breath,deep breath and Vasaval as well as SSR incubation period of the upper limbs and lower limbs.Results①During the period of quiet breath,HRV decreased significantly in PD group compared with that in ET group(P<0.05),and abnormality rate of HRV in PD group was higher than that in ET group.HRV did not significantly differ between PD and PD-plus.HRV did not significantly differ among the three groups during the period of deep breath and Vasaval.②SSR incubation period showed no significant difference among PD,PD-plus and ET groups.③The specificity and sensibility of HRV in PD and PD-plus differential diagnosis were22.8%and82.6%,while for PD and ET differential diagnosis the values were66.9%and82.6%.The specificity and sensibility of SSR in PD and PD-plus differential diagnosis were39.0%and52.6%,29.4%and52.6%,respectively,for PD and ET differential diagnosis.Conclusion Compared with those in ET patients,HRV in PD patients decreases and HRV abnormality rate increases.HRV is of great value in differential diagnosis of PD and ET but not in differential diagnosis of PD and PD-plus.Determining SSR incubation period does not have much value in differential diagnosis of PD,PD-plus and ET.

关 键 词：帕金森病 鉴别诊断 自主神经障碍 心率变异 皮肤交感反应 

分 类 号：R742.5[医药卫生—神经病学与精神病学]