震颤分析对于特发性震颤与帕金森病的鉴别诊断价值  

Application of tremor analysis in differential diagnosis of essential tremor and Parkinson’s disease

作　　者：张乐[1] 屈秋民[1] 曹红梅[1] ZHANG Le;QU Qiu-min;CAO Hong-mei(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

出　　处：《西安交通大学学报（医学版）》2019年第4期624-628,共5页Journal of Xi’an Jiaotong University（Medical Sciences）

基　　金：陕西省自然科学基金资助项目(No.2013JM4014)~~

摘　　要：目的探讨加速器联合表面肌电图对特发性震颤(ET)与帕金森病(PD)的鉴别诊断价值。方法回顾性收集西安交通大学第一附属医院神经内科门诊确诊的ET和PD患者资料,对2组患者进行震颤分析,比较2组患者的震颤特点。结果ET患者61例,其中男性27例(44.3%);年龄21~84(58.8±15.8)岁,平均病程(8.8±8.2)年。PD患者49例,男性23例(46.9%);年龄44~84(64.3±9.0)岁。ET组以单波峰为主,72.1%患者负重后出现双波峰;PD组95.9%患者以谐波现象为主,均未见双波峰出现。震颤时相互拮抗的2组肌肉收缩模式,ET组以同步收缩为主,PD组同时存在同步收缩及交替收缩模式(P<0.05)。ET组震颤波频率较PD组高(6.62±1.70vs.4.77±0.67,P<0.05),波峰的半宽值较大(0.95±0.30vs.0.82±0.21,P<0.05),而2组半宽功率无明显差异(χ2=49.22,P<0.05)。多因素分析显示,双波峰、谐波现象、震颤部位、负重1kg后震颤时峰频率在两组中存在统计学差异,周围波与ET呈正相关,周围波的出现越倾向于诊断ET(P=0.003,OR=90.496);谐波现象与ET存在正相关,谐波现象的出现更倾向于诊断PD(P=0.014,OR=0.042)。负重1kg后震颤时峰频率的ROC曲线下面积为0.845,震颤分析诊断ET最佳诊断界值5.445Hz,灵敏度为77.0%,特异度为85.7%;阳性预测值为87.0%,阴性预测值为75.0%。结论ET和PD的震颤频率、肌肉收缩模式、半宽值、负重后频率及波形变化存在差异;震颤分析对于ET与PD震颤的鉴别具有较高的价值。Objective To explore the value of tremor analysis using accelerator combined with electromyography (EMG) in differential diagnosis of essential tremor (ET) and Parkinson s disease (PD). Methods We made a retrospective analysis and comparison of 61 ET patients in the outpatient department of Neurology,The First Affiliated Hospital of Xi'an Jiaotong University,and 49 PD patients. Tremor analysis was performed in the two groups,and differences in tremor characteristics between the two groups were compared. Results ① General information: 61 ET patients,including 27 males (44.3%),aged 21-84 years (mean 58.8±15.8 years),with an average duration of 8.8 years (8.2 years). There were 49 PD patients including 23 males (46.9%),aged 44-84 years (mean 64.3±9 years).② Tremor waveform: ET group had single wave crest. 72.1% patients had double peaks after loading. 95.9% patients in PD group were mainly harmonic,and no double peaks appeared.③ The muscle contractile modes in the two groups were mutually antagonistic in tremor. ET group had mainly synchronous contraction,while PD group had synchronous contraction and alternating contraction mode ( P <0.05) simultaneously.④ The characteristics of tremor wave: the frequency of ET group was higher than that of PD group (6.62±1.70 vs . 4.77±0.67, P <0.05),and the half width of wave peak was larger (0.95±0.30 vs. 0.82±0.21, P <0.05), but there was no significant difference in the half width power between the two group (χ 2 =49.22, P <0.05).The multiple factor analysis showed that significant differences between the two groups in the double wave peak,harmonic phenomenon,tremor position and tremor after the weight negative. The surrounding waves were positively correlated with ET. The appearance of the surrounding waves was more inclined to diagnose ET ( P = 0.003 , OR value=90.496). The harmonic phenomenon was positively related to ET,and the harmonic phenomenon was more inclined to appear in PD ( P =0.014, OR value=0.042). The area under the ROC curve of the peak frequenc

关 键 词：特发性震颤 帕金森病 加速器 震颤分析 鉴别诊断 

分 类 号：R742.5[医药卫生—神经病学与精神病学]