MRI、EAS-EMG和TCS鉴别多系统萎缩P型和帕金森病的价值  

The value of MRI,EAS-EMG and TCS in identifying multi-system atrophy of P-type and Parkinson’s disease

作　　者：胡新颖 刘恒方[1] 张敏[1] 石磊[1] 王新华[1] 陈彦杏 HU Xinying;LIU Hengfang;ZHANG Min(Department of Neurology,The Fifth Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China)

机构地区：[1]郑州大学第五附属医院神经内科

出　　处：《中风与神经疾病杂志》2020年第1期17-21,共5页Journal of Apoplexy and Nervous Diseases

摘　　要：目的探讨头部磁共振成像(MRI)、肛门括约肌肌电图(EAS-EMG)和经颅超声成像(TCS)三种辅助检查对多系统萎缩P型(MSA-P型)和帕金森病(PD)的鉴别诊断价值。方法选取临床确诊的21例MSA-P型和33例PD患者,均行MRI、EAS-EMG、TCS检查且病历资料全面并保存完整。采用ROC曲线对其MRI、EAS-EMG、TCS结果进行对比分析。结果MSA-P型组的壳核裂隙征、MUP平均时限、平均波幅、多相波百分比、自发电位发生率、卫星电位发生率均高于PD组,但黑质高回声面积、黑质高回声总面积与中脑总面积比值均低于PD组(均P<0.01)。ROC曲线显示,在两者的鉴别诊断方面,壳核裂隙征的特异度最高(97.0%),黑质高回声面积的敏感度最高(81.0%),MUP平均时限的曲线下面积(AUC)最高(0.781);三种指标联合对两者鉴别诊断的敏感度为95.2%,AUC为0.939,鉴别诊断价值极高。结论MRI、EAS-EMG、TCS对鉴别MSA-P型和PD的价值各不相同,互为补充,且三种指标联合具有良好的鉴别诊断价值。Objective To explore the three auxiliary examinations of magnetic resonance imaging(MRI),anal sphincter electromyography(EAS-EMG)and transcranial ultrasound imaging(TCS)for multi-system atrophy of P-type(MSA-P)and Parkinson’s disease(PD)differential diagnostic value.Methods Twenty-one patients with clinically diagnosed MSA-P and 33 patients with PD were enrolled.All of the patients underwent MRI,EAS-EMG,and TCS,and the medical records were comprehensive and preserved.The MRI,EAS-EMG and TCS results were compared and analyzed by the receiver operating characteristic(ROC)curves.Results Slit-like hyperintensity in the posterolateral margin of the putamen,MUP mean time,mean amplitude,percentage of polyphase wave,incidence of spontaneous generation and satellite potential were higher in the MSA-P group than in the PD group.However,the high echogenic area of the substantia nigra,the ratio of the total area of the substantia nigra and the total area of the midbrain were lower than those of the PD group(both P<0.01).The ROC curve showed that the slit-like hyperintensity in the posterolateral margin of the putamen had the highest specificity(97.0%)for the differential diagnosis of the two,the highest sensitivity of the hyperechoic area of the substantia nigra(81.0%),and the highest AUC of the MUP mean time(0.781).The sensitivity of the three indicators combined to the differential diagnosis was 95.2%,and the AUC was 0.939.The differential diagnosis value was extremely high.Conclusion The diagnostic value of MRI,EAS-EMG and TCS in MSA-P and PD is different and complement each other,and the combination of the three indicators has good diagnostic value.

关 键 词：经颅超声成像 肛门括约肌肌电图 磁共振成像 多系统萎缩P型 帕金森病 

分 类 号：R742.5[医药卫生—神经病学与精神病学]