震颤分析用于帕金森病分型的可行性  

The diagnostic value of tremor analysis for defining the Parkinson′s disease subtype

作　　者：刘小璇[1] 张朔[1] 刘娜[1] 孙阿萍[1] 张英爽[1] 樊东升[1] Liu Xiaoxuan;Zhang Shuo;Liu Na;Sun Aping;Zhang Yingshuang;Fan Dongsheng(Department of Neurology,Peking University Third Hospital,Beijing 100191,China)

机构地区：[1]北京大学第三医院神经内科,北京100191

出　　处：《中华医学杂志》2020年第3期207-212,共6页National Medical Journal of China

基　　金：北京大学医学部-乌尔姆大学联合项目基金(PKU2017ZC001-2)。

摘　　要：目的本研究对早期确诊帕金森病患者进行震颤分析检测,以期为临床分型找到更加客观的辅助检查依据。方法本研究采取横断面调查的方法,收集2015年1月到2016年12月在北京大学第三医院诊治的早期确诊的帕金森病患者65例,所有患者均记录统一帕金森病评定量表(UPDRS)评分,Hoehn-Yahr(H-Y分级),简易精神状态检查(MMSE),汉密尔顿抑郁量表(HAMD)评分等。根据UPDRS中姿势和步态障碍评分与震颤评分的比例,将患者分为震颤为主型(TD),强直为主型(PIGD)及混合型。所有患者行震颤分析检查,分析比较结果。结果65例初确诊的帕金森病患者年龄为(63±10)岁,病程为(14±8)个月,TD型患者28例,PIGD型患者21例,混合型16例,震颤分析结果表明,3组患者在震颤频率和震颤幅度的比较差异无统计学意义(P>0.05),但TD型患者主动肌和拮抗肌的交替收缩和谐波共振现象出现的比例明显较高(P<0.05)。TD型有20例患者(71.4%)出现典型帕金森病震颤分析的表现,PIGD型的患者仅4例(14.3%)表现为上述的典型表现,更多患者表现为静止期无明确的震颤主峰,部分患者在姿势时可引出每秒6~8次的震颤频率,并出现主动肌和拮抗肌同时收缩。混合型患者可同时出现上述两种表现,其中出现典型帕金森病患者为10例(62.5%)。结论震颤分析作为一个客观评价震颤的电生理指标,可以作为帕金森病临床分型的辅助手段,揭示患者的病理受损通路,为患者的预后及治疗提供客观依据。Objective To find more objective evidence and support for clinical classification of Parkinson′s disease by means of tremor analysis in patients with early confirmed Parkinson′s disease.Methods A cross-sectional study was conducted to collect 65 patients with early Parkinson′s disease treated in the Third Hospital of Peking University from January 2015 to December 2016.Unified Parkinson′s Disease Rating Scale(UPDRS),Hoehn-Yahr scale(H-Y scale),Mini-mental state examination(MMSE),Hamilton depression scale(HAMD)were recorded in all patients.According to the ratio of UPDRS rigidity score to tremor score,the patients were divided into tremor dominant(TD),postural instability/gait difficulty(PIGD)and mixed types.All patients were examined by tremor analysis and the results were analyzed and compared.Results Among the 65 patients,the mean age of onset was(63±10)years,the course of disease was(14±8)months.Twenty-one patients were classified to TD group,28 patients were classified to PIGD type,and 16 patients with mixed type.There was no significant difference in frequency and amplitude of tremor between the three groups(P>0.05),but the proportion of alternating contraction and harmonic resonance of active and antagonistic muscles in TD group was significantly higher(P<0.05).Twenty patients(71.4%)in TD group showed typical Parkinson′s disease manifestations in tremor analysis.Only four patients(14.3%)in PIGD group showed the typical manifestations.More patients in PIGD group showed no clear main peak of tremor at rest.Some patients showed 6-8 Hz/sec peak frequency in posture position and simultaneous contraction of the active and antagonist muscles.These two manifestations occured simultaneously in mixed type patients,including 10 cases(62.5%)with typical Parkinson′s disease manifestations.Conclusion As an objective electrophysiological method to evaluate tremor type,tremor analysis can be used as an important assistant method for clinical classification of Parkinson′s disease.It can provide information o

关 键 词：帕金森病 震颤分析 表型 肌电图 

分 类 号：R742[医药卫生—神经病学与精神病学]