帕金森动力图对早期帕金森病患者运动功能的量化研究  

Quantitative Assessment of Motor Function in Patients with Early-stage Parkinson's Disease Using Parkinson's Kinetigraph System

作　　者：李蓝婷 刘卫国[1] 李建宁 谢敏珍 华平[1] 于翠玉[1] 张丽[3] 黄沛钰[4] 张敏鸣 徐评议[5] LI Lan-ting;LIU Wei-guo;LI Jian-ning;XIE Min-zhen;HUA Ping;YU Cuhyu;ZHANG Li;HUANG Pei-yu;ZHANG Min-ming;XU Ping-yi(Department of Neurology,the Affiliated Brain Hospital of Nanjing Medical University,Nanjing 210029,China;Departm ent of Neurology,Nanjing Qixia District Hospital,Nanjing 210046,China;Department of Geriatrics,the Affiliated Brain Hospital of Nanjing Medical University,Nanjing 210029,China;Department of Radiology,the Second Affiliated Hospital of Zhejiang University School of Medicine,Hangzhou 310009,China;Department of Neurology,the First Affiliated Hospital of Guangzhou Medical University,Guangzhou 510120,China)

机构地区：[1]南京医科大学附属脑科医院神经内科,南京210029 [2]南京市栖霞区医院神经内科,南京210046 [3]南京医科大学附属脑科医院老年医学科,南京210029 [4]浙江大学医学院附属第二医院放射科,杭州310009 [5]广州医科大学附属第一医院神经内科,广州510120

出　　处：《中国临床神经科学》2020年第2期141-148,共8页Chinese Journal of Clinical Neurosciences

基　　金：国家重点研发计划重点专项(编号:2016YFC1306600、2017YFC1310302);国家自然科学基金面上项目(编号:81571348);江苏省科技计划项目重点项目(编号:BE2019611);江苏省自然科学基金面上项目(编号:BK20151077)。

摘　　要：目的利用帕金森动力图系统(PKG)对帕金森病(PD)前驱期、初诊未服药早期PD患者的运动症状进行评估,探讨其对早期PD的辅助诊断价值。方法收集在南京市社区筛查的PD前驱期患者24例,在南京医科大学附属脑科医院PD专病门诊就诊的初诊未服药早期PD患者38例,根据患者有无静止性震颤将患者分为震颤阳性组和震颤阴性组。采用统一PD评定量表Ⅲ(UPDRSⅢ)评估运动症状,并计算UPDRSⅢ-T(不包括震颤评分)、同侧UPDRSⅢ和同侧UPDRSⅢ-T(同侧指症状明显侧)分值。患者佩戴PKG腕表,连续7 d记录数据,分析PKG参数运动迟缓评分(BKS)、震颤时间百分比(PTT)与临床PD量表的相关性,并对PTT进行ROC曲线分析。结果BKS与UPDRSⅢ、UPDRSⅢ-T、同侧UPDRSⅢ、同侧UPDRSⅢ-T均呈正相关。回归分析显示,UPDRSⅢ为4时,BKS为26.66,大于健康人群BKS第75百分位数。ROC曲线分析显示,PTT预测静止性震颤的最佳界值为8.1%,敏感度为70.0%,特异度为92.9%。结论PKG参数与运动症状评估量表具有良好相关性,可检测到轻微PD症状,建议作为PD早期运动症状的筛查工具。Aim To assess motor function quantitatively in patients with prodromal Parkinson’s disease(PD)and de novo patients with early-stage PD using Parkinson’s Kinetigraph System(PKG)and explore its auxiliary value in early diagnosis.Methods 24 prodromal PD patients were recruited from Nanjing community from March 2017 to December 2018.38 de novo patients with early-stage PD were recruited from the Movement Disorder Clinic at the Department of Neurology of Brain Hospital Affiliated to Nanjing Medical University from March 2019 to December 2019.The patients were divided into two groups:subjects with resting tremor and subjects without resting tremor.Patients were evaluated by Unified Parkinson Disease Rating Scale(UPDRS)partⅢ and tremor scores were removed from the UPDRSⅢ(referred to as UPDRSⅢ-T).The homolateral UPDRSⅢ and UPDRSⅢ-T on the most severely affected limb of patients were calculated.The PKG was worn for 7 days on the wrist of the most affected side.The correlation of Bradykinesia Score(BKS)and Percent Time with Tremor(PTT)with clinical rating scale was analyzed.Receiver Operating Characteristic(ROC)was performed to find the score that discriminated between subjects with resting tremor and subjects without resting tremor.Results BKS was positively correlated with UPDRSⅢ,UPDRSⅢ-T,homolateral UPDRSⅢand homolateral UPDRSⅢ-T.A UPDRSⅢ of 4 corresponded to a BKS of 26.66 which was higher than the 75 th percentile of healthy controls.The optimal cut-off of PTT was 8.1%.The sensitivity and selectivity were 70.0% and 92.9% respectively.Conclusion The values of PKG had a good correlation with clinical rating scale.It can detect mild parkinsonian signs with a high sensitivity which is recommended as a screening tool for motor symptoms of early-stage PD.

关 键 词：帕金森病 前驱期 早期诊断 可穿戴设备 运动功能 

分 类 号：R742.5[医药卫生—神经病学与精神病学]