震颤分析在帕金森病和原发性震颤鉴别诊断中的应用  

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

作　　者：陈培琼 丁昕 余聪 陈名峰[1] CHEN Peiqiong;DING Xin;YU Cong(Department of Neurology,Fujian Provincial Jinshan Hospital(Fujian Provincial Hospital-South hospital),Fuzhou 350001,Fujian China)

机构地区：[1]福建省立金山医院(福建省立医院南院)神经内科,福建福州350001

出　　处：《癫痫与神经电生理学杂志》2022年第1期34-39,共6页Journal of Epileptology and Electroneurophysiology(China)

基　　金：福建医科大学启航基金资助项目(2017XQ1145)。

摘　　要：目的探讨震颤分析在帕金森病(parkinson's disease,PD)和原发性震颤(essential tremor,ET)鉴别诊断中的应用价值。方法选取2017年9月至2020年11月在福建省立金山医院门诊和住院确诊的PD患者27例(PD组)和ET患者23例(ET组),所有患者均至少有一侧上肢静止性或姿势性震颤,用肌电图进行震颤检测,分析震颤峰频率、振幅、肌肉收缩模式以及谐波共振、再现性震颤的出现率。结果(1)ET组较PD组发病年龄更早(P<0.05),病程更长(P<0.05),有震颤家族史比例更高(P<0.05);(2)静止、固定姿势和负重500 g、负重1000 g状态时,PD组震颤峰频率无明显改变(P>0.05),ET组震颤峰频率亦无明显改变(P>0.05),但PD组震颤峰频率均较ET组低(P<0.05);(3)PD组的肌电爆发模式以交替性肌肉收缩为主,而ET组以同步性肌肉收缩为主,两组比较差异有统计学意义(P<0.05);(4)PD组再现性震颤出现率为37%,而ET组无震颤再现现象,两组比较差异有统计学意义(P<0.05);(5)PD组谐波共振出现率较ET组高(P<0.05)。结论震颤分析可以为PD和ET的鉴别诊断提供客观、实用的依据,具有很重要的临床应用价值。Objective To explore the application value of tremor analysis in differential diagnosis of Parkinson’s disease(PD)and essential tremor(ET).Methods A total of 27 PD patients(PD group)and 23 ET patients(ET group)were selected from outpatients and inpatients who were diagnosed in Fujian Provincial Jinshan Hospital from September 2017 to November 2020.All patients had static or postural tremor of at least one upper limb.Electromyography(EMG)was applied to detect tremor.The frequency,amplitude,muscle contraction mode,harmonic resonance and re-emergent tremor(RET)were analyzed.Results(1)ET group had an earlier age of onset tremor(P<0.05),a longer course of disease(P<0.05)and a higher proportion of family history of tremors(P<0.05)than PD group.(2)At rest,posture,weight loading with 500g and weight loading with 1000g,the tremor peak frequency in PD group were not significantly changed(P>0.05),nor were in ET group(P>0.05).Tremor peak frequency of PD group was lower than that of ET group(P<0.05).(3)The patterns of EMG bursts in PD group were dominated by alternative muscle contractions,while those in ET group were dominated by synchronous muscle contractions(P<0.05).(4)The incidence rate of re-emergent tremor(RET)in PD group was 37%,but there was no RET in ET group(P<0.05).(5)The incidence rate of harmonic resonance in PD group was higher than that in ET group(P<0.05).Conclusion Tremor analysis can provide objective and practical basis for the differential diagnosis of PD and ET,and it is of very important clinical application value.

关 键 词：帕金森病(PD) 原发性震颤(ET) 震颤分析 肌电图 静止性震颤 姿势性震颤 

分 类 号：R742.5[医药卫生—神经病学与精神病学] R741.044[医药卫生—临床医学]