前庭诱发肌源性电位对早期帕金森病患者脑干功能的评估  

Evaluation of brainstem function using vestibular evoked myogenic potentials in patients with early-stage Parkinson′s disease

作　　者：沈赟[1] 谢伟晔 李函星 王芬[3] 戴永萍[2] 刘春风[1] Shen Yun;Xie Weiye;Li Hanxing;Wang Fen;Dai Yongping;Liu Chunfeng(Department of Neurology,the Second Affiliated Hospital of Soochow University,Clinical Research Center of Neurological Disease of the Second Affiliated Hospital of Soochow University,Suzhou 215004,China;Department of Neurology,the Second Affiliated Hospital of Soochow University,Suzhou 215004,China;Clinical Research Center of Neurological Disease of the Second Affiliated Hospital of Soochow University,Suzhou 215004,China)

机构地区：[1]苏州大学附属第二医院神经内科,苏州大学附属第二医院神经疾病研究中心,苏州215004 [2]苏州大学附属第二医院神经内科,苏州215004 [3]苏州大学附属第二医院神经疾病研究中心,苏州215004

出　　处：《中华神经科杂志》2023年第5期485-493,共9页Chinese Journal of Neurology

基　　金：“十四五”江苏省医学重点学科(ZDXK202217);苏州市科技计划项目(SLT201924,SKJY2021090);苏州大学附属第二医院学科建设托举工程(优势学科托举项目XKTJ-XK202001)。

摘　　要：目的通过测量早期帕金森病患者的前庭诱发肌源性电位(VEMP),探讨其在早期帕金森病脑干评估中的临床意义及可能的辅助诊断效能。方法连续纳入2019年1月至2022年1月于苏州大学附属第二医院神经内科确诊的早期帕金森病患者123例(帕金森病组)及同期经广告招募的健康对照者122名(健康对照组)。对所有受试者行胸锁乳突肌肌源性VEMP(cVEMP)及眼外肌肌源性VEMP(oVEMP)检查,比较两组患者VEMP的参数特点,并利用受试者工作特征曲线评估VEMP对早期帕金森病的辅助诊断效能。利用Spearman相关分析评价帕金森病组内VEMP参数与运动及自主神经功能障碍等非运动症状之间的相关性。结果相较于健康对照组,帕金森病组的cVEMP双侧潜伏期[左侧P1潜伏期(Lp13):19.0(16.4,20.9)ms比13.1(12.0,14.2)ms,Z=-11.18,左侧N1潜伏期(Ln23):27.4(24.6,29.9)ms比21.2(19.8,23.0)ms,Z=-10.14;右侧P1潜伏期(Rp13):18.8(16.2,20.9)ms比13.0(11.7,14.1)ms,Z=-10.84,右侧N1潜伏期(Rn23):27.7(24.3,29.7)ms比21.1(19.6,22.9)ms,Z=-10.50]以及oVEMP双侧潜伏期[左侧N1潜伏期(Ln10):12.7(10.7,14.4)ms比10.4(9.7,11.4)ms,Z=-8.02,左侧P1潜伏期(Lp15):16.5(15.1,18.3)ms比14.5(13.4,15.3)ms,Z=-7.96;右侧N1潜伏期(Rn10):12.8(11.4,14.0)ms比10.5(9.7,11.5)ms,Z=-8.85,右侧P1潜伏期(Rp15):16.7(15.3,18.3)ms比14.4(13.3,15.1)ms,Z=-9.39]均显著延长(均P<0.001)。以健康对照组为参考,帕金森病组cVEMP的Lp13、Ln23、Rp13及Rn23的曲线下面积(AUC)值均大于0.7,其中Lp13及Rp13的AUC值大于0.9,提示早期帕金森病患者已存在显著脑干受损,具有一定的辅助诊断价值(均P<0.001);oVEMP的Ln10、Lp15、Rn10、Rp15的AUC值均大于0.7(均P<0.001)。帕金森病患者的oVEMP右侧校正波幅即Rn10-p15校正波幅与左旋多巴等效剂量呈正相关(r=0.21,P=0.020),Rn10与非运动症状评估量表评分呈正相关(r=0.21,P=0.023);cVEMP左侧校正波幅即Lp13-n23校正波幅与帕金森病自主神经功能障碍量表评分呈Objective To investigate whether vestibular-evoked myogenic potentials(VEMP)can be used to assess brainstem and its supplementary diagnostic value in patients with early-stage Parkinson′s disease(PD).Methods A total of 123 patients with early-stage PD(PD group)diagnosed in the Department of Neurology of the Second Affiliated Hospital of Soochow University from January 2019 to January 2022 were consecutively enrolled,and 122 healthy controls(healthy control group)were included.Cervical VEMP(cVEMP)and ocular VEMP(oVEMP)examinations were performed on all subjects.VEMP parameters between the 2 groups were compared,and receiver operating characteristic curve was used to evaluate the auxiliary diagnostic efficacy of VEMP for early-stage PD.Correlations between VEMP parameters and motor and non-motor symptoms such as autonomic dysfunction were analyzed in the PD group using Spearman correlation analysis.Results Bilateral latencies of cVEMP[left P1 latency(Lp13):19.0(16.4,20.9)ms vs 13.1(12.0,14.2)ms,Z=-11.18,left N1 latency(Ln23):27.4(24.6,29.9)ms vs 21.2(19.8,23.0)ms,Z=-10.14;right P1 latency(Rp13):18.8(16.2,20.9)ms vs 13.0(11.7,14.1)ms,Z=-10.84,right N1 latency(Rn23):27.7(24.3,29.7)ms vs 21.1(19.6,22.9)ms,Z=-10.50]and bilateral latencies of oVEMP[left N1 latency(Ln10):12.7(10.7,14.4)ms vs 10.4(9.7,11.4)ms,Z=-8.02,left P1 latency(Lp15):16.5(15.1,18.3)ms vs 14.5(13.4,15.3)ms,Z=-7.96;right N1 latency(Rn10):12.8(11.4,14.0)ms vs 10.5(9.7,11.5)ms,Z=-8.85,right P1 latency(Rp15):16.7(15.3,18.3)ms vs 14.4(13.3,15.1)ms,Z=-9.39]of the PD group significantly prolonged compared to the healthy control group(all P<0.001).Compared to the healthy control group,the area under the curve(AUC)values of Lp13,Ln23,Rp13 and Rn23 of cVEMP in the PD group were all greater than 0.7,and the AUC values of Lp13 and Rp13 in the PD group were greater than 0.9(all P<0.001);the AUC values of Ln10,Lp15,Rn10,and Rp15 of oVEMP in the PD group were all greater than 0.7(all P<0.001).The Rn10-p15 corrected amplitude in PD patients was positively correlate

关 键 词：帕金森病 脑干 ROC曲线 前庭诱发肌源性电位 

分 类 号：R742.5[医药卫生—神经病学与精神病学]