新诊断未用药帕金森病患者的眼球运动特点分析  

Analysis of eye movement characteristics in newly diagnosed drug-naive Parkinson′s disease

作　　者：林茵 周梦溪 姜春燕 吴丽 和青 赵蕾[1] 董幼镕[1] 陈伟[1] Lin Yin;Zhou Mengxi;Jiang Chunyan;Wu Li;He Qing;Zhao Lei;Dong Yourong;Chen Wei(Department of Neurology,Shanghai Ninth People′s Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200011,China;the Department of Neurology,Fengcheng Hospital of Fengxian District of Shanghai,Shanghai201411,China)

机构地区：[1]上海交通大学医学院附属第九人民医院神经内科,上海200011 [2]上海市奉贤区奉城医院神经内科,上海201411

出　　处：《中华神经科杂志》2023年第9期976-985,共10页Chinese Journal of Neurology

基　　金：上海交通大学医学院附属第九人民医院学科特色生物样本库项目(YBKB202120);上海市康复医学会健康管理科研基金课题面上项目(2022KJCX008)。

摘　　要：目的探讨新诊断未用药帕金森病患者的眼球运动特点及其与患者运动及非运动症状之间的相关性。方法纳入2017年11月至2021年12月于上海交通大学医学院附属第九人民医院新诊断的未用药帕金森病患者75例与同期当地社区招募的健康对照者46名。所有受试者均接受视频眼震电图记录下的眼球运动评估,包括水平方向上视觉介导的反射性扫视(水平扫视)和平滑追踪运动(SPEM),对帕金森病患者进行运动症状(Hoehn-Yahr分期、国际运动障碍协会统一帕金森病评定量表第三部分、冻结步态问卷)和非运动症状(非运动症状问卷、16项气味识别测试、汉密尔顿抑郁量表17项、简易精神状态检查量表、蒙特利尔认知评估量表汉化基础版、快速眼球运动睡眠期行为紊乱筛查量表)的评估。分析帕金森病患者和健康对照者各眼球运动参数的差异,包括水平扫视的潜伏期和精准度以及视标光点分别以0.1、0.2、0.4 Hz频率水平移动时的SPEM增益值,采用线性回归分析模型分析与健康对照存在差异的眼球运动参数与帕金森病患者运动及非运动症状之间的相关性。分别对扫视潜伏期、扫视精准度、不同频率SPEM增益值等眼球运动参数采用受试者工作特征(ROC)曲线进行敏感度及特异度分析,再将扫视潜伏期、扫视精准度和0.4 Hz改变最明显的SPEM增益值拟合进行ROC曲线分析。结果与健康对照组相比,新发帕金森病组患者扫视潜伏期明显延长[(210.4±41.3)ms比(191.3±18.9)ms,t=-3.455,P=0.001]、扫视精准度降低(88.4%±6.8%比92.2%±6.1%,t=3.064,P=0.003)、SPEM增益值在0.1、0.2和0.4 Hz上与健康对照相比均显著降低(0.68±0.15比0.74±0.14,t=2.261,P=0.026;0.72±0.16比0.79±0.16,t=2.704,P=0.008;0.67±0.19比0.78±0.19,t=2.937,P=0.004)。扫视潜伏期,扫视精准度,0.1、0.2、0.4 Hz频率SPEM增益值的ROC曲线下面积(AUC)均小于0.7,分别为0.641(P=0.010)、0.681(P=0.00Objective To explore eye movement characteristics in newly diagnosed,drug-naive Parkinson′s disease(PD)patients and their correlation with motor and non-motor symptoms.Methods Seventy-five newly diagnosed,drug-naive PD patients and 46 healthy controls(HCs)were included in this cross-sectional study.Patients were recruited from the Department of Neurology,Shanghai Ninth People′s Hospital,Shanghai Jiao Tong University School of Medicine from November 2017 to December 2021,while HCs were recruited from the local community during the same period.For PD patients,motor severity was measured with the modified Hoehn and Yahr stage,Movement Disorder Society Unified Parkinson′s Disease Rating Scale partⅢand the Freezing of Gait questionnaire.Non-motor symptoms were evaluated by serial scales such as Non-Motor Symptoms Questionnaire,16-item odor identification test from Sniffin Sticks,17-item Hamilton Rating Scale for Depression,Chinese version of Mini-Mental State Examination,Montreal Cognitive Assessment Basic and REM Behavior Disorder Screening Questionnaire.All subjects underwent oculomotor test including pro-saccade task and smooth pursuit eye movement(SPEM)task in the horizontal direction via videonystagmography.Visually guided saccade latency,saccadic accuracy and gain in SPEM at three frequencies(0.1,0.2,0.4 Hz)of the horizontal axis were compared between the 2 groups.The association between key oculomotor parameters and clinical phenotypes was explored in PD patients.The receiver operating characteristic(ROC)analyses of eye movement parameters as independent factors were also performed for detecting PD from HCs,then combining the saccadic latency,saccadic accuracy and the most significant SPEM gain(0.4 Hz)as the model to distinguish PD from HCs.Results Relative to HCs,newly diagnosed,drug-naive PD patients showed prolonged saccadic latency[(210.4±41.3)ms vs(191.3±18.9)ms,t=-3.445,P=0.001]and decreased saccadic accuracy(88.4%±6.8%vs 92.2%±6.1%,t=3.064,P=0.003).SPEM gain in PD was uniformly reduced at eac

关 键 词：帕金森病 眼球运动 眼震电图描记术 眼扫视 平滑追踪 

分 类 号：R742.5[医药卫生—神经病学与精神病学]