经颅超声联合嗅觉测试对早期帕金森病的临床应用价值  

Clinical value of transcranial sonography combined with olfactory test in early Parkinson′s disease

作　　者：任亚坤 张迎春[1] 王才善[1] 丁常伟 杨敏 盛余敬[1] 张英[1] 陈晓芳[1] 毛攀 毛成洁[2] 刘春风[2] Ren Yakun;Zhang Yingchun;Wang Caishan;Ding Changwei;Yang Min;Sheng Yujing;Zhang Ying;Chen Xiaofang;Mao Pan;Mao Chengjie;Liu Chunfeng(Department of Ultrasound,the Second Affiliated Hospital of Soochow University,Suzhou 215004,China;Department of Neurology and Clinical Research Center of Neurological Disease,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超声中心,苏州215004 [2]苏州大学附属第二医院神经内科和神经疾病临床研究中心,苏州215004

出　　处：《中华超声影像学杂志》2023年第12期1055-1061,共7页Chinese Journal of Ultrasonography

基　　金：苏州大学附属第二医院神经疾病研究中心课题(ND2023B01);苏州市科技发展计划(民生科技)项目(SYS2020148);江苏省老年医学临床技术应用研究项目(LD2021031);苏州大学附属第二医院学科建设托举工程(XKTJ-TD202007)。

摘　　要：目的探讨经颅超声(TCS)联合嗅觉测试对早期帕金森病(PD)的辅助诊断价值以及二者在PD患者认知功能方面的临床应用价值。方法回顾性纳入2018年1月至2022年1月苏州大学附属第二医院157例早期PD患者作为PD组,157例健康志愿者作为对照组,均进行TCS检查和嗅觉测试。分析两组临床特征、TCS及嗅觉测试结果差异;以临床诊断为金标准,评估TCS、嗅觉测试及二者联合对早期PD的辅助诊断价值;分析PD组TCS检查的中脑面积、中脑黑质强回声面积以及第三脑室宽度与认知评分的相关性;依据嗅觉测试得分,将PD组分成PD伴嗅觉障碍(PD-OD)110例和PD不伴嗅觉障碍(PD-NOD)47例,比较两组间临床评分及TCS检查结果的差异。结果①PD组黑质强回声面积、黑质强回声阳性率、第三脑室宽度及OD率高于对照组,而中脑面积、嗅觉测试分数低于对照组(均P<0.001);②TCS联合嗅觉测试对早期PD诊断的敏感性、诊断符合率(90.0%、77.1%)高于单独TCS(60.0%、71.3%)及单独嗅觉测试(70.1%、72.3%),但特异性(63.7%)低于二者单独诊断(TCS为82.8%,嗅觉测试为75.2%),(均P<0.001);③MoCA评分、视空间/执行力、记忆、注意力以及语言均与中脑面积呈正相关(r_(s)=0.38、0.32、0.27、0.25、0.23,均P<0.05),与第三脑室宽度呈负相关(r_(s)=-0.39、-0.22、-0.39、-0.22、-0.32,均P<0.05),而定向只与第三脑室宽度呈负相关(r_(s)=-0.24,P<0.05);④PD-OD组MoCA评分[22(18,25)]低于PD-NOD组[24(20,26)](P=0.040)。结论①TCS联合嗅觉测试可提高早期PD诊断的敏感性及诊断符合率,具有一定辅助价值;②PD患者认知评分与中脑面积呈正相关、与第三脑室宽度呈负相关;③PD-OD患者认知评分低于PD-NOD患者;④TCS及嗅觉测试可能有助于评估PD患者的认知功能。Objective To explore the adjunctive diagnostic value of transcranial sonography(TCS)combined with olfactory test in early Parkinson′s disease(PD)and the clinical value of both in the cognitive function of PD patients.Methods TCS and olfactory test were performed in 157 early PD patients(PD group)and 157 healthy controls(control group)in the Second Affiliated Hospital of Soochow University from January 2018 to January 2022.The differences in clinical characteristics,TCS,and olfactory test results between the two groups were analyzed.The values of TCS,olfactory test,and their combination in diagnosing early PD were evaluated using clinical diagnosis as the gold standard.The correlations of the midbrain area,the midbrain substantia nigra hyperechoic area,and the third ventricle width in TCS examination with the cognitive score were analyzed in the PD group.According to the olfactory test scores,157 patients with early PD were divided into two groups:110 cases of PD with olfactory dysfunction(PD-OD)and 47 cases of PD without olfactory dysfunction(PD-NOD).The differences in clinical scores and TCS results between the two groups were compared.Results The midbrain substantia nigra hyperechoic area,substantia nigra hyperechoic positivity rate,third ventricle width,and olfactory dysfunction rate were higher in the PD group compared to the control group,while the midbrain area and olfactory test scores were lower than those in the control group(all P<0.001).The sensitivity and the coincidence rate of TCS combined with the olfactory test for early PD diagnosis(90.0%,77.1%)were higher than those of TCS alone(60.0%,71.3%)and olfactory test alone(70.1%,72.3%),but the specificity(63.7%)was lower than that of both alone(82.8%for TCS and 75.2%for olfactory test),(all P<0.001).MoCA score,visual space and executive ability,memory,attention,and language were positively correlated with the area of the midbrain(r_(s)=0.38,0.32,0.27,0.25,0.23;all P<0.05)and negatively correlated with the width of the third ventricle(r_(s)=-0.39,-0.22

关 键 词：超声检查 经颅 帕金森病 嗅觉测试 认知功能 

分 类 号：R742.5[医药卫生—神经病学与精神病学]