帕金森综合征与特发性震颤震颤类型特点研究

The analysis of tremor in essential tremor and Parkinsonism

目的应用肌电图进行震颤记录对帕金森综合征和特发性震颤的震颤特点进行分析。方法对首都医科大学附属北京天坛医院2006—2007年收治的38例特发性震颤患者和42例帕金森综合征(包含帕金森病和狭义帕金森综合征)应用肌电图表面电极记录方法,在静止时与姿势时记录震颤,对震颤形式进行评价。结果通过对肌电图记录的震颤进行评价,发现特发性震颤和帕金森综合征均含有静止时震颤和姿势时震颤两种形式。在静止时和姿势时共包括4种节律形式:无震颤,交替性震颤节律,同步性震颤节律,交替同步节律。静止时交替性震颤节律在特发性震颤和帕金森综合征之间差异有统计学意义(P<0.01),静止时无震颤在特发性震颤和帕金森综合征之间差异有统计学意义(P<0.01),静止时交替同步性震颤节律与交替同步性震颤节律在特发性震颤和帕金森综合征之间差异无统计学意义(P>0.05)。姿势时同步性震颤节律与交替性震颤节律在特发性震颤和帕金森综合征之间差异有统计学意义(P<0.01),姿势时交替同步性震颤节律与无震颤在特发性震颤和帕金森综合征之间差异无统计学意义(P>0.05)。在应用静止时和姿势时同时评价的方法发现帕金森综合征震颤表现为12种形式,特发性震颤表现为9种形式。结论通过震颤类型分析可以看出,帕金森综合征和特发性震颤震颤类型分布不同。可为二者鉴别诊断提供依据。

Objective To investigate the characteristics of tremor in patients with essential tremor and patients with Parkinsonism for differential diagnosis between them. Methods Thirty,eight patients with essential tremor（ET） and forty-two patients with Parkinsonism （PDS）were enrolled in the study. The tremor was recorded by surface EMG. The characteristics of tremor were analysed and the difference between them was compared. Results The essential tremor and Parkinsonism both had resting tremor and posture tremor. There were four types of condition in resting tremor and posture tremor： no tremor, alternating tremor, synchronic tremor, alternating-synchronic tremor. In resting state there was significant difference in alternating tremor between PDS and ET （P 〈 0.01 ） ;there were the same conditions in no tremor between alternating tremor and synchronic tremor between alternating tremor, however, there was no significant difference in synchronic tremor and alternating-synchronic tremor between PDS and ET （ P 〉 0. 05 ） respectively. In posture state there was significant difference in synchronic tremor between PDS and ET （ P 〈 0. 01 ）, and there was significant difference in no tremor between synchronic tremor and synchronic tremor between alternating tremor respectively;while there was no significant difference in alternating tremor between PDS and ET（ P 〉 0.05 ）. Evaluating in both resting tremor and posture tremor, we found there were 12 types of condition in Parkinsonism and 9 types of condition in essential tremor. Conclusion ET and PDS have different characteristics of tremor. The difference may be used as an adjunctive tool for differential diagnosis.