加速度记录仪定量化评价运动障碍性疾病

Actigraph monitor in quantitative evaluation of severity of movement disorders

目的利用不同方法解析加速度记录仪记录的身体活动，定量化评价神经科不同疾病所致运动障碍的程度。方法81例帕金森病（Parkinson’s disease，PD）患者以及61例伴有上肢功能障碍的急性脑梗死（acute cerebral infarction，ACI）患者，根据PD与ACI国际治疗指南常规治疗，于治疗前与治疗后（PD患者24～38d后，脑梗死患者约28d后）分别将加速度记录仪佩戴于同一例患者利手侧手腕连续记录6d。同时利用统一PD评分量表（UPDRS）评价治疗前后PD患者的临床评分，应用Fugl—Meyer量表（FMA）和功能独立性评定量表（FIM）评价ACI患者上肢运动功能和进食、梳洗、穿脱上衣等功能；解析加速度记录仪记录的身体活动数据，用幂型自相关指数（power-law exponent，PLE）以及去趋势波动分析指数（detrended fluctuation analysis，DFA）分别评价PD患者与ACI患者用药前后的指数变化，并分析各组患者的临床量表评分与PLE和DFA的相关性。结果与用药前比较治疗后PD患者的UPDRS总分与UPDRS运动障碍部分（UPDRSⅢ）评分以及PLE指数均显著改善（UPDRS总分：32．8±16．2、28．8±14．7，Z=2．080，P=0．038；UPDRSⅢ：18．6±8．2、15．7±6．8，Z=2．155，P=0．031；PLE：0．98±0．25、0．82±0．21；Z=2．212，P=0．027），PLE指数的改善率与UPDRS总分、UPDRSⅢ评分的改善率呈直线相关（r=0．699、0．823，均P〈0．05）；ACI患者FMA评分、FIM评分以及DFA指数较治疗前显著改善（FMA：12．39±8．21、30．28±7．29，Z=3．016，P=0．004；FIM：8．98±7．29、13．21±7．6，Z=2．282，P=0．038；DFA：0．86±0．31、0．98±0．27，Z：2．360，P=0．036），DFA指数与ACI患者的FMA、FIM评分的改善率呈直线相关（r=0．638、0．712，均P〈0．05）；PLE指数与ACI的临床量表评分、DFA指数与PD的临床量表评分无相关性。结论解析加速度记录仪所记录的身体活动的PLE指数可能能够定量化评价肢体僵硬、运动迟缓类型运动障碍的程度，而DFA则可能对肢体瘫痪或无力类型运动障碍的评价有较高的特异性，利用针对性的分析方法解析加速度记录仪记录的身体活动可作为运动障碍性疾病患者使用的定量化评价工具。

Objective To quantitatively assess severity of movement disability by analyzing physical activities recorded by an actigraph monitor in patients with neurology disorders. Methods Eighty-one patients with Parkinson＇ s disease （PD） and 61 patients with acute cerebral infarction （ACI） accompanying impaired upper limb motor function were included in the study. PD patients and ACI patients were treated using the international PD and ACI treatment guidelines, respectively. The patients were asked to wear an Actigraph monitor for 6 days before the treatment in both PD and ACI patient groups and at 24--38 days post-treatment in PD patients or at 28 days post-treatment in ACI patients. The recorded data was analyzed by power-law exponent （PLE） and detrended fluctuation analysis （DFA）. Clinically, before and after the treatments, PD patients were evaluated using the conventional Unified Parkinson Disease Rating Scale （UPDRS）, and ACI patients were evaluated by assessing upper limb motor function using Fugl-Meyer Assessment （FMA） and Functional Independence Measure （FIM）. The correlation of the UPDRS scores with PLE was analyzed in PD patients, and the correlation of FMA or FIM with DFA in ACI patients. Results Both the UPDRS scores and the PLE values in PD patients were improved after the drug administration （ UPDRS total：32. 8 ± 16. 2 and 28.8 ± 14. 7, Z = 2. 080, P = 0. 038 ; UPDRS m ： 18.6 ± 8.2 and 15. 7 ±6. 8, Z=2. 155, P =0. 031 ; PLE：0. 98 ±0. 25 and 0. 82 ±0. 21, Z =2. 212, P =0. 027, before and after the treatment, respectively）. There were a linear correlation coefficient of 0. 699 between the improvements of total UPDRS scores and the PLE values, and of 0. 823 between the UPDRS m and the PLE values. FMA, FIM scores and DFA were improved significantly than before treatment （FMA：12.39 ± 8.21 and30.28±7.29, Z=3.016, P=0.004; FIM： 8.98 ±7.29 and 13.21 ±7.6, Z=2.282, P= 0. 038 ; DFA： 0. 86 ± 0. 31 and 0. 98 ± 0. 27, Z = 2. 360, P = 0. 036, before and after the treatment, respectively）. It also showed linear correlations between the improvements of FMA scores and DFA （r = 0. 638）, and between FIM scores and DFA （r =0. 712, both P 〈0. 05）. There was no correlation between UPDRS scores and DFA values in PD patients, nor between FIM scores or FMA scores and PLE values in ACI patients. Conclusions Actigraph device can be used to monitor patients activity in movement disorders. Analysis of its PLE can provide a quantitative evaluation in PD while its DFA may provide useful specific assessment of impaired upper limb motor function in ACI patients. It can also be used in quantitatively assessing new drug efficacy.