经颅超声诊断帕金森病

Transcranial sonography in diagnosis of Parkinson disease

目的探讨经颅超声(TCS)诊断帕金森病(PD)的临床应用价值。方法随机选取478例临床确诊的神经变性疾病患者(病例组),根据诊断标准分为PD、帕金森叠加综合征、继发性帕金森综合征及原发性震颤亚组;另选取同期124名正常志愿者作为对照组。应用TCS盲法测量黑质(SN)高回声面积,比较各组SN高回声阳性率及SN高回声面积差异,计算TCS诊断PD的敏感度及特异度。对PD亚组患者进行急性多巴反应试验,比较SN高回声阳性率与多巴反应试验阳性率的差异。结果 TCS的中脑显示率为81.72%(492/602),剔除中脑显示不清者后,病例组入组389例,其中PD患者170例,对照组103名。PD亚组SN高回声阳性率和SN高回声面积均明显高于其余各组(P均<0.01)。TCS诊断PD的敏感度为81.76%(139/170),特异度为77.64%(250/322)。PD亚组多巴反应阳性率与SN高回声阳性率差异无统计学意义(P>0.01)。结论 SN高回声为PD的典型TCS特征,对于诊断PD具有重要应用价值。

Objective To observe the value of transcranial sonography （TCS） on diagnosis of Parkinson disease （PD）. Methods Totally 478 patients （disease group） clinically diagnosed as neurodegenerative diseases were stratified as PD, Parkinsonism-plus syndromes, secondary parkinsonism and essential tremor subgroups. In addition, 124 normal volunteer were selected as control group. All subjects underwent TCS to obtain the area of substantia nigra （SN） hyperechoes. The positive rate and area of SN hyperechoes were compared among the groups. The sensitivity and specificity of area of SN hy- perechoes for diagnosing PD was calculated, respectively. Dopaminergic responsiveness test was performed in PD patients, and the positive rate of Dopaminergic responsiveness test was compared with the rate of SN hyperechoes. Results The display rate of midbrain in TCS was 81.72X （492/602）. After rejecting subjects with unclear images, there were 389 in disease group （including 170 PD cases） and 103 in control group. The rate and area of SN hyperechoes in PD subgroup were both higher than those in the other groups. The diagnostic sensitivity and specificity o{ SN hyperechoes was 81.76 （139/170） and 77.64% （250/322）, respectively. There was no statistical difference between positive rate of SN hyperech- oes and dopamine response in PD subgroup （P〉0.01）. Conclusion SN hyperechoes was a characteristic manifestation on TCS in patients with PD, having important clinical application value.