血管性帕金森综合征与帕金森病的临床与影像学特点

Clinical features and imaging between vascular Parkinsonism and Parkinson disease

目的探讨血管性帕金森综合征(VP)和原发性帕金森病(PD)临床特点及影像学表现的差异。方法选取VP、PD患者各30例,观察二者脑血管病危险因素、脑血管病病史情况,行UPDRSⅢ、ADL、PSQI、MMSE、HAD量表的相关评分,测量卧立位血压,进行嗅觉测定,分析患者颅脑CT或MRI病灶特点。结果 VP组有脑血管病危险因素、脑血管病病史比例明显高于PD组(P均<0.05)。两组肌强直、震颤症状、锥体束征、假性球麻痹、智能障碍、嗅觉障碍情况比较均有统计学差异(P均<0.05)。影像学表现上,VP组以脑室旁白质及基底节区多发性腔隙性梗死多见,PD则无特征性改变,两组比较P<0.05。结论 VP是一种特殊类型的帕金森综合征,临床特征、影像学表现和嗅觉功能检测可以作为与PD的重要鉴别点。

Objective To compare the difference of clinical and imaging features between vascular Parkinsonism（ VP） and Parkinson disease（ PD）. Methods 30 patients with VP and30 patients with PD were chosed in our study. The study was carried out in the following ways. Comparing general state of health,the risk factors and history of cerebrovascular disease; Scoring all patients by unified Parkinson ＇s disease rating scale part Ⅲ（ UPDRS Ⅲ）,daily living scale（ ADL）,the pittsburgh sleep quality index scale（ PSQI）,Easy-mental state examination（ MMSE）,and the hospital anxiety depression scale（ HAD）,thereby analyzing their clinical features quantitatively. Meanwhile,measuring blood pressure in decubitus position and erect position,analyzing their olfactory sensation by olfactory test. Analyzing and comparing the lesion characteristics in CT or MRI of all patients. Results VP group had significantly higher cerebrovascular disease risks and rate of cerebrovascular disease history than those of PD group（ all P〈0. 05）. The two group had significant difference in rigidity,tremor,pyramidal signs,pseudobulbar palsy,mental retardation,olfaction disorder（ all P〈0. 05）. As for CT /MRI imaging features,VP group was characterized as multiple lacunar infarction in periventricular white matter and basal ganglia,bilaterally,with brain atrophy and leukoaraiosis,while single lacunar infarction was rare. There were no characteristic changes in PD group. Conclusions VP is a special type of Parkinsonism. The difference in clinical,imaging features and olfactory test could be important discriminations.