加速度传感器定量电生理测定对帕金森震颤与原发性震颤的鉴别诊断效果

Evaluating the electrophysiological features of tremor in Parkinson＇s disease and essential tremor using accelerometry

目的通过加速度传感器定量电生理测定研究帕金森病（PD）和原发性震颤（ET）患者左右两侧肢体震颤幅度、震颤频率、频谱宽度的特征。方法回顾性分析并比较2015年5月至2016年4月在浙江大学附属第二医院门诊就诊的伴有震颤型帕金森病患者35例，原发性震颤患者40例，通过加速度传感器测定震颤程度不同的35例帕金森震颤（PT）患者和40例原发性震颤患者的震颤幅度、震颤频率、震颤频谱宽度以及负重对其影响，以总结两组患者的电生理学特点。结果在静止状态、姿势状态和负重状态下，帕金森病平均振幅震颤弱的一侧比震颤强的一侧震颤幅度小，弱侧分别为（147±32）、（142±36）、（157±40）μV，强侧分别为（185±41）、（164±29）、（190±33）μV；原发性震颤组平均振幅震颤弱的一侧也比震颤强的一侧震颤幅度小，弱侧分别为（149±33）、（157±33）、（169±43）μV，强侧分别为（176±39）、（189±39）、（213±36）μV。在静止状态、姿势状态和负重状态下，震颤峰值频率帕金森病组震颤弱的一侧比震颤强的一侧快，弱侧分别为（6．1±1．1）、（6．4±1．7）、（6．5±2．0）Hz，强侧分别为（5．4±1．3）、（5．5±1．1）、（5．7±1．1）Hz，原发性震颤组震颤弱的一侧和震颤强的一侧震颤峰值频率接近，弱侧分别为（6．5±1．3）、（7．0±1．2）、（7．2±1．5）Hz，强侧分别为（7．0±1．0）、（7．3±1．0）、（7．6±1．1）Hz。在静止状态和姿势状态下，震颤频谱宽度帕金森病组震颤弱的一侧较震颤强的一侧宽，弱侧分别为（2．1±0，6）、（2．4±1．1）Hz，强侧分别为（1．6±0．8）、（1．7±0．9）Hz，但是在负重状态下，两侧频谱宽度接近，弱侧为（2．3±1．2）Hz，强侧为（2．2±1．1）Hz；在静止状态、姿势状态和负重状态下，原发性震颤组频谱宽度震颤弱的一侧同震颤强的一侧接近弱侧分别为（2．0±1．1）、（2．2±0．9）、（1．9±1．0）Hz，强侧分别为（1．8±0．6）、（1．9±0．8）、（2．1±0．7）Hz。结论帕金森病组和原发性震颤组患者震颤幅度均存在不对称性；帕金森病患者震颤峰值频率是不对称的，频谱宽度存在不对称性，而原发性震颤患者是对称的，通过加速度传感器测定的震颤参数能够用来区分帕金森病和原发性震颤患者。

Objective To investigate the electrophysiological features of tremor intensity, frequency and frequency dispersion of Parkinsonian （PT group ） and essential （ET group ） tremors using aceelerometry. Methods The amplitude, frequency and frequency dispersion of rest tremor, postural tremor and the influence of weight on tremor of 35 PT patients and 40 ET patients in Department of Neurology, the Second Affiliated Hospital Zhejiang University School of Medicine from May 2015 to April 2016 were retrospectively analyzed and compared. Data of the more and less trembling hands were statistically elaborated. Results In resting, postural and loading states, PT amplitudes of the less affected hand were smaller than the more affected one. The less affected hand were （ 147 ± 32 ） , （ 142 ± 36 ） , （ 157 ± 40） μV, the more affected hand were （ 185 ± 41 ）, （ 164 ± 29 ）, （ 190 ± 33 ） μV, respectively ; ET amplitudes of the less affected hand were also smaller than the more affected one, and the less affected hand were （ 149 ± 33 ）, （ 157 ± 33 ）, （ 169 ±43 ） μV, the more affected hand were （ 176 ± 39 ）, （ 189 ± 39 ）, （213 ±36）μV, respectively; PT frequencies of the less affected hand were faster than the more affected one, with the less affected hand （6. 1 ±1.1）, （6.4±1.7）, （6.5±2.0）Hz, the more affected hand （ 5.4 ± 1.3）, （5.5 ± 1.1 ）, （ 5.7 ± 1.1 ） Hz, respectively, but ET frequencies of the less affected hand were similar to the more affected one, with the less affected hand （6.5 ± 1.3 ）, （7.0 ± 1.2）, （7.2 ± 1.5 ） Hz, the more affected hand （7.0 ± 1.0）, （7.3 ± 1.0）, （7.6 ± 1.1 ） Hz, respectively; in resting and postural states, PT frequency dispersions of the less affected hand were broader than the more affected one, the less affected hand were （ 2. 1 ± 0.6 ） , （ 2.4 ± 1. 1 ） Hz, respectively; the more affected hand were （ 1.6 ± 0.8 ）, （ 1.7 ± 0.9） Hz, respectively. But in loading state, PT frequency dispersions were similar in both sides （2.3 ± 1.2, 2.2 ± 1.1 ） Hz ; In resting, postural and loading states, ET frequency dispersions were also similar in both two sides , the less affected hand were （2.0 ± 1.1 ） , （2.2 ± 0.9 ） , （ 1.9 ± 1.0） Hz , the more affected hand were （1.8 ±0.6）, （1.9 ±0.8）, （2.1 ±0.7）Hz. Conclusions Tremor intensity is significantly asymmetric both in PT and ET, while frequency and frequency dispersion are symmetric in ET but asymmetric in PT. Bilateral assessment of frequency related tremor parameters may be useful for differentiating ET from PT.