多系统萎缩与帕金森病患者的经颅超声研究

Transcranial sonography in patients with multiple system atrophy and Parkinson＇s disease

目的对比分析多系统萎缩（MSA）与帕金森病（PD）患者的经颅超声（TCS）图像特点，探讨TCS技术在二者诊断与鉴别诊断中的应用价值。方法收集经运动障碍疾病专科确诊的29例MSA、45例PD及45例健康对照组的TCS资料，对比分析三组间黑质、豆状核、第三脑室宽度及中脑面积特点。结果三组中，MSA组豆状核异常强回声比例79．3％（23／29）高于PD组24．4％（11／45）及健康对照组22．2％（10／45），组间差异均有统计学意义（X^2=21．37、23．26，均P〈0．01）；PD组黑质异常强回声比例84．4％（38／45）高于MSA组13．8％（4／29）及健康对照组11．1％（5／45），组间差异均有统计学意义（X^2=35．87、48．50，均P〈0．01）。MSA组第三脑室宽度与中脑面积分别为（7．49±3．09）mm、（4．31±0．59）cm^2，与PD组（5．94±2．36）mm、（4．82±0．84）cm。及健康对照组（5．88±2．43）mm、（4．79±0．79）cm。相比较，MSA组第三脑室平均值最宽但中脑面积最小（F=4．10、4．68，P=0．02、0．01）。结论TCS通过显示黑质和豆状核特异性强回声以及第三脑室宽度与中脑面积的差异，为MSA和PD的诊断与鉴别诊断提供一定的价值。

Objectives To compare and contrast the characteristics of transcranial sonography （TCS）inmuhiple system atrophy（MSA）and Parkinson＇s disease（PD）, and to assess the value of TCS in the diagnosis and differential diagnosis between MSA and PD. Methods TCS files were collected in 29 MSA patients and 45 PD patients diagnosedby the Departmentof Movement Disorders and 45 healthy controls. The echogenicity of the substantia nigra and lenticular nucleus, the mesencephalic area and the width of the third ventricle among the three groups were analyzed. Results Among the three groups, the rate of hyperechogenicity of the lenticular nucleus was the highest in the MSA group 79.3%（23/29）, with 24.4% （11/45）in the PD group and 22.2% （10/45）in the healthy controls. There were statistical differences between the MSA group and the PD group（X^2 = 21.37, P〈0.01）and also between the MSA group and the healthy control group（x2 = 23.26, P〈0.01）. In contrast, the rate of hyperechogenicity of the substantia nigra was 84.4% （38/45）in the PD group, higher than in the MSA group 13.8~ （4/29）and the control group（11. 10% or 5/45）. There were statistical differences between the MSA group and the PD group（X^2=35.87, P% 0.01）and also between the MSA group and the healthy controls（X^2 =48.50,P〈0.01）. The widths of the third ventricle and the mesencephalic areas of the three groups were（7.49± 3.09） mm and （4.31±0.59） cm^2 , respectively, for the MSA group （5.94±2.36）mm and （4.82±0.84）cm^2 ,respectively,for the PD group;（5.88±2.43）mm and （4.79 0.79） cm2 , for the healthy controls. The MSA group had the widest thirdventricle （F = 4.10, P=0.02）and smallest mesencephalic area（F=4.68,P=0.01）. Conclusions The hyperechogenicity of the substantia nigra and lenticular nucleus, the width of the third ventricle and the size of the mesencephalic area measured by TCS can be important parameters indistinguishing MSA from PD.