经颅超声在诊断和鉴别诊断帕金森病中的应用及黑质回声与临床特征的关系研究

Application of transcranial sonography in diagnosis and differential diagnosis and the relationships study between substantia nigra echo and clinical features of Parkinson's disease

目的探讨中脑黑质经颅超声(TCS)检查在帕金森病的诊断和鉴别诊断中的应用价值,及其与临床特征的相关性。方法回顾性分析100例帕金森病病人和50例特发性震颤的临床资料,行TCS检测所有病人黑质回声强度、面积,并计算双侧黑质高回声总面积/中脑总面积比值(S/M),黑质区高回声面积≥0.20 cm2和(或)S/M≥7%时视为TCS扫描阳性,否则为TCS扫描阴性。帕金森病组病人行统一帕金森病量表(UPDRS)Ⅱ、Ⅲ部分评分和帕金森病自主神经症状量表评分。结果帕金森病组TCS扫描阳性比例、黑质高回声面积和S/M比值均高于特发性震颤组(P<0.01)。帕金森病组TCS扫描阳性病人中年龄、UPDRSⅡ部分评分及自主神经症状量表评分均明显高于TCS扫描阴性病人(P<0.05),而两者UPDRSⅢ部分评分无明显差别(P>0.05)。在帕金森病组,男性、年龄大、UPDRSⅡ部分评分高及自主神经症状量表评分高的病人出现黑质高回声的发生率更高。结论中脑黑质TCS检测可为帕金森病的临床诊断和鉴别诊断提供一定的帮助。

Objective To discuss the application value of transcranial sonography（TCS） in diagnosis and differential diagnosis and its relationships with clinical features of Parkinson＇s disease（PD）. Methods Clinical data of 100 PD patients and 50 patients with essential tremor（ET） were analyzed retrospectively. TCS examination was performed for the echo signal intensity and area of the substantia nigra（SN） in all the patients, and then, the ratio of the bilateral SN area and the whole midbrain area（S/M） was calculated.The area of the SN hyperechogenicity ≥ 0.20 cm2 or S/M ≥ 7% was considered as positive scan（TCS＋）, or else as TCS-. The PD patients were scored by unified Parkinson＇s disease rating scales（UPDRS） Ⅱ and Ⅲ and autonomic symptoms profile. Results The rate of TCS＋, the area of the SN hyperechogenicity and S/M ratio in PD were significantly higher than those in ET patients（ P 〈0.01）. Age and the score of UPDRS Ⅱ and autonomic symptoms profile in TCS＋ group were significantly higher than that of TCSgroup in PD patients（P 0.05）, while there was no significant difference in the score of UPDRS Ⅲ between the two groups（P〉 0.05）.The incidence rate of SN hyperechogenicity was higher in male and older patients and paintents with high scores of UPDRS Ⅱ and autonornic symptoms profile in PD group. Conclusion TCS examination of SN can provide certain help for diagnosis and differential diagnosis of PD.