临床不同分期帕金森病患者震颤特点分析

Analysis of tremor characteristics in patients with Parkinson's disease in different stages

目的研究不同临床分期帕金森病(PD)患者震颤的特点。方法收集2014-11—2015-05首都医科大学附属北京天坛医院神内病房临床确诊或临床诊断PD可能性大的75例患者。患者至少具有一侧上肢静止性或姿势性震颤,按照Hoehn-Yahr分期分为1~1.5期、2~2.5期、3期3组,分别检测各组患者静止、姿势及持物1000g震颤的优势频率、振幅及震颤节律形式。结果 (1)震颤优势频率:静止、姿势状态下为4~7 Hz,1~1.5期与2~2.5期、3期组间比较差异无统计学意义(P>0.05)。持物1000g状态下,1~1.5期与2~2.5期、3期组间比较差异有统计学意义(P<0.01),1~1.5期患者优势频率除了4~7Hz之外,还有7~10Hz、无规律及无震颤。(2)震颤振幅:随病情进展有下降趋势。(3)震颤节律形式:临床不同分期患者静止、姿势及持物1000g时震颤的节律形式均以交替形式为主,但随着病情进展,非交替节律比例有增加趋势。结论 PD患者震颤属于中枢性震颤,静止、姿势震颤优势频率为4~7Hz,不随病情进展而变化。疾病初期,持物1000g状态震颤优势频率可能受外周调节而表现多样。震颤节律不受病情进展及姿势影响。随病情进展,非交替节律比例有增加趋势,震颤振幅有下降趋势。

Objective To explore the characteristics of the tremor of Parkinson＇s disease（PD）,including tremor frequency,amplitude and rhythm form in PD patients with different clinical stages.MethodsFrom November 2014 to May 2015,75 patients who were definitely or probably diagnosed as PD in a neurological ward were tested and analyzed for dominant tremor frequency,amplitude and rhythm under resting-state,posturing and holding 1000 g state respectively.Candidates with stationary or postural tremor in at least one upper extremity,were divided into 1-1.5phase,2-2.5phase,and 3phase groups according to the Hoehn-Yahr stage.Results（1）The predominat frequency of tremor：the predominat frequency of tremor was 4-7 Hz in rest and postural positions.There was no significant difference among different clinical stages（P〉0.05）.When holding 1000 g load,there was a statistically significant difference between the 1-1.5phase and 2-2.5,3phases（P〈0.01）.Patients in 1-1.5phase had tremor frequency of 4-7Hz,7-10 Hz,or irregular tremor and no tremor occurs.（2）Tremor amplitude：It was observed that the amplitude of tremor decreased with the progression of the disease.（3）Tremor rhythm pattern：rhythm pattern of tremor at different status in different clinical stages was alternating rhythm tremor,but with the progress of the disease,the proportion of non alternating rhythm had increased.Conclusions Tremor of PD was central tremor.Dominant frequency of rest,and posture tremor was 4-7Hz,and did not change with the progression of the disease.At the early stage of PD,dominant tremor frequency when holding 1000 g load may be subject to peripheral regulation and varied.Tremor rhythm is not affected by disease progression and posture.But with the disease progression,the proportion of non-alternating rhythm increases,tremor amplitude decreases.