帕金森病患者眼球平稳追踪运动的临床研究

Clinical significance of smooth pursuit eye movement in PD patients

目的探讨原发性帕金森病(Parkinson’s disease,PD)患者眼球平稳追踪运动(smooth pursuit eye movement,SPEM)的临床意义。方法选择我院收治的PD患者32例为PD组,同期体检中心的健康体检者30例为对照组,收集所有受试者SPEM增益值及PD患者的分型、震颤分值等情况。对比2组SPEM增益值,及不同分型PD患者SPEM增益值的差异。采用多重线性回归分析SPEM增益值的影响因素,采用ROC曲线分析SPEM增益值在PD患者分型中的潜在价值。结果与对照组比较,PD组SPEM增益值显著降低(0.80±0.11 vs 0.91±0.13,P=0.001)。在PD组中,3种分型的SPEM增益值差异有统计学意义(P=0.027);与姿势异常步态障碍型患者比较,震颤优势型患者SPEM增益值显著降低(0.7±0.1 vs 0.8±0.1,P<0.01)。SPEM增益值与震颤分值呈负相关(P=0.000),SPEM增益值对非震颤型PD诊断的敏感性为79.2%,特异性为87.5%,ROC曲线下面积为0.807(95%CI:0.641~0.973,P=0.010)。结论与非震颤型患者比较,震颤优势型PD患者有更明显的SPEM功能下降,SPEM增益值可能成为鉴别震颤优势型和非震颤型较好的指标。

Objective To study the clinical significance of smooth pursuit eye movement（SPEM）in primary PD patients.Methods Thirty-two PD patients admitted to our hospital served as a PD group and 30 subjects underging physical examination in our hospital served as a control group in this study.The added SPEM value,types of PD patients,and tremor fraction were recorded.The added SPEM values in different types of PD patients were compared between the two groups.The influencing factors for added SPEM values were analyzed by multivariate linear regression analysis.The added SPEM values were analyzed by ROC curve analysis in PD patients.Results The added SPEM value was significantly lower in PD group than in control group（0.80±0.11 vs 0.91±0.13,P=0.001）.The added SPEM value was significantly different in 3 types of PD patients（P=0.027）.The added SPEM value was significantly lower in PD patients with dominant tremor than in those with posture unstable gait（0.7±0.1 vs 0.8±0.1,P〈0.01）.The added SPEM value was negatively related with the tremor fraction（P=0.000）.The sensitivity and specificity of added SPEM value in diagnosis of PD were 79.2% and 87.5% respectively.The area under the ROC curve was 0.807（95%CI：0.641-0.973,P=0.010）.Conclusion The SPEM function is significantly poorer in PD patients with dominant tremor than in those without tremor.The added SPEM value can thus used as a rather good indicator for differential diagnosis of dominant tremor from that of non-dominant tremor in PD patients.