血管性帕金森综合征对比原发性帕金森病临床特点及MR差异分析

Clinical features and MR differences of vascular Parkinson′s disease and primary Parkinson′s disease

目的探讨血管性帕金森综合征与原发性帕金森病临床特点及影像学的差异。方法选取2014年9月-2016年6月在本院诊治的50例原发性帕金森病患者(对照组)和50例血管性帕金森综合征患者(观察组),分析2组患者在临床表现及影像学检查方面存在的差异。结果观察组患者发病年龄>60岁有35例,对照组有17例,观察组发病年龄大于对照组,差异有统计学意义(P <0.05)。两组患者肌强直、言语障碍、尿失禁发生情况相比差异无统计学意义(P>0.05)。观察组行走困难、步态不稳、偏瘫、球麻痹发生率分别为36%、30%、40%、20%,而对照组分别为9%、12%、6%、8%,2组比较差异有统计学意义(P <0.05)。对照组患者静止性震颤、上肢连带运动减少发生率分别为68%、62%,均高于观察组的22%、16%,2组比较差异有统计学意义(P <0.05)。观察组病理征阳性、腱反射增强或亢进、折刀样增高、铅管样增高、下肢肌张力增高的患者例数均高于对照组(P <0.05)。对照组齿轮样增高、上肢肌张力增高的患者例数高于观察组(P <0.05)。观察组患者出现脑萎缩、皮层下白质病变、脑叶损害、脑干损害、小脑损害、基底节区病变的例数明显高于对照组,差异有统计学意义(P <0.05)。结论高龄、高血压、糖尿病、高血脂、心脏病、脑卒中是血管性帕金森综合征患者的危险因素,血管性帕金森综合征和原发性帕金森病患者有类似的临床表现,但血管性帕金森综合征主要累及下肢。影像学检查有助于两种疾病的进一步鉴别诊断。

Objective To investigate the clinical and imaging features of vascular Parkinsonism and primary Parkinson′s disease. Methods 50 cases of patients with idiopathic Parkinson′s disease （control group） and 50 patients with vascular parkinsonism （study group） were select in our hospital between September 2014 and June 2016 . the two groups of patients in clinical manifestations and the existence of differences were checked and analyzed in terms of imaging. Results There were 35 cases in the observation group with age of 〉60 years old and 17 cases in the control group. The age of onset was significantly higher in the observation group than that in the control group （P 〈0.05）. There was no significant difference in the incidence of myotonia, speech disorder and urinary incontinence between the two groups （P 〉0.05）. The incidence of walking difficulty, gait instability, hemiplegia, and ball paralysis in the observation group was 36%, 30%, 40%, and 20%, respectively, compared with 9%, 12%, 6%, and 8% in the control group, respectively. The difference was statistically significant （P 〈0.05）. The incidence of resting tremor and upper limb joint movement in the control group was （68%, 62%） significantly higher than that in the observation group （22%, 16%） （P 〈0.05）. The number of patients with positive pathological signs, increased tendon reflex or hyperthyroidism, increased stenosis, elevated lead tube, and increased muscle tone in lower limbs in the observation group were significantly higher than those in the control group （P 〈0.05）. The number of patients with increased gear-like height and increased upper limb muscle tone in the control group was markedly higher than that in the observation group （P 〈0.05）. The number of patients with brain atrophy, subcortical white matter lesions, brain lobe lesions, brain stem damage, cerebellar damage, and basal ganglia lesions in the observation group was significantly higher than that in the control group （P 〈0.05）. Conclusion Older age, hypertension, diabetes, hyperlipidemia, heart disease, and stroke are risk factors for vascular Parkinsonism. Vascular Parkinson′s disease and patients with primary Parkinson′s disease have similar clinical manifestations, but Vascular Parkinsonism mainly affects the lower extremities. Imaging studies help to further identify the two diseases.