眼动功能检查在帕金森病与多系统萎缩P型鉴别诊断的价值

The value of eye movement function examination in the differential diagnosis of Parkinson’s disease and multiple system atrophy with predominant parkinsonism

目的 评价眼动功能检查在鉴别帕金森病(PD)与多系统萎缩P (MSA-P)型的价值。方法 纳入陕西省人民医院39例PD患者和11例MSA-P型患者,行前庭眼动功能和视觉眼动功能检查并记录。结果 前庭眼动功能结果发现PD组患者均未出现自发眼震,而MSA-P型患者中仅有1例出现垂直下跳眼震。视觉眼动功能检查包括扫视试验(ST)和平滑跟踪试验(SPT)。ST、SPT速度(向左和向右)在PD组、MSA-P组与对照组三者之间差异无统计学意义(P>0.05)。ST潜伏期、ST准确度、SPT增益(向左和向右)PD组及MSA-P组患者均较对照组延长及下降,差异有统计学意义(P<0.05),但PD组与MSA-P组之间差异无统计学意义(P> 0.05)。MSA-P组(81.8%)出现SPT模式异常的比例较PD组(59.0%)明显增高,差异有统计学意义(P<0.05)。进一步分析发现,MSA-P患者的SPT模式异常多表现为追赶性扫视,而PD组患者的SPT模式异常多表现为预期性扫视,两者差异有统计学意义(P<0.05)。结论 视觉眼动功能检查尤其是SPT模式在PD与MSA-P型患者的鉴别诊断中具有一定价值,值得临床推广。

Objective To evaluate the value of eye movement function examination in distinguishing Parkinson disease(PD) and multiple system atrophy with predominant parkinsonism(MSA-P).Methods 39 PD patients and 11 MSA-P patients from Shaanxi Provincial People’s Hospital were enrolled,and the vestibular eye movement function and visual eye movement function were examined and recorded.Results The results of vestibular eye movement function showed that no patients in the PD group had spontaneous nystagmus,while only one of the MSA-P patients had vertical saccade nystagmus.Visual eye movement function examination include saccade test(ST) and smooth pursuit test(SPT).ST and SPT speeds(both left and right) were not found to be statistically different between the PD group,MSA-P group and the control group(P> 0.05).ST latency,ST accuracy,SPT gain(both left and right) in PD group and MSA-P group were prolonged and decreased compared with the control group,the difference was statistically significant(P <0.05),but there was no statistical difference between the PD group and the MSA-P group(P> 0.05).The proportion of abnormal SPT patterns in the MSA-P group(81.8%)was significantly higher than that in the PD group(59.0%),and the difference was statistically significant(P <0.05).Further analysis found that the abnormal SPT patterns of MSA-P patients were mostly catch-up saccades,while the abnormal SPT patterns of PD patients mostly presented anticipatory saccades.The difference between the PD group and the MSA-P group was statistically significant(P <0.05).Conclusion Visual eye movement function examination,especially SPT patterns,has some value in the differential diagnosis of PD and MSA-P patients,and it is worthy of clinical promotion.