颅脑超声在诊断帕金森病患者中的临床应用

Clinical application of craniocerebral ultrasound in the diagnosis of Parkinson's disease

目的:应用经颅多普勒超声(transcranial Doppler,TCD)观察患者的黑质情况,分析TCD在诊断帕金森病(Parkinson disease,PD)中的临床应用价值。方法:选取2018年3月—2019年12月聊城市人民医院收治的60例PD患者(PD组)和60名健康人群(对照组)进行研究,所有纳入对象均进行TCD检查,观察两组患者中脑区黑质的回声强度,测量单侧黑质强回声的面积及强度;采用多因素方差分析,分析患者病程、血尿酸与黑质回声增强面积及强度的相关性;采用帕金森评分量表(UPDRS)对PD患者进行评分,分析UPDRS评分与黑质强回声面积及强度的相关性。结果:TCD检查结果显示PD组中脑区黑质出现强回声51例(85%),对照组中脑区黑质出现强回声21例(35%),两组比较差异有统计学意义(P<0.05)。PD组单侧中脑区黑质强回声面积为(0.37±0.09)cm2,与对照组的(0.13±0.07)cm2比较差异有统计学意义(P<0.05)。PD组单侧中脑区黑质强回声强度(21.34±0.12)与对照组的(15.43±0.08)比较差异有统计学意义(P<0.05)。多因素方差分析显示血尿酸是帕金森病患者黑质强回声形成的独立保护因素,而发病病程是帕金森病黑质强回声形成独立危险因素,但帕金森病黑质强回声的面积及强度与UPDRS评分无明显相关性。结论:使用经颅多普勒超声诊断帕金森病的准确率较高,可作为帕金森病的主要诊断方法,具有重要的临床应用价值。

Objective Using transcranial Doppler ultrasound(TCD)to observe the substantia nigra and analyze the clinical value of TCD in the diagnosis of Parkinson's disease(PD)in patients.Methods 60 PD patients(PD group)and 60 healthy people(control group)admitted to Liaocheng people's Hospital from March 2018 to December 2019 were selected for the study,all the patients in the group were TCD examined,the echo intensity of substantia nigra in the middle brain of the two groups was observed,and the area and intensity of the hyperechogenicity of unilateral substantia nigra were measured,to analyze the correlation between the course of disease,blood uric acid and the enhancement area and intensity of substantia nigra echo by multiple logistic regression analysis;Parkinson's score scale(UPDRS)was used to score PD patients and to analyze the correlation between UPDRS score and the hyperechogenicity area and intensity of substantia nigra.Results TCD examination showed that 51 cases(85%)of PD group had hyperechogenicity in substantia nigra,In control group,21 cases(35%)had hyperechogenicity in substantia nigra,a statistically significant difference between the two groups(P<0.05).The hyperechogenicity area of substantia nigra in PD group was(0.37±0.09)cm2,which was significantly different from that in control group(0.13±0.07)cm2(P<0.05).There was significant difference between the unilateral substantia nigra hyperechoic intensity in PD group(21.34±0.12)and that in control group(15.43±0.08)(P<0.05).Multiple logistic regression analysis showed that serum uric acid was an independent protective factor for the formation of substantia nigra hyperechogenicity in Parkinson's disease,the course of the disease is an independent risk factor for the formation of hyperechogenicity in the substantia nigra,however,there was no significant correlation between the area and intensity of substantia nigra hyperechogenicity in Parkinson's disease and UPDRS score.Conclusion The accuracy of transcranial Doppler ultrasound in the diagnosis of Parkinson's disease is high,which can be used as the main diagnostic method of Parkinson's disease and has important clinical application value.