伴自主神经功能障碍帕金森病患者肛门括约肌肌电图特征的临床意义分析

Clinical significance of anal sphincter electromyography in patients with Parkinson's disease associated with autonomic dysfunction

目的分析伴自主神经功能障碍帕金森病患者肛门括约肌肌电图特征的临床意义。方法选择我院自2020年1月至2022年7月接诊的150例帕金森病患者作为研究对象,伴有自主神经功能障碍(PD-AS)118例、不伴有自主神经功能障碍(PD-NAS)32例。所有患者经肛门括约肌肌电图检测平均时限、平均波幅、多相波百分比、自发电位出现率、卫星电位出现率,进行帕金森病自主神经症状量表(SCOPA-AUT)评分,肛门括约肌肌电图定量指标与SCOPA-AUT评分的关系。结果PD-AS组平均时限大于PD-NAS组,多相波百分比、卫星电位出现率均高于PD-NAS组,差异均有统计学意义(P<0.05);经多因素Logistic回归分析,平均时限、多相波百分比、卫星电位均是帕金森病患者伴自主神经功能障碍的独立预测因素(P<0.05);PD-AS组SCOPA-AUT评分为(15.56±5.48)分,高于PD-NAS组的(2.25±0.43)分,差异有统计学意义(P<0.05);经Pearson相关性分析,伴自主神经功能障碍帕金森病患者平均时限、多相波百分比均与SCOPA-AUT评分呈正相关(r值分别为0.983、0.985,P值均为0.000);经ROC曲线分析,平均时限、多相波百分比诊断帕金森病患者发生自主神经功能障碍的最佳截断值分别为14.28 ms、49.73%,联合诊断的AUC为0.903,敏感度为90.48%、特异度为69.35%。结论帕金森病患者的肛门括约肌肌电图异常程度与其自主神经功能障碍程度的关系密切,其中平均时限联合多相波百分比诊断自主神经功能障碍的效能较好。

Objective To analyze the clinical significance of anal sphincter electromyography in patients with Parkinson's disease with autonomic dysfunction.Methods 150 patients with Parkinson's disease admitted to our hospital from January 2020 to July 2022 were selected as subjects,including 118 patients with PD dysfunction(PD-AS)and 32 patients without PD dysfunction(PD-NAS).The mean duration,mean amplitude,percentage of polyphase wave,occurrence rate of spontaneous potential and occurrence rate of satellite potential were detected by anal sphincter electromyography in all patients,and the autonomic nervous symptom Scale(SCOPA-AUT)score was performed.The relationship between quantitative indicators of anal sphincter electromyography and SCOPA-AUT score was analyzed.Results The average duration of PD-AS group was higher than that of PD-NAS group,and the percentage of polyphase wave and the occurrence rate of satellite potential were higher than those of PD-NAS group,with statistical significance(P<0.05).Multivariate Logistic regression analysis showed that mean duration,percentage of multiphase wave and satellite potential were independent predictors of autonomic dysfunction in PD patients(P<0.05).The SCOPA-AUT score of PD-AS group was(15.56±5.48)points,higher than that of PD-NAS group(2.25±0.43)points,and the difference was statistically significant(P<0.05).According to Pearson correlation analysis,the mean duration and percentage of multiphase wave in PD patients with autonomic nervous dysfunction were positively correlated with SCOPA-AUT score(r values 0.983 and 0.985,P values 0.000).According to ROC curve analysis,the optimal cut-off values of mean time limit and percentage of multiphase wave for the diagnosis of autonomic dysfunction in PD patients were 14.28ms and 49.73%,the AUC of combined diagnosis was 0.903,the sensitivity was 90.48%,and the specificity was 69.35%.Conclusion The degree of anal sphincter EMg abnormalities is closely related to the degree of autonomic dysfunction in PD patients,and the average time limit combined with polyphase wave percentage is more effective in diagnosing autonomic dysfunction.