交感神经皮肤反应在诊断帕金森病自主神经功能障碍的应用价值

The Application Value of Sympathetic Skin Response in Autonomic Dysfunction of Parkinson s Disease

目的 探讨交感神经皮肤反应(SSR)在诊断帕金森病(PD)患者自主神经功能障碍(AutD)的应用价值。方法 以137例PD患者和50例对照组作为研究对象,进行Hoehn-Yahr分级、UPDRS-Ⅲ评分和SCOPA-AUT评分,根据SCOPA-AUT评分结果分为自主神经症状组(PD-AS)和PD无自主神经症状组(PD-NAS),并检测SSR。比较PD-AS组、PD-NAS组和对照组SSR的差别,评估SSR与PD患者的临床资料及AutD的关联性。结果 PD患者中PD-AS组102例,PD-NAS组35例。PD-AS组和PD-NAS组的SSR异常率分别为88.2%和28.6%。PD-NAS组的SSR潜伏期、波幅与对照组比较,差别无统计学意义(P>0.05);PD-AS组的SSR潜伏期、波幅与对照组和PD-NAS组比较,差别有统计学意义(P<0.01)。除性别外,年龄、病程、UPDRS-Ⅲ、Hoehn-Yahr分级均与SSR潜伏期呈正相关(P<0.01),与SSR波幅呈负相关(P<0.01)。PD患者总体和PD-AS组的SCOPA-AUT总分、消化系统、泌尿系统、心血管系统、体温调节系统、瞳孔调节系统和生殖系统症状评分均与SSR潜伏期呈正相关(P<0.05),与SSR波幅呈负相关(P<0.05)。消化系统症状评分对PD-AS组的上、下肢潜伏期均值均呈正向影响(F=33.398,P<0.01;F=13.736,P<0.01);泌尿系统症状和体温调节症状评分对PD-AS组的上肢波幅均值呈负向影响(F1=49.331,P<0.01;F2=30.152,P<0.01);体温调节症状评分对PD-AS组的下肢波幅均值呈负向影响(F=24.893,P<0.01)。结论 SSR潜伏期越长、波幅越低,AutD越严重,SSR可以作为PD患者AutD诊断的可靠评估手段。SSR潜伏期延长对于早期识别PD AutD有意义,且可能作为PD患者消化系统AutD的量化指标。SSR波幅可能作为泌尿系统功能和体温调节系统功能障碍的量化指标。

Objective To explore the application value of sympathetic skin response(SSR)in the diagnosis of autonomic dysfunction in patients with Parkinson s disease(PD).Methods 137 PD patients and 50 healthy controls were included as the study subjects,and all patients were evaluated Hoehn-Yahr stage scale,UPDRS-Ⅲscale,and SCOPA-AUT scale.According to the SCOPA-AUT results,they were divided into patients with autonomic dysfunction(PD-AS)and patients without autonomic dysfunction(PD-NAS),and SSR testing were performed in order to find the difference among PD-AS group,PD-NAS group and healthy control group,and to evaluate the correlation between SSR and clinical data of PD patients and autonomic dysfunction.Results There were 102 cases in the PD-AS group and 35 cases in the PD-NAS group.88.2%patients with PD-AS had abnormal SSR,28.6%patients with PD-NAS had abnormal SSR.There was no statistically significant difference in SSR latency and amplitude between the PD-NAS group and the healthy control group(P>0.05),while there was a statistically significant difference in SSR latency and amplitude between the PD-AS group and the healthy control group,as well as the PD-NAS group(P<0.01).Except for gender,age,course of disease,UPDRS-Ⅲ,Hoehn-Yahr were positively correlated with SSR latency(P<0.01),and negatively correlated with SSR amplitude(P<0.01).The scores of SCOPA-AUT,digestive system,urinary system,cardiovascular system,thermoregulation system,pupil regulation system and reproductive system symptom in PD patients and the PD-AS group were positively correlated with SSR latency(P<0.05),and negatively correlated with SSR amplitude(P<0.05).The scores of digestive system symptom showed a positive correlation with the average latency of the upper and lower limbs in the PD-AS group(F=33.398,P<0.01;F=13.736,P<0.01);The scores of urinary system symptoms and thermoregulation symptoms showed a negative correlation with the average amplitude of upper limb waves in the PD-AS group(F1=49.331,P<0.01;F2=30.152,P<0.01);The scores of thermoregulation symptoms showed a negative correlation with on the average amplitude of lower limb waves in the PD-AS group(F=24.893,P<0.01).Conclusion The longer the latency of SSR,the lower the amplitude,and the more severe the autonomic dysfunction.SSR can be a reliable evaluation tool for the diagnosis of autonomic dysfunction in PD patients.The prolongation of SSR latency is significant for early recognition of autonomic dysfunction in PD,and may be used as a quantitative indicator of autonomic dysfunction in the digestive system of PD patients.SSR amplitude may be used as a quantitative indicator of urinary system function and thermoregulation system dysfunction.