震颤分析用于早期帕金森病的诊断价值

doi:10.19723/j.issn.1671-167X.2019.06.021

摘要/Abstract

摘要：

目的研究震颤分析在以震颤为主的帕金森病患者中的早期识别作用。方法本研究为前瞻性队列研究,入组对象为年龄>45岁、病程小于3年、于2014年1月至2015年12月在北京大学第三医院门诊或住院的单侧肢体震颤患者,记录流行病学资料、统一帕金森病评定量表-Ⅲ评分、非运动症状量表评分等。对所有患者进行震颤分析和中脑超声检查,按照震颤分析是否符合典型帕金森病的表现将患者分为三组:单侧震颤,震颤分析符合典型帕金森病表现,对侧无特异性表现(25例);单侧震颤,震颤分析双侧均符合典型帕金森病表现(15例);单侧震颤,震颤分析不符合典型帕金森病表现(30 例)。每半年或一年进行电话随访或面访,直到患者确定诊断。结果三组患者的发病年龄、性别分布、汉密尔顿抑郁量表评分、Hoehn-Yahr(H-Y)分级差异无统计学意义(P>0.05)。统一帕金森病评定量表-Ⅲ评分的平均值三组分别为18.23、18.79和14.67,差异有统计学意义(P=0.001)。非运动症状量表评分的平均值三组分别为15.81、17.07和9.90,差异有统计学意义(P<0.001)。中脑超声检查的阳性率三组分别为48.0%、60.0%和26.67%,差异无统计学意义(P=0.702)。经过3年的随访,本组70例患者中有35例(50%)符合2015年国际帕金森病和运动障碍协会的帕金森病诊断标准,19例(27.1%)为特发性震颤,7例(10%)为帕金森叠加综合征。在进行帕金森病的早期诊断方面,震颤分析灵敏度为82.8%,特异度为68.6%,中脑超声灵敏度为65.7%,特异度为62.9%,两种检查方法具有一致性(Kappa=0.568)和差异性(P=0.031)。结论震颤分析可以较为敏感和优越地识别以震颤为主要表现的早期帕金森病患者,但同时应注意结合患者的非运动症状和中脑超声检查。

关键词: 帕金森病, 震颤, 肌电图

Abstract:

Objective: To investigate the diagnostic value of tremor analysis in early stages of Parkinson’s syndrome, when the clinical symptoms of tremor onset are not unilaterally often able for a definite diagnosis to be made.Methods: We included 70 patients with unilateral tremor, under 45 years old and disease duration within 3 years enrolled in Peking University Third Hospital from January, 2014 to December 2015. We recorded clinical features, unified Parkinson’s disease rating scale (UPDRS)-Ⅲ, non-motor symptom (NMS) scores. Tremor analysis and transcranial sonography were performed for all the patients. Based on the results of tremor analysis, we arbitrarily divided the patients into 3 groups: (1) The patients with classical Parkinson’s syndrome manifestations on one side (25 cases); (2) The patients with classical Parkinson’s syndrome manifestations on both sides (15 cases); (3) The patients with no classical Parkinson’s syndrome manifestations (30 cases). The patients were monitored every 6 months to 3 years, until the final diagnosis was made.Results: There was no significant difference in age, gender distribution, Hamilton depression scale (HAMD) scores and H-Y scores among the three groups (P>0.05). The average UPDRS-Ⅲ motor scores of the three groups were significantly different (P=0.001), with 18.23, 18.79 and 14.67, respectively. The average scores of NMS were significantly different, with 15.81, 17.07 and 9.90, respectively (P<0.001). The positive rates of transcranial sonography (TCS) in the three groups were 48.0%, 60.0% and 26.67%, with no significant difference (P=0.702). After three years of follow-up, 35 patients (50%) met the diagnostic criteria of Parkinson’s disease of International Parkinson and Movement Disorder Society (MDS) in 2015, 19 patients (27.1%) met the criteria of idiopathic tremor, and 7 patients (10%) met the criteria of Parkinson’s plus syndrome. The sensitivity and specificity of tremor analysis for early diagnosis of Parkinson’s disease were 82.8% and 68.6%, respectively. Compared with TCS, the sensitivity and specificity of TCS were 65.7% and 62.9%. There were consistency (Kappa=0.568) and significant difference (P=0.031) between the two methods.Conclusion: Tremor analysis is sensitive and a superior way in identifying early Parkinson’s syndrome patients with tremor dominant manifestation. The combination of non-motor symptoms and transcranial sonography are also needed at diagnosis.

Key words: Parkinson disease, Tremor, Electromyogram

中图分类号:

R742.5

刘小璇,张朔,刘娜,孙阿萍,张英爽,樊东升. 震颤分析用于早期帕金森病的诊断价值[J]. 北京大学学报（医学版）, 2019, 51(6): 1096-1102.

Xiao-xuan LIU,Shuo ZHANG,Na LIU,A-ping SUN,Ying-shuang ZHANG,Dong-sheng FAN. Diagnostic value of tremor analysis in identifying the early Parkinson’s syndrome[J]. Journal of Peking University(Health Sciences), 2019, 51(6): 1096-1102.

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Items	Group 1 (n=25)	Group 2 (n=15)	Group 3 (n=30)	Statistics	P
Age of onset/years	61.27±9.85	60.86±9.95	64.63±9.59	F=1.118	0.333
Gender (M/F)	15/10	9/6	13/17	χ²=1.988	0.385
Disease course/months	11.08±4.0	11.93±7.05	17.33±10.05	F=5.189	0.008
UPDRS-Ⅲ	18.23±4.28	18.79±3.77	14.67±3.38	F=8.428	0.001
NMS	15.81±4.05	17.07±8.43	9.9±5.24	F=11.112	<0.001
HAMD	8.85±3.53	9.29±4.25	8.20±4.95	F=0.339	0.714
MMSE	26.58±1.68	26.5±1.70	27.83±1.32	F=5.997	0.004
NMS>2	7 (28.0)	9 (60.0)	6 (20.0)	χ²=7.636	0.022
TCS (+)	12 (48.0)	9 (60.0)	8 (26.7)	χ²=5.271	0.072
H-Y scale	1.21±0.68	1.07±0.58	0.63±0.52	F=6.955	0.002

Items	Group 1 (n=25)	Group 2 (n=15)	Group 3 (n=30)	Statistics	P
Peak frequency/Hz
At rest
Tremor side	5.38±0.70	5.27±0.78	6.59±1.65	F=4.422	0.040
Non-tremor side	2.89±2.18	4.94±0.70	5.33±2.49	F =6.007	0.001
Posture
Tremor side	6.38±0.71	6.16±1.47	6.87±2.36	F =3.095	0.304
Non-tremor side	4.32±2.14	5.68±2.08	5.07±3.04	F =0.995	0.322
Tremor amplitude/μV
At rest
Tremor side	162.69±172.79	204.01±148.72	133.63±189.42	F =0.555	0.557
Non-tremor side	136.68±90.86	185.62±110.19	138.43±169.47	F =0.413	0.664
Posture
Tremor side	216.2±94.41	300.5±233.76	187.33±131.96	F =0.722	0.400
Non-tremor side	185.4±174	230.95±134.22	201.86±93.19	F =0.361	0.699
Alternative ratio
At rest
Tremor side	18 (72.0)	14 (93.3)	6 (20.0)	χ²=29.307	<0.001
Posture
Tremor side	14 (56.0)	8 (53.3)	4 (13.3)	χ²=12.776	0.002
Harmonic resonance
At rest
Tremor side	12 (48.0)	9 (60.0)	4 (13.3)	χ²⁼12.042	0.002
Non-tremor side	7 (28.0)	6 (40.0)	2 (6.7)	χ²=7.597	0.022
Posture
Tremor side	4 (16.0)	4 (26.7)	8 (26.7)	χ²=1.037	0.595
Non-tremor side	2 (8.0)	4 (26.7)	4 (13.3)	χ²= 2.707	0.258

Items	Tremor analysis (+)		Tremor analysis (-)	TCS (+)	TCS (-)	P
Items	Group 1 (n=25)	Group 2 (n=15)	Group 3 (n=30)	TCS (+)	TCS (-)	P
PD	17	12	6	23	12
Non-PD	8	3	24	13	22	0.031