本文選題：多系統(tǒng)萎縮　切入點：帕金森病　出處：《大連醫(yī)科大學(xué)》2014年碩士論文　論文類型：學(xué)位論文

【摘要】：目的：多系統(tǒng)萎縮（multiple systematrophy，，MSA）和PD（Parkinson's disease，PD）在臨床表現(xiàn)上均有自主神經(jīng)癥狀，使得MSA與PD難以鑒別，尤其在疾病早期，MSA誤診為PD超過20%。因此，提高對MSA和PD的認(rèn)識，探索能夠早期區(qū)別MSA和PD的有效、無創(chuàng)的客觀檢測方法，對于最大限度地降低MSA和PD患者的誤診率和致殘率具有重要臨床意義。既往研究推薦了多種用于早期鑒別MSA和PD的客觀檢測方法，包括咽鼓管充氣實驗、傾斜實驗、催汗功能實驗、定量催汗軸突反射實驗、交感皮膚反應(yīng)、正電子斷層發(fā)射掃描、磁共振波譜分析、肛門括約肌和尿道括約肌肌電圖、膀胱功能評價、臥立位血壓以及瞳孔試驗等；但這些客觀檢測方法在MSA和PD早期鑒別診斷中的價值尚有爭議。本研究通過比較MSA與PD患者間心率變異性（heart ratevariability，HRV）各項參數(shù)的差異，旨在為臨床早期鑒別這兩種疾病尋求特異性的客觀指標(biāo)。 方法：選取2012年10月至2014年1月于大連醫(yī)科大學(xué)附屬第一醫(yī)院神經(jīng)內(nèi)科住院治療的MSA患者34例和PD患者31例（病程均2年），并以30例健康體檢者作為對照組。收集所有受試者的下列數(shù)據(jù)：流行病學(xué)特點（包括包括性別、年齡和病程）以及HRV各項參數(shù)（包括頻域和時域）。分別對MSA和PD患者采用Hoehn-Yahr（H-Y）分期、統(tǒng)一的帕金森病綜合評分表（Unifed Parkinson's Disease Rating Scale，UPDRS）和簡易智能狀態(tài)檢查表（Mini Mental State Examination，MMSE）評分評估疾病的嚴(yán)重程度。采用單因素方差分析和受試者工作特征曲線（receiver operator characteristic curve，ROC）分析，篩選出特異的臨床和實驗室指標(biāo)用于早期識別這兩種疾病。 結(jié)果： MSA組34例中，男性18例（52.9%），女性16例（47.1%）；MSA-P型26例（76.3%），MSA-C型8例（23.5%）。PD組31例中，男性14例（45.2%），女性17例（54.8%）。對照組30例，其中男性15例（50.0%），女性15例（50.0%）。三組性別構(gòu)成比差異無統(tǒng)計學(xué)意義（χ2=0.011，P0.05）。MSA組、PD組和對照組的年齡分別為(60.26±6.46)歲、（62.74±5.96）歲和（59.37±6.02）歲，三組平均年齡比較差異無統(tǒng)計學(xué)意義（F=2.478，P=0.090）。MSA組和PD組患者M(jìn)MSE評分、病程比較差異均無統(tǒng)計學(xué)意義（P分別0.05）。但MSA組和PD組患者UPDRS評分分別為（24.32±3.99）分和（21.32±3.64）分，差異具有統(tǒng)計學(xué)意義（P0.05）。MSA組和PD組患者平均H-Y分期分別為（2.44±0.44）期和（1.29±0.62）期，差異具有統(tǒng)計學(xué)意義（P0.05）。三組受試者HRV時域參數(shù)SDNN、SDANN、rMSSD比較，差異均無統(tǒng)計學(xué)意義（P分別0.05）；但對照組和MSA組患者PNN50%、CV比較，差異均具有統(tǒng)計學(xué)意義（P分別0.01）。三組受試者HRV頻域參數(shù)中ULF、總功率、LF/HF比較，差異均無統(tǒng)計學(xué)意義（P分別0.05）；但對照組和MSA組患者的VLF、LF、HF比較，差異均具有統(tǒng)計學(xué)意義（P分別0.01）。ROC曲線分析結(jié)果表明，PNN50%、CV、VLF、LF、HF、H-Y分期、UPDRS均具有統(tǒng)計學(xué)意義（P分別0.01）。VLF、CV、LF、HF、PNN50%、UPDRS評分和H-Y分期的ROC曲線下面積及其95%置信區(qū)間分別為0.703（0.599-0.807）、0.667（0.561-0.773）、0.660（0.553-0.767）、0.650（0.542-0.758）、0.640（0.532-0.748）、0.305（0.179-0.431）和0.068（0.010-0.126）。ROC曲線下面積由大到小的指標(biāo)依次為VLF、CV、LF、HF、PNN50%、UPDRS評分和H-Y分期。 結(jié)論：（1）在疾病早期，MSA組患者較PD組患者總體病情嚴(yán)重。（2）與PD不同，MSA患者早期即有交感和迷走神經(jīng)受累，從而出現(xiàn)心血管自主神經(jīng)功能障礙。（3）HRV分析簡便、無創(chuàng)且費用低廉，是評估MSA患者心血管自主神經(jīng)活動的有效方法。（4）與HRV其他指標(biāo)相比，VLF對評估MSA等神經(jīng)系統(tǒng)變性疾病早期心血管自主神經(jīng)功能障礙可能具有更好的參考價值，有助于MSA和PD的早期鑒別診斷。
[Abstract]:Objective: multiple system atrophy (multiple systematrophy, MSA) and PD (Parkinson's disease PD) have autonomic symptoms in clinical manifestation, the MSA and the PD is difficult to identify, especially early in the disease, MSA misdiagnosed as PD more than 20%. so that to improve the understanding of MSA and PD, and to explore the early differences between MSA and PD effective, no objective invasive detection method, to minimize the misdiagnosis of MSA and PD in patients with the rate of disability and has important clinical significance. Previous studies have recommended a variety of objective detection method for early identification of MSA and PD, including the eustachian tube inflation experiment, tilt test, sudomotor function test, quantitative sudomotor axon reflex test, sympathetic skin response, positron emission tomography scanning, magnetic resonance spectroscopy, anal sphincter and urethral sphincter electromyography, bladder function evaluation, orthostatic blood pressure and pupil test; but the objective detection The value of the method in the early differential diagnosis of MSA and PD is still controversial. In this study, we compared the differences between the parameters of heart RateVariability (HRV) between MSA and PD patients in order to find specific objective indicators for identifying these two diseases in early stage.
Methods: from October 2012 to January 2014 at the Dalian Medical University hospital in 34 cases of PD patients and 31 MSA patients were first Affiliated Hospital (the duration of disease was 2 years), and 30 healthy subjects as control group. The following data were collected from all subjects: epidemiological characteristics (including gender, age and course) and the HRV parameters (including time domain and frequency domain). Using the Hoehn-Yahr of MSA and PD patients (H-Y) staging, unified Parkinson's Disease Rating Scale (Unifed Parkinson's Disease integrated Rating Scale, UPDRS) and mini mental state examination (Mini Mental State Examination, MMSE) to evaluate the disease severity score was analyzed by single. ANOVA and receiver operating characteristic curve (receiver operator characteristic curve, ROC) analysis, screening of clinical and laboratory indices specific in early identification of these two kinds of diseases. Disease.
緇撴灉錛

本文編號：1620519