本文選題：原發(fā)性震顫 + 帕金森病��； 參考：《浙江大學》2017年碩士論文

【摘要】：研究目的:探討原發(fā)性震顫(essential tremor,ET)的非運動癥狀,同時探討ET和帕金森病(Parkinson disease,PD)震顫和電生理上的異同點,為原發(fā)性震顫診斷提供診斷思路。研究方法:選取2015年5月至2016年4月在浙江大學附屬第二醫(yī)院門診就診ET患者70例,PD患者50例以及性別年齡匹配的健康志愿者(生理性震顫組)45例。其中50例ET患者納入非運動癥狀的研究,這部分患者應用漢密爾頓焦慮量表(Hamilton anxiety scale,HAMA,14 項版本)及漢密爾頓抑郁量表(Hamilton depression scale,HAMD,24項版本)評價焦慮及抑郁,匹茨堡睡眠量表(Pittsburgh sleep scale,PQSI)評估患者睡眠質量,采用健康狀況調查問卷簡表(the MOS item short from health survey,SF-36)評估患者日常健康狀況;采用簡明心理量表(mini-mental state examination,MMSE)量表評估患者認知功能。通過震顫評分系統(tǒng),完善ET、PD患者震顫評分。通過加速度傳感器測定對所有受試者進行不同姿勢狀態(tài)下的震顫分析檢查�；仡櫺苑治霾⒈容^伴有震顫型帕金森病患者35例,原發(fā)性震顫患者40例,通過加速度傳感器測定震顫程度不同的35例帕金森震顫(PT)患者和40例原發(fā)性震顫(ET)患者的震顫幅度、震顫頻率、震顫頻譜寬度以及負重對其影響,以總結兩組患者的電生理學特點。研究結果:1、典型ET患者表現(xiàn)為姿勢性或意向性震顫,但在一些嚴重病例可出現(xiàn)靜止性震顫,可伴有頭部、口面部或聲音震顫。ET組MMSE評分總分為25.60±2.76分,低于健康對照組28.16±1.71分(P0.001)。ET組睡眠障礙發(fā)生率(62%)較對照組(15%)高(P0.05),ET組PSQI平均分為(6.42±2.71),同健康對照組平均分(3.84±2.13)比較,差異有統(tǒng)計學意義(P0.05)。ET組患者發(fā)生中度焦慮或者嚴重焦慮的比例(78%)高于健康對照組發(fā)生率(22.5%)(P0.05),ET組患者發(fā)生中度抑郁或者嚴重抑郁的比例(34%)也較健康對照組(7.5%)高(P0.05)。焦慮和抑郁會影響患者的身心健康,并且和患者的生活質量相關。2、兩組患者震顫評分及肌電圖表現(xiàn):患者震顫評分的比較:PD和ET患者,負重狀態(tài)下震顫評分均比靜止狀態(tài)高(P0.05)。震顫峰值頻率比較:三組患者負重狀態(tài)同靜止狀態(tài)比較,震顫頻率均有所下降,健康對照組下降明顯,差異有統(tǒng)計學意義(P0.05),PD組和ET組差異無統(tǒng)計學意義。如果按照震顫評分將雙上肢均受累的ET組和PD組分為強側和弱側時,在靜止狀態(tài)、姿勢狀態(tài)和負重狀態(tài)下,帕金森病及原發(fā)性震顫組平均振幅震顫弱的一側比震顫強的一側震顫幅度小(P0.05);帕金森病組震顫峰值頻率震顫弱的一側比震顫強的一側快(P0.05),原發(fā)性震顫組震顫強弱不同的兩側震顫峰值頻率接近;在靜止狀態(tài)和姿勢狀態(tài)下,帕金森病組震顫頻譜寬度震顫弱的一側比強的一側寬(P0.05);在靜止狀態(tài)、姿勢狀態(tài)和負重狀態(tài)狀態(tài)下,原發(fā)性震顫組震顫強的一側頻譜寬度接近弱的一側。研究結論:ET患者有運動癥狀,還伴有非運動癥狀。按照震顫強弱不同的側別來分,PD患者震顫峰值頻率和峰值寬度是不對稱的,而ET患者是對稱的,通過加速度傳感器測定的震顫參數(shù)能夠用來區(qū)分ET和PD患者。
[Abstract]:Objective: To investigate the non motor symptoms of essential tremor (ET), and to explore the similarities and differences between ET and Parkinson's disease (Parkinson disease, PD), and to provide diagnostic ideas for the diagnosis of primary tremor. Methods of studying ET patients in the Second Affiliated Hospital of Zhejiang University from May 2015 to April 2016. There were 70 cases, 50 PD patients and 45 healthy volunteers (physiological tremor group). Of them, 50 cases of ET were included in the study of non motor symptoms. The patients were evaluated by the Hamilton Anxiety Scale (Hamilton anxiety scale, HAMA, 14 versions) and the Hamilton Depression Scale (Hamilton depression scale, HAMD, 24 versions). Price anxiety and depression, Pittsburgh Sleep Scale (PQSI) were used to assess patients' sleep quality. The health status of patients was assessed by the health status questionnaire (the MOS item short from health survey, SF-36), and the patient's cognitive function was assessed by a simple mental scale. The tremor score of ET and PD patients was perfected by the tremor score system. The tremor analysis of all the subjects was measured by acceleration sensor. 35 patients with tremor type Parkinson's disease, 40 cases of primary tremor and 35 cases of different degree of tremor were measured by acceleration sensor. The amplitude of tremor, the frequency of tremor, the spectrum width of the tremor and the effect of weight negative on 40 patients with Parkinson and 40 patients with primary tremor (ET) were used to summarize the electrophysiological characteristics of the two groups of patients. The results were as follows: 1, the typical ET patients showed postural or intentional tremor, but in some serious cases, static tremor could be accompanied by the presence of static tremor. The total score of MMSE score in.ET group of head, mouth, face or sound tremor was 25.60 + 2.76 points, which was lower than that of healthy control group 28.16 + 1.71 (P0.001).ET group (62%) higher than that of control group (15%), PSQI in group ET was (6.42 + 2.71), compared with the average score of healthy control group (3.84 + 2.13), the difference was statistically significant (P0.05) group.ET patients The proportion of moderate or severe anxiety (78%) was higher than that in the healthy control group (22.5%) (P0.05). The proportion of moderate depression or severe depression in the ET group (34%) was also higher than that in the healthy control group (7.5%) (P0.05). Anxiety and depression could affect the physical and mental health of the patients, and were associated with the quality of life of the patients, and the two groups of patients tremor. Score and EMG performance: the comparison of the patients' tremor score: PD and ET patients, the score of the tremor was higher than the static state (P0.05). The peak frequency of the tremor was compared: the three groups of patients were compared with the static state, the frequency of the tremor decreased and the healthy control group decreased significantly (P0.05), and the difference between the PD group and the ET group was poor. There was no statistical significance. If the ET and PD groups were divided into strong and weak sides, the average amplitude of the mean amplitude of Parkinson's disease and primary tremor was less than that of the one with a strong tremor (P0.05), and the frequency of the peak tremor in the Parkinson's disease group. The weak side of the tremor is faster than the one with a strong tremor (P0.05). The peak frequency of the two sides of the tremor in the primary tremor group is close to that of the two sides of the tremor. In the static and postural state, the tremor of the Parkinson's disease group is wider than the strong side of the tremor (P0.05); in the static, postural and negative state, the primary tremor group The spectrum width of the one side of the tremor is close to the weak side. Conclusion: ET patients have motor symptoms with non motor symptoms. The peak frequency and peak width of PD patients are asymmetric according to the different side of the tremor strength, while the ET patients are symmetrical, and the parameters measured by the acceleration sensor can be used to distinguish ET. And PD patients.

【學位授予單位】：浙江大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R742.5

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