本文選題：帕金森病 + 血管性帕金森綜合征��； 參考：《蘇州大學》2016年博士論文

【摘要】：第一部分帕金森病嗅球體積改變的系統(tǒng)評價與meta分析目的:系統(tǒng)評價帕金森病(PD)嗅球(OB)體積與正常對照(HC)組之間的差異。方法:計算機檢索PubMed、Embase數(shù)據(jù)庫,檢索時限為建庫至2015年1月。由兩位研究者按照納入與排除標準獨立篩選文獻、提取數(shù)據(jù)資料、評價文獻質量,使用STATA12.0進行meta分析。采用亞組分析探索異質性來源,使用漏斗圖、Begg’s和Egger’s檢驗評估發(fā)表偏移。結果:納入病例-對照研究6篇,共216例PD患者,175例HC。Meta分析結果顯示,PD組與HC組比較左、右兩側OB體積均顯著減小,右側均數(shù)差(MD)-8.071,95%可信區(qū)間(CI)(-14.721,-1.421);左側MD-10.124,95%CI(-16.476,-3.773)。PD組內OB體積比較右側較左側顯著增大,MD 1.168,95%CI(0.264,2.971);HC組內兩側OB體積比較無統(tǒng)計學差異。漏斗圖、Begg’s和Egger’s檢驗未發(fā)現(xiàn)顯著發(fā)表偏移,敏感性分析顯示研究結果穩(wěn)定、可靠。結論:PD左、右兩側OB體積均較HC顯著減小。由于可納入研究偏少且異質性顯著,仍需新的高質量觀察性研究進一步證實結論的穩(wěn)定性。第二部分帕金森病和血管性帕金森綜合征嗅覺功能改變的研究目的:研究帕金森病(PD)與血管性帕金森綜合征(VP)的嗅覺功能改變及其影響因素,探討Sniffin’Sticks方法(SST)嗅覺功能檢查在PD診斷和鑒別診斷中的應用價值。方法:選取2015年03月~2015年12月南通大學第二附屬醫(yī)院就診的PD、VP患者及性別、年齡匹配的同期體檢正常對照(HC)各40例。記錄納入對象年齡、性別、簡易智能精神狀態(tài)檢查量表(MMSE)評分及PD組和VP組病程、HoehnYahr(H-Y)分級、帕金森病統(tǒng)一評分量表運動部分(UPDRS-Ⅲ)評分。采用SST檢查方法分別評價pd、vp、hc三組嗅覺閾值(ot)、嗅覺辨別閾值(od)、嗅覺識別閾值(oi)及tdi總分,比較pd、vp、hc三組間嗅覺功能的差異,評估三組嗅覺功能與年齡、性別、mmse、病程、h-y分級、updrs-Ⅲ等變量的相關性。應用受試者工作特征曲線(roc)評價tdi在pd診斷中的價值。結果:pd、vp、hc三組間基線資料無統(tǒng)計學差異。pd組嗅覺障礙發(fā)生率為92.5%,vp組為37.5%,hc組為35%;pd組嗅覺障礙發(fā)生率明顯高于hc組及vp組。三組tdi總分分別為pd組20.07±4.45,vp組30.53±5.90,hc組31.00±4.99,pd組tdi總分顯著低于hc組和vp組,vp組與hc組間無統(tǒng)計學差異。hc組內tdi總分與年齡負相關(r=-0.987,p0.05),與mmse正相關(r=0.866,p0.05);pd組內tdi總分與病程負相關(r=-0.484,p0.05),與mmse正相關(r=0.618,p0.05),與性別、年齡、h-y分級及updrs-Ⅲ評分無關;vp組內tdi總分與年齡、病程、h-y分級負相關(分別為r=-0.989,p0.05;r=-0.770,p0.05;r=-0.353,p0.05),與mmse正相關(r=0.838,p0.05),與性別、updrs-Ⅲ評分無關。區(qū)分pd組和hc組時tdi總分曲線下面積(auc)為0.944,臨界值為23.313,靈敏度為82.5%,特異度為97.5%;區(qū)分pd組和vp組時,tdi總分auc為0.911,臨界值為23.563,靈敏度為87.5%,特異度為82.5%。結論:sst嗅覺檢測方法臨床應用簡單、結果可靠、可操作性強。與hc及vp比較,pd患者存在較為顯著的嗅覺障礙。vp嗅覺功能與hc比較無顯著差異。使用sst能夠為pd的診斷和鑒別診斷提供重要的參考信息。第三部分帕金森病和血管性帕金森綜合征嗅球體積的改變研究目的:研究帕金森病(pd)與血管性帕金森綜合征(vp)的嗅球(ob)體積變化及其影響因素,探討磁共振(mri)ob體積測定在pd診斷和鑒別診斷中的應用價值。方法:選取2015年03月~2015年12月南通大學第二附屬醫(yī)院就診的pd、vp患者及性別、年齡匹配的同期體檢正常對照組(hc)各40例。記錄納入對象年齡、性別、簡易智能精神狀態(tài)檢查量表(mmse)評分及pd組和vp組病程、hoehnyahr(h-y)分級、帕金森病統(tǒng)一評分量表運動部分(updrs-Ⅲ)評分,評價pd、vp、hc三組嗅覺閾值(ot)、嗅覺辨別閾值(od)、嗅覺識別閾值(oi)及tdi總分。采用西門子verio3.0t超導型高分辨率全身mri成像儀和16通道頭線圈測量pd、vp、hc三組左、右兩側ob體積,分別比較pd、vp、hc三組間左側和右側ob體積差異,評估三組左、右兩側ob體積與年齡、性別、mmse、病程、h-y分級、updrs-Ⅲ等變量的相關性。使用受試者工作特征曲線(roc)分別評價左、右兩側ob體積在pd診斷中的價值。結果:pd、vp、hc三組間基線資料無統(tǒng)計學差異。三組左側ob體積分別為pd組32.00±4.60,vp組38.53±2.41,hc組38.85±2.47;三組間左側ob體積比較差異具有顯著性(p0.05)。pd組與hc組比較ob體積差異有顯著性(p0.05);pd組與vp組比較ob體積差異有顯著性(p0.05);hc組與vp組比較ob體積差異無統(tǒng)計學意義。三組右側ob體積分別為pd組32.07±4.72,vp組38.56±2.51,hc組38.79±2.56;三組間右側ob體積比較差異具有顯著性(p0.05)。pd組與hc組比較ob體積差異有顯著性(p0.05);pd組與vp組比較ob體積差異有顯著性(p0.05);hc組與vp組比較ob體積差異無統(tǒng)計學意義。pd、vp、hc三組組內比較左、右兩側ob體積間差異均無統(tǒng)計學意義。hc組內左、右兩側ob體積均與年齡負相關(分別為r=-0.989,p0.05;r=-0.984,p0.05),與mmse正相關(分別為r=0.907,p0.05;r=0.901,p0.05)。pd組內左、右兩側ob體積均與mmse正相關(分別為r=0.427,p0.05;r=0.412,p0.05),與年齡、性別、病程、h-y分級、updrs-Ⅲ無關。vp組內左、右兩側ob體積均與年齡、病程負相關,與h-y分級、updrs-Ⅲ無關。hc組內左、右兩側ob體積均與tdi總分正相關(分別為r=0.978,p0.05;r=0.979,p0.05);pd組內左、右兩側ob體積均與tdi總分不相關;vp組內左、右兩側ob體積均與tdi總分正相關(分別為r=0.0.954,p0.05;r=0.933,p0.05)。區(qū)分pd組和hc組時左側ob體積曲線下面積(auc)為0.883,臨界值為35.055,靈敏度為67.5%,特異度為97.5%;右側ob體積auc為0.872,臨界值為35.646,靈敏度為67.5%,特異度為95%。區(qū)分pd組與vp組時左側ob體積auc為0.879,臨界值為34.721,靈敏度為67.5%,特異度為95%;右側ob體積auc為0.869,臨界值為35.650,靈敏度為67.5%,特異度為92.5%。結論:高分辨率mri能夠清晰顯影ob結構并準確測量ob體積。pd左、右兩側ob體積與hc及vp比較均明顯減小,左、右兩側ob體積變化均與sst嗅覺功能變化無相關性。VP左、右兩側OB體積與HC比較均無統(tǒng)計學差異,左、右兩側OB體積與SST嗅覺功能變化趨勢一致。測量OB體積能夠為PD的診斷和鑒別診斷提供重要的參考信息。
[Abstract]:Part 1 systematic evaluation and meta analysis of the volume change of Parkinson's olfactory bulb: a systematic evaluation of the difference between the volume of the olfactory bulb (OB) and the normal control (HC) group of the Parkinson's disease (PD). Methods: the computer retrieved the PubMed, Embase database, and the retrieval time was built to January 2015. The two researchers were independently screened in accordance with the inclusion and exclusion criteria. Literature, extracting data, evaluating the quality of literature, using STATA12.0 for meta analysis. Using subgroup analysis to explore the source of heterogeneity, using funnel map, Begg 's and Egger' s test to evaluate publication migration. Results: 6 cases of case control study were included in 216 cases of PD patients and 175 cases of HC.Meta analysis showed that PD group and HC group were left, right side OB. The volume was significantly reduced, the right mean number difference (MD) -8.071,95% confidence interval (CI) (-14.721, -1.421), the OB volume in the left MD-10.124,95%CI (-16.476, -3.773).PD group was significantly larger than that in the left side, and the MD 1.168,95%CI was significantly higher than that in the left side, and there was no statistical difference between the two sides of the group. The sensitivity analysis showed that the results of the study were stable and reliable. Conclusion: the OB volume of PD left and right side decreased significantly than that of HC. The stability of the conclusion was further confirmed by the new high quality observational study. Second part of the olfactory function changes of Parkinson's disease and vascular Parkinson syndrome. Objective: To study the changes of olfactory function and its influencing factors of Parkinson's disease (PD) and vascular Parkinson syndrome (VP), and to explore the application value of Sniffin 'Sticks method (SST) olfactory function examination in the diagnosis and differential diagnosis of PD. Methods: selected PD, VP patients and VP patients in the Second Affiliated Hospital of Nantong University from 03 months to December 2015 2015 and Gender, age matched normal control (HC) 40 cases. Records included age, sex, simple intelligent mental state examination scale (MMSE) score and course of PD and VP, HoehnYahr (H-Y) classification, Parkinson's disease unified score exercise (UPDRS- III) score. The olfactory threshold of PD, VP, HC three groups was evaluated by SST method. Value (OT), olfactory discrimination threshold (OD), olfactory recognition threshold (OI) and TDI total score, compare the differences of olfactory function between groups of PD, VP and HC three groups, and evaluate the correlation between three groups of olfactory function and age, sex, MMSE, course of disease, H-Y classification, updrs- III and other variables. The value of the application of subjects' working characteristic curves (ROC) was used to evaluate the value of TDI in the three groups. The incidence of olfactory disorder in group.Pd was 92.5%, 37.5% in group VP and 35% in group HC. The incidence of olfactory disorder in group PD was significantly higher than that in group HC and VP. The total score of TDI in group three was 20.07 + 4.45, VP group 30.53 + 5.90, HC group 31 + 4.99, PD group was significantly lower than that of the group and group. There was no statistical difference between the group and the group. The total score of TDI in the group was negatively correlated with age (r=-0.987, P0.05), and was positively correlated with MMSE (r=0.866, P0.05). The total score of TDI in the PD group was negatively correlated with the course of the disease (r=-0.484, P0.05), and the positive correlation with MMSE (r=0.618) was not related to sex, age, classification and grade III score. 770, P0.05; r=-0.353, P0.05) and MMSE positive correlation (r=0.838, P0.05), independent of sex, updrs- III score. The area under the TDI total curve (AUC) under PD and HC is 0.944, the critical value is 23.313, the sensitivity is 82.5%, and the specificity is 97.5%. When the PD group and the group are distinguished, the total score is 0.911, the critical value is 23.563, the sensitivity is 87.5%, the specificity is 8. 2.5%. conclusion: the SST olfactory detection method is simple, reliable and operable. Compared with HC and VP, PD patients have significant olfactory impairment.Vp olfactory function and no significant difference between HC and HC. The use of SST can provide important reference information for the diagnosis and differential diagnosis of PD. Third parts of Parkinson's disease and vascular Parkinson Objective: To study the volume changes of the olfactory bulb (OB) of Parkinson's disease (PD) and vascular Parkinson syndrome (VP) and its influencing factors, and to explore the application value of OB volume of magnetic resonance (MRI) in the diagnosis and differential diagnosis of PD. Method: to select the Second Affiliated Hospital of Nantong University, 03 month, 2015, and December. PD, VP patients and sex, age matched normal control group (HC), 40 cases each. Records included age, sex, simple intelligent mental state examination scale (MMSE) score, PD group and group VP course, hoehnyahr (H-Y) classification, Parkinson's disease unified score exercise part (updrs- III) score, and evaluate PD, VP, HC three groups of olfactory threshold, Olfactory discrimination threshold (OD), olfactory recognition threshold (OI) and TDI total score. Use SIEMENS verio3.0t superconducting high resolution whole body MRI imaging instrument and 16 channel head coils to measure PD, VP, HC three groups left and right side ob volume. Compare the difference between the left and right sides of the PD, VP, HC three groups, and evaluate the volume and age, sex, and sex of the left and right sides of the three groups. The correlation between the course of disease, H-Y classification, updrs- III and other variables. The value of the OB volume in the left and right sides of the PD was evaluated using the working characteristic curve of the subjects (ROC). Results: there was no statistical difference between the three groups of PD, VP, HC. The left ob volume of the three groups was 32 + 4.60 in PD group, 38.53 in the VP group, 38.85 in the HC group, and in the three group left between the three groups. Compared with group HC, the volume difference between group.Pd and HC was significant (P0.05). The OB volume difference between group PD and VP group was significant (P0.05); HC group and VP group had no significant difference in ob volume. The three groups were 32.07 + 4.72, 38.56 + 2.51, 38.79 + 2.56, and the right volume between the three groups. The difference was significant (P0.05) between group.Pd and HC group (P0.05), and the difference of OB volume between group PD and VP group was significant (P0.05), and there was no statistical significance between HC and VP group, and there was no significant difference in the volume difference between the three groups. The product was negatively correlated with age (r=-0.989, P0.05, r=-0.984, P0.05), and the positive correlation with MMSE (r=0.907, P0.05; r=0.901, P0.05).Pd group, and the OB volume on both sides of the right side were all related to MMSE. A negative correlation between the course of the disease and the H-Y classification, updrs- III was not related to the.Hc group, and the OB volume on the right side was positively correlated with the total TDI score (r=0.978, P0.05; r=0.979, P0.05), and the OB volume in the left and right sides of the PD group was not related to the total TDI total. In group HC, the area under the left ob volume (AUC) is 0.883, the critical value is 35.055, the sensitivity is 67.5%, the specificity is 97.5%, the right ob volume AUC is 0.872, the critical value is 35.646, the sensitivity is 67.5%, the specificity is 95%. division PD group and VP group, the OB volume AUC is 0.879, the critical value is 34.721, the sensitivity is 67.5%, the specificity is 95%, and the right ob body. The product AUC is 0.869, the critical value is 35.650, the sensitivity is 67.5%, the specificity is 92.5%. conclusion: the high resolution MRI can clearly develop the OB structure and accurately measure the OB volume.Pd left. The OB volume on the right side is obviously decreased compared with HC and VP, and the left and right side OB volume changes are not related to the SST olfactory function. There is no statistical difference. The OB volume of left and right side is the same as that of SST olfactory function. The measurement of OB volume can provide important reference information for the diagnosis and differential diagnosis of PD.

【學位授予單位】：蘇州大學
【學位級別】：博士
【學位授予年份】：2016
【分類號】：R742.5

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1 王敏;帕金森病患者的輔助診斷與手運動補償研究[D];華東理工大學;2012年

2 黃思菲;快動眼期睡眠行為障礙和帕金森病患者嗅覺分析及價值[D];復旦大學;2014年

3 高靚;CCL2在帕金森病輕度認知功能障礙中的作用及機制研究[D];南方醫(yī)科大學;2015年

4 谷有全;TLR4在帕金森病小鼠中腦的表達及其對炎癥介質釋放的影響[D];南方醫(yī)科大學;2014年

5 李紅燕;早發(fā)型帕金森病患者的臨床特征及維吾爾族早發(fā)型家族性帕金森病PARKIN基因突變的研究[D];安徽醫(yī)科大學;2014年

6 胡盼盼;帕金森病患者的認知神經心理學研究[D];安徽醫(yī)科大學;2014年

7 劉崴;帕金森病LRRK2和VPS35基因突變研究[D];天津醫(yī)科大學;2012年

8 康文巖;α-突觸共核蛋白在帕金森病發(fā)病機制及生物學標記物中的研究[D];上海交通大學;2012年

9 李桂花;新疆地區(qū)帕金森病危險因素、癥狀學和ATP13A2基因多態(tài)性研究[D];新疆醫(yī)科大學;2015年

10 張迎春;帕金森病患者經顱超聲影像學特點分析[D];蘇州大學;2015年

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3 陳伏祥;帕金森病輕度認知障礙患者腦灰質改變研究[D];福建醫(yī)科大學;2015年

4 韓薇;α-突觸核蛋白(SNCA)基因多態(tài)性與帕金森病易感性的meta分析[D];河北醫(yī)科大學;2015年

5 王倩;帕金森病患者自主神經功能的研究[D];河北醫(yī)科大學;2015年

6 劉疏影;不同帕金森病亞型（早發(fā)晚發(fā)型）的多巴胺轉運體顯像特征分析[D];復旦大學;2014年

7 徐睿鑫;楊明會教授治療帕金森病學術經驗研究[D];中國人民解放軍醫(yī)學院;2015年

8 李洋;帕金森病患者嗅覺相關腦區(qū)的MRI研究[D];蘇州大學;2015年

9 李玲;早期帕金森病患者視網(wǎng)膜及視野改變的臨床研究[D];蘇州大學;2015年

10 程筱雨;血清反應因子在帕金森病發(fā)病中的作用和機制研究[D];蘇州大學;2015年

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