【摘要】：目的： 本研究擬用受試者工作特征曲線(Receiver operating characteristic curve, ROC曲線)法來(lái)制定經(jīng)顱超聲(Transcranial sonography, TCS)在帕金森病(Parkinson's disease, PD)診斷中的最佳閾值,探討TCS對(duì)于PD的診斷價(jià)值。 方法： 招募符合入選標(biāo)準(zhǔn)的PD患者228例和正常對(duì)照者167例,分別進(jìn)行TCS檢測(cè),測(cè)量每側(cè)黑質(zhì)強(qiáng)回聲(Hyperechogenicity of substantia nigra, SN)及同側(cè)中腦回聲面積,并計(jì)算單側(cè)黑質(zhì)強(qiáng)回聲面積與同側(cè)中腦面積比值(Area of the unilateral hyperechogenicity of substantia nigra/Area of the ipsilateral midbrain, S/M1)和雙側(cè)黑質(zhì)強(qiáng)回聲面積和與整個(gè)中腦面積比值(The sum areas of the bilateral Substantia nigra hyperechogenicity/The whole area of the midbrain, S/M2)。用ROC曲線分別計(jì)算SN、S/M1、S/M2最佳閾值,計(jì)算各自的靈敏度、特異度、陽(yáng)性預(yù)測(cè)值、陰性預(yù)測(cè)值。對(duì)SN、S/M1、 S/M2與PD病人的臨床特征進(jìn)行相關(guān)性分析。排除所有一側(cè)顳窗差和雙側(cè)顳窗差的受試者后,納入統(tǒng)計(jì)學(xué)計(jì)算的均為雙側(cè)顳窗好的受試者。結(jié)果： PD組共228例患者,其中70例因一側(cè)或雙側(cè)顳窗透聲差而被排除,實(shí)際入選158例；正常對(duì)照組共167例,其中51例因一側(cè)或雙側(cè)顳窗透聲差而被排除,實(shí)際入選116例。(1)PD組SN、S/M1、S/M2均明顯高于正常對(duì)照組,且有顯著性差異(P0.001)。(2)ROC曲線法制定的本實(shí)驗(yàn)室的SN、S/M1、S/M2的最佳閾值分別為018cm2、0.07、0.04。SN、S/M1、S/M2的靈敏度(Sensitivity)、特異度(Specificity)、陽(yáng)性預(yù)測(cè)值(Positive predictive value, PPV)、陰性預(yù)測(cè)值(Negative predictive value,NPV)分別為63.3%、70.7%、78.7%、60.5%,60.8%、79.3%、80.0%、59.7%和75.9%、68.1%、76.4%、59.7%。三種超聲指標(biāo)在ROC曲線面積分別為0.757、0.749、0.771,均獲得中等的診斷準(zhǔn)確性。(3)黑質(zhì)強(qiáng)回聲面積與PD的病程相關(guān)(p0.001)；S/M1與PD的病程和UPDRSⅢ相關(guān)(p0.05)；S/M2與PD的UPDRSⅢ相關(guān)(p0.05)。結(jié)論： 本研究發(fā)現(xiàn)黑質(zhì)強(qiáng)回聲面積、單側(cè)黑質(zhì)面積與同側(cè)中腦面積比值、兩側(cè)黑質(zhì)面積和與整個(gè)中腦面積比值均可作為TCS診斷PD的超聲診斷指標(biāo)。本實(shí)驗(yàn)室黑質(zhì)強(qiáng)回聲面積、S/M1、S/M2的最佳閾值為0.18cm2、0.07、0.04。以此三個(gè)超聲指標(biāo)的最佳閾值來(lái)判定PD可獲得中等的診斷準(zhǔn)確性。本研究認(rèn)為,顳窗的成功率直接關(guān)系到TCS最佳閾值的靈敏度、特異度,也就是TCS對(duì)PD的診斷價(jià)值。
[Abstract]:Objective: to determine the optimal threshold of transcranial ultrasound (Transcranial sonography, TCS) in the diagnosis of Parkinson's disease (Parkinson's disease, PD) by using the receiver operating characteristic curve (Receiver operating characteristic curve, ROC curve). To explore the diagnostic value of TCS in PD. Methods: TCS was performed in 228 patients with PD and 167 normal controls. The (Hyperechogenicity of substantia nigra, SN) of substantia nigra strong echo in each side and the echo area of ipsilateral midbrain were measured. The ratio of unilateral substantia nigra hyperechoic area to ipsilateral mesencephalic area (Area of the unilateral hyperechogenicity of substantia nigra/Area of the ipsilateral midbrain,) was calculated. S/M1) and bilateral hyperechoic area of substantia nigra and ratio to the whole mesencephalic area (The sum areas of the bilateral Substantia nigra hyperechogenicity/The whole area of the midbrain, S/M2). The optimal threshold of SN,S/M1,S/M2 was calculated by ROC curve, and the sensitivity, specificity, positive predictive value and negative predictive value were calculated. The clinical features of patients with SN,S/M1, S/M2 and PD were analyzed. After excluding all the subjects whose temporal window difference and bilateral temporal window difference were excluded, the subjects with good bilateral temporal window were included in the statistical calculation. Results: in PD group, 70 cases were excluded because of one side or bilateral temporal window transmissivity difference. In the control group, 51 cases were excluded due to one side or bilateral temporal window transmission difference. (1) SN,S/M1,S/M2 in PD group was significantly higher than that in normal control group (P < 0.05). There was significant difference between (P0.001). (2) ROC curve and the optimal thresholds of SN,S/M1,S/M2 in our laboratory were 0.18cm2, 0.07,0.04.SN, S0 M1, S0 M2, respectively. The sensitivity of (Sensitivity), specificity (Specificity), was 0.18 cm 2, 0.07, 0.04. SN, S? M 1, S? M 2, respectively. The positive predictive value (Positive predictive value, PPV),) and negative predictive value (Negative predictive value,NPV) were 63.3%, 70.7%, 78.7%, 60.5%, 60.8%, 79.3%, 80.0%, 59.7% and 75.9%, respectively. 68.1%, 76.4%, 59.7%. The diagnostic accuracy of the three ultrasound indexes were 0.757,0.749 and 0.771 in ROC curve area, respectively. (3) the strong echo area of substantia nigra was correlated with the course of PD (p0.001), S/M1 was correlated with the course of PD and UPDRS 鈪，

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