多系统萎缩与帕金森病患者心率变异性的临床比较研究

发布时间：2018-03-16 15:27

  本文选题：多系统萎缩　切入点：帕金森病　出处：《大连医科大学》2014年硕士论文　论文类型：学位论文

【摘要】：目的：多系统萎缩（multiple systematrophy，，MSA）和PD（Parkinson's disease，PD）在临床表现上均有自主神经症状，使得MSA与PD难以鉴别，尤其在疾病早期，MSA误诊为PD超过20%。因此，提高对MSA和PD的认识，探索能够早期区别MSA和PD的有效、无创的客观检测方法，对于最大限度地降低MSA和PD患者的误诊率和致残率具有重要临床意义。既往研究推荐了多种用于早期鉴别MSA和PD的客观检测方法，包括咽鼓管充气实验、倾斜实验、催汗功能实验、定量催汗轴突反射实验、交感皮肤反应、正电子断层发射扫描、磁共振波谱分析、肛门括约肌和尿道括约肌肌电图、膀胱功能评价、卧立位血压以及瞳孔试验等；但这些客观检测方法在MSA和PD早期鉴别诊断中的价值尚有争议。本研究通过比较MSA与PD患者间心率变异性（heart ratevariability，HRV）各项参数的差异，旨在为临床早期鉴别这两种疾病寻求特异性的客观指标。 方法：选取2012年10月至2014年1月于大连医科大学附属第一医院神经内科住院治疗的MSA患者34例和PD患者31例（病程均2年），并以30例健康体检者作为对照组。收集所有受试者的下列数据：流行病学特点（包括包括性别、年龄和病程）以及HRV各项参数（包括频域和时域）。分别对MSA和PD患者采用Hoehn-Yahr（H-Y）分期、统一的帕金森病综合评分表（Unifed Parkinson's Disease Rating Scale，UPDRS）和简易智能状态检查表（Mini Mental State Examination，MMSE）评分评估疾病的严重程度。采用单因素方差分析和受试者工作特征曲线（receiver operator characteristic curve，ROC）分析，筛选出特异的临床和实验室指标用于早期识别这两种疾病。 结果： MSA组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组31例中，男性14例（45.2%），女性17例（54.8%）。对照组30例，其中男性15例（50.0%），女性15例（50.0%）。三组性别构成比差异无统计学意义（χ2=0.011，P0.05）。MSA组、PD组和对照组的年龄分别为(60.26±6.46)岁、（62.74±5.96）岁和（59.37±6.02）岁，三组平均年龄比较差异无统计学意义（F=2.478，P=0.090）。MSA组和PD组患者MMSE评分、病程比较差异均无统计学意义（P分别0.05）。但MSA组和PD组患者UPDRS评分分别为（24.32±3.99）分和（21.32±3.64）分，差异具有统计学意义（P0.05）。MSA组和PD组患者平均H-Y分期分别为（2.44±0.44）期和（1.29±0.62）期，差异具有统计学意义（P0.05）。三组受试者HRV时域参数SDNN、SDANN、rMSSD比较，差异均无统计学意义（P分别0.05）；但对照组和MSA组患者PNN50%、CV比较，差异均具有统计学意义（P分别0.01）。三组受试者HRV频域参数中ULF、总功率、LF/HF比较，差异均无统计学意义（P分别0.05）；但对照组和MSA组患者的VLF、LF、HF比较，差异均具有统计学意义（P分别0.01）。ROC曲线分析结果表明，PNN50%、CV、VLF、LF、HF、H-Y分期、UPDRS均具有统计学意义（P分别0.01）。VLF、CV、LF、HF、PNN50%、UPDRS评分和H-Y分期的ROC曲线下面积及其95%置信区间分别为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曲线下面积由大到小的指标依次为VLF、CV、LF、HF、PNN50%、UPDRS评分和H-Y分期。 结论：（1）在疾病早期，MSA组患者较PD组患者总体病情严重。（2）与PD不同，MSA患者早期即有交感和迷走神经受累，从而出现心血管自主神经功能障碍。（3）HRV分析简便、无创且费用低廉，是评估MSA患者心血管自主神经活动的有效方法。（4）与HRV其他指标相比，VLF对评估MSA等神经系统变性疾病早期心血管自主神经功能障碍可能具有更好的参考价值，有助于MSA和PD的早期鉴别诊断。
[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.
缁撴灉锛

本文编号：1620519