左旋多巴负荷试验诊断帕金森病的准确性研究

发布时间：2018-04-16 04:01

本文选题：帕金森病 + 左旋多巴负荷试验　；参考：《中风与神经疾病杂志》2017年11期

【摘要】：目的探讨左旋多巴负荷试验诊断及鉴别诊断帕金森病的准确性,研究影响该试验结果的相关因素。方法收集具有帕金森综合征运动症状90例患者,给予美多芭125 mg/次,4次/d,连续7 d的改良左旋多巴负荷试验,并进行1 y随访,记录最终完成随访的85例患者的临床资料,以试验前后统一帕金森病评分量表(UPDRS)运动部分的改善率为指标,建立左旋多巴负荷试验的ROC曲线,评估该试验的灵敏度和特异度,应用Logistic回归分析引起该试验假阳性和假阴性结果的影响因素。结果左旋多巴负荷试验灵敏度达86.7%,特异度达76%,与随访后的临床诊断Kappa值为0.58,该试验诊断准确性可靠。HY分级、服用多巴胺能制剂时间是引起试验假阴性的独立影响因素(P0.05);病程是引起试验假阳性的独立影响因素(P0.05)。结论改良的左旋多巴负荷试验对帕金森病诊断的准确性高;帕金森病患者的疾病程度轻、服用多巴胺能制剂时间长对左旋多巴负荷试验的反应不明显;部分非帕金森综合征患者在疾病早期具有一定的多巴胺能反应性。
[Abstract]:Objective to investigate the accuracy of Levodopa stress test in the diagnosis and differential diagnosis of Parkinson's disease and to study the related factors affecting the results of the test.Methods 90 patients with motor symptoms of Parkinson's syndrome were treated with modified L-dopa load test for 7 days with medopa 125 mg/ / d for 7 days. All patients were followed up for 1 y. The clinical data of 85 patients who were finally followed up were recorded.The ROC curve of the left dopa load test was established to evaluate the sensitivity and specificity of the exercise part of the unified Parkinson's disease scale before and after the test.Logistic regression analysis was used to analyze the factors influencing the false positive and false negative results of the test.Results the sensitivity and specificity of the levodopa stress test were 86.7 and 760.The diagnostic Kappa value of the test was 0.58 and the diagnostic accuracy of the test was reliable.The time of taking dopaminergic preparation was the independent influencing factor of false negative test and the course of disease was the independent influencing factor of false positive test.Conclusion the improved levodopa stress test has a high accuracy in the diagnosis of Parkinson's disease, and the patients with Parkinson's disease have a mild degree of disease and a long period of time taken by dopaminergic agents has no obvious response to the levodopa stress test.Some patients with non-Parkinson's syndrome have dopaminergic reactivity at the early stage of the disease.
【作者单位】：郑州大学第一附属医院神经内科;
【分类号】：R742.5

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