原发性震颤的临床及电生理学特征研究

发布时间：2018-04-29 06:08

本文选题：原发性震颤 + 帕金森病　；参考：《浙江大学》2017年硕士论文

【摘要】：研究目的:探讨原发性震颤(essential tremor,ET)的非运动症状,同时探讨ET和帕金森病(Parkinson disease,PD)震颤和电生理上的异同点,为原发性震颤诊断提供诊断思路。研究方法:选取2015年5月至2016年4月在浙江大学附属第二医院门诊就诊ET患者70例,PD患者50例以及性别年龄匹配的健康志愿者(生理性震颤组)45例。其中50例ET患者纳入非运动症状的研究,这部分患者应用汉密尔顿焦虑量表(Hamilton anxiety scale,HAMA,14 项版本)及汉密尔顿抑郁量表(Hamilton depression scale,HAMD,24项版本)评价焦虑及抑郁,匹茨堡睡眠量表(Pittsburgh sleep scale,PQSI)评估患者睡眠质量,采用健康状况调查问卷简表(the MOS item short from health survey,SF-36)评估患者日常健康状况;采用简明心理量表(mini-mental state examination,MMSE)量表评估患者认知功能。通过震颤评分系统,完善ET、PD患者震颤评分。通过加速度传感器测定对所有受试者进行不同姿势状态下的震颤分析检查。回顾性分析并比较伴有震颤型帕金森病患者35例,原发性震颤患者40例,通过加速度传感器测定震颤程度不同的35例帕金森震颤(PT)患者和40例原发性震颤(ET)患者的震颤幅度、震颤频率、震颤频谱宽度以及负重对其影响,以总结两组患者的电生理学特点。研究结果:1、典型ET患者表现为姿势性或意向性震颤,但在一些严重病例可出现静止性震颤,可伴有头部、口面部或声音震颤。ET组MMSE评分总分为25.60±2.76分,低于健康对照组28.16±1.71分(P0.001)。ET组睡眠障碍发生率(62%)较对照组(15%)高(P0.05),ET组PSQI平均分为(6.42±2.71),同健康对照组平均分(3.84±2.13)比较,差异有统计学意义(P0.05)。ET组患者发生中度焦虑或者严重焦虑的比例(78%)高于健康对照组发生率(22.5%)(P0.05),ET组患者发生中度抑郁或者严重抑郁的比例(34%)也较健康对照组(7.5%)高(P0.05)。焦虑和抑郁会影响患者的身心健康,并且和患者的生活质量相关。2、两组患者震颤评分及肌电图表现:患者震颤评分的比较:PD和ET患者,负重状态下震颤评分均比静止状态高(P0.05)。震颤峰值频率比较:三组患者负重状态同静止状态比较,震颤频率均有所下降,健康对照组下降明显,差异有统计学意义(P0.05),PD组和ET组差异无统计学意义。如果按照震颤评分将双上肢均受累的ET组和PD组分为强侧和弱侧时,在静止状态、姿势状态和负重状态下,帕金森病及原发性震颤组平均振幅震颤弱的一侧比震颤强的一侧震颤幅度小(P0.05);帕金森病组震颤峰值频率震颤弱的一侧比震颤强的一侧快(P0.05),原发性震颤组震颤强弱不同的两侧震颤峰值频率接近;在静止状态和姿势状态下,帕金森病组震颤频谱宽度震颤弱的一侧比强的一侧宽(P0.05);在静止状态、姿势状态和负重状态状态下,原发性震颤组震颤强的一侧频谱宽度接近弱的一侧。研究结论:ET患者有运动症状,还伴有非运动症状。按照震颤强弱不同的侧别来分,PD患者震颤峰值频率和峰值宽度是不对称的,而ET患者是对称的,通过加速度传感器测定的震颤参数能够用来区分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.

【学位授予单位】：浙江大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R742.5

【相似文献】