帕金森病与血管性帕金森综合征嗅觉功能与嗅球体积的改变研究

发布时间：2018-05-03 16:19

本文选题：帕金森病 + 血管性帕金森综合征　；参考：《苏州大学》2016年博士论文

【摘要】：第一部分帕金森病嗅球体积改变的系统评价与meta分析目的:系统评价帕金森病(PD)嗅球(OB)体积与正常对照(HC)组之间的差异。方法:计算机检索PubMed、Embase数据库,检索时限为建库至2015年1月。由两位研究者按照纳入与排除标准独立筛选文献、提取数据资料、评价文献质量,使用STATA12.0进行meta分析。采用亚组分析探索异质性来源,使用漏斗图、Begg’s和Egger’s检验评估发表偏移。结果:纳入病例-对照研究6篇,共216例PD患者,175例HC。Meta分析结果显示,PD组与HC组比较左、右两侧OB体积均显著减小,右侧均数差(MD)-8.071,95%可信区间(CI)(-14.721,-1.421);左侧MD-10.124,95%CI(-16.476,-3.773)。PD组内OB体积比较右侧较左侧显著增大,MD 1.168,95%CI(0.264,2.971);HC组内两侧OB体积比较无统计学差异。漏斗图、Begg’s和Egger’s检验未发现显著发表偏移,敏感性分析显示研究结果稳定、可靠。结论:PD左、右两侧OB体积均较HC显著减小。由于可纳入研究偏少且异质性显著,仍需新的高质量观察性研究进一步证实结论的稳定性。第二部分帕金森病和血管性帕金森综合征嗅觉功能改变的研究目的:研究帕金森病(PD)与血管性帕金森综合征(VP)的嗅觉功能改变及其影响因素,探讨Sniffin’Sticks方法(SST)嗅觉功能检查在PD诊断和鉴别诊断中的应用价值。方法:选取2015年03月~2015年12月南通大学第二附属医院就诊的PD、VP患者及性别、年龄匹配的同期体检正常对照(HC)各40例。记录纳入对象年龄、性别、简易智能精神状态检查量表(MMSE)评分及PD组和VP组病程、HoehnYahr(H-Y)分级、帕金森病统一评分量表运动部分(UPDRS-Ⅲ)评分。采用SST检查方法分别评价pd、vp、hc三组嗅觉阈值(ot)、嗅觉辨别阈值(od)、嗅觉识别阈值(oi)及tdi总分,比较pd、vp、hc三组间嗅觉功能的差异,评估三组嗅觉功能与年龄、性别、mmse、病程、h-y分级、updrs-Ⅲ等变量的相关性。应用受试者工作特征曲线(roc)评价tdi在pd诊断中的价值。结果:pd、vp、hc三组间基线资料无统计学差异。pd组嗅觉障碍发生率为92.5%,vp组为37.5%,hc组为35%;pd组嗅觉障碍发生率明显高于hc组及vp组。三组tdi总分分别为pd组20.07±4.45,vp组30.53±5.90,hc组31.00±4.99,pd组tdi总分显著低于hc组和vp组,vp组与hc组间无统计学差异。hc组内tdi总分与年龄负相关(r=-0.987,p0.05),与mmse正相关(r=0.866,p0.05);pd组内tdi总分与病程负相关(r=-0.484,p0.05),与mmse正相关(r=0.618,p0.05),与性别、年龄、h-y分级及updrs-Ⅲ评分无关;vp组内tdi总分与年龄、病程、h-y分级负相关(分别为r=-0.989,p0.05;r=-0.770,p0.05;r=-0.353,p0.05),与mmse正相关(r=0.838,p0.05),与性别、updrs-Ⅲ评分无关。区分pd组和hc组时tdi总分曲线下面积(auc)为0.944,临界值为23.313,灵敏度为82.5%,特异度为97.5%;区分pd组和vp组时,tdi总分auc为0.911,临界值为23.563,灵敏度为87.5%,特异度为82.5%。结论:sst嗅觉检测方法临床应用简单、结果可靠、可操作性强。与hc及vp比较,pd患者存在较为显著的嗅觉障碍。vp嗅觉功能与hc比较无显著差异。使用sst能够为pd的诊断和鉴别诊断提供重要的参考信息。第三部分帕金森病和血管性帕金森综合征嗅球体积的改变研究目的:研究帕金森病(pd)与血管性帕金森综合征(vp)的嗅球(ob)体积变化及其影响因素,探讨磁共振(mri)ob体积测定在pd诊断和鉴别诊断中的应用价值。方法:选取2015年03月~2015年12月南通大学第二附属医院就诊的pd、vp患者及性别、年龄匹配的同期体检正常对照组(hc)各40例。记录纳入对象年龄、性别、简易智能精神状态检查量表(mmse)评分及pd组和vp组病程、hoehnyahr(h-y)分级、帕金森病统一评分量表运动部分(updrs-Ⅲ)评分,评价pd、vp、hc三组嗅觉阈值(ot)、嗅觉辨别阈值(od)、嗅觉识别阈值(oi)及tdi总分。采用西门子verio3.0t超导型高分辨率全身mri成像仪和16通道头线圈测量pd、vp、hc三组左、右两侧ob体积,分别比较pd、vp、hc三组间左侧和右侧ob体积差异,评估三组左、右两侧ob体积与年龄、性别、mmse、病程、h-y分级、updrs-Ⅲ等变量的相关性。使用受试者工作特征曲线(roc)分别评价左、右两侧ob体积在pd诊断中的价值。结果:pd、vp、hc三组间基线资料无统计学差异。三组左侧ob体积分别为pd组32.00±4.60,vp组38.53±2.41,hc组38.85±2.47;三组间左侧ob体积比较差异具有显著性(p0.05)。pd组与hc组比较ob体积差异有显著性(p0.05);pd组与vp组比较ob体积差异有显著性(p0.05);hc组与vp组比较ob体积差异无统计学意义。三组右侧ob体积分别为pd组32.07±4.72,vp组38.56±2.51,hc组38.79±2.56;三组间右侧ob体积比较差异具有显著性(p0.05)。pd组与hc组比较ob体积差异有显著性(p0.05);pd组与vp组比较ob体积差异有显著性(p0.05);hc组与vp组比较ob体积差异无统计学意义。pd、vp、hc三组组内比较左、右两侧ob体积间差异均无统计学意义。hc组内左、右两侧ob体积均与年龄负相关(分别为r=-0.989,p0.05;r=-0.984,p0.05),与mmse正相关(分别为r=0.907,p0.05;r=0.901,p0.05)。pd组内左、右两侧ob体积均与mmse正相关(分别为r=0.427,p0.05;r=0.412,p0.05),与年龄、性别、病程、h-y分级、updrs-Ⅲ无关。vp组内左、右两侧ob体积均与年龄、病程负相关,与h-y分级、updrs-Ⅲ无关。hc组内左、右两侧ob体积均与tdi总分正相关(分别为r=0.978,p0.05;r=0.979,p0.05);pd组内左、右两侧ob体积均与tdi总分不相关;vp组内左、右两侧ob体积均与tdi总分正相关(分别为r=0.0.954,p0.05;r=0.933,p0.05)。区分pd组和hc组时左侧ob体积曲线下面积(auc)为0.883,临界值为35.055,灵敏度为67.5%,特异度为97.5%;右侧ob体积auc为0.872,临界值为35.646,灵敏度为67.5%,特异度为95%。区分pd组与vp组时左侧ob体积auc为0.879,临界值为34.721,灵敏度为67.5%,特异度为95%;右侧ob体积auc为0.869,临界值为35.650,灵敏度为67.5%,特异度为92.5%。结论:高分辨率mri能够清晰显影ob结构并准确测量ob体积。pd左、右两侧ob体积与hc及vp比较均明显减小,左、右两侧ob体积变化均与sst嗅觉功能变化无相关性。VP左、右两侧OB体积与HC比较均无统计学差异,左、右两侧OB体积与SST嗅觉功能变化趋势一致。测量OB体积能够为PD的诊断和鉴别诊断提供重要的参考信息。
[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.

【学位授予单位】：苏州大学
【学位级别】：博士
【学位授予年份】：2016
【分类号】：R742.5

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