经颅超声在帕金森病诊断中最佳阈值和诊断价值的研究

发布时间：2019-04-10 14:26

【摘要】：目的： 本研究拟用受试者工作特征曲线(Receiver operating characteristic curve, ROC曲线)法来制定经颅超声(Transcranial sonography, TCS)在帕金森病(Parkinson's disease, PD)诊断中的最佳阈值,探讨TCS对于PD的诊断价值。 方法： 招募符合入选标准的PD患者228例和正常对照者167例,分别进行TCS检测,测量每侧黑质强回声(Hyperechogenicity of substantia nigra, SN)及同侧中脑回声面积,并计算单侧黑质强回声面积与同侧中脑面积比值(Area of the unilateral hyperechogenicity of substantia nigra/Area of the ipsilateral midbrain, S/M1)和双侧黑质强回声面积和与整个中脑面积比值(The sum areas of the bilateral Substantia nigra hyperechogenicity/The whole area of the midbrain, S/M2)。用ROC曲线分别计算SN、S/M1、S/M2最佳阈值,计算各自的灵敏度、特异度、阳性预测值、阴性预测值。对SN、S/M1、 S/M2与PD病人的临床特征进行相关性分析。排除所有一侧颞窗差和双侧颞窗差的受试者后,纳入统计学计算的均为双侧颞窗好的受试者。结果： PD组共228例患者,其中70例因一侧或双侧颞窗透声差而被排除,实际入选158例；正常对照组共167例,其中51例因一侧或双侧颞窗透声差而被排除,实际入选116例。(1)PD组SN、S/M1、S/M2均明显高于正常对照组,且有显著性差异(P0.001)。(2)ROC曲线法制定的本实验室的SN、S/M1、S/M2的最佳阈值分别为018cm2、0.07、0.04。SN、S/M1、S/M2的灵敏度(Sensitivity)、特异度(Specificity)、阳性预测值(Positive predictive value, PPV)、阴性预测值(Negative predictive value,NPV)分别为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%。三种超声指标在ROC曲线面积分别为0.757、0.749、0.771,均获得中等的诊断准确性。(3)黑质强回声面积与PD的病程相关(p0.001)；S/M1与PD的病程和UPDRSⅢ相关(p0.05)；S/M2与PD的UPDRSⅢ相关(p0.05)。结论： 本研究发现黑质强回声面积、单侧黑质面积与同侧中脑面积比值、两侧黑质面积和与整个中脑面积比值均可作为TCS诊断PD的超声诊断指标。本实验室黑质强回声面积、S/M1、S/M2的最佳阈值为0.18cm2、0.07、0.04。以此三个超声指标的最佳阈值来判定PD可获得中等的诊断准确性。本研究认为,颞窗的成功率直接关系到TCS最佳阈值的灵敏度、特异度,也就是TCS对PD的诊断价值。
[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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