CAJ | 학술논문

目的观察帕金森病(PD)及多系统萎缩(MSA)患者运动皮质兴奋性的差异，并探讨磁刺激双上肢运动诱发电位(MEP)能否作为鉴别二者的神经电生理指标之一。方法选取2005至2010年我院的PD患者34例作为PD组，MSA患者22例作为MSA组，年龄性别相匹配的正常健康者15例作为正常对照组。采用磁刺激双上肢MEP作为观察指标，比较3组静息阈值(RMT)、中枢传导时间(CMCT)、波幅(AMP)的变化及与病情严重程度的关系。结果 PD组患者RMT较MSA组及正常对照组明显降低，差异具有统计学意义(P＜0.01)，MSA组RMT较正常对照组降低，差异有统计学意义(P＜0.01)；3组中枢传导时间(CMCT)差异无统计学意义(P＞0.05)；PD组患者AMP明显高于MSA组和正常对照组，差异有统计学意义(P＜0.01)，MSA组AMP与正常对照组比较，差异无统计学意义(P＞0.05)。随PD患者病情加重，皮质RMT进行性降低，CMCT进行性缩短,AMP无明显变化；而MSA患者RMT、CMCT、AMP与病情严重程度无关。结论 PD与MSA患者运动皮质兴奋性存在差异，双上肢运动诱发电位RMT和CMCT在鉴别PD和MSA上有一定参考价值，波幅改变的临床意义尚待进一步研究。
목적 관찰파금삼병(PD)급다계통위축(MSA)환자운동피질흥강성적차이，병탐토자자격쌍상지운동유발전위(MEP)능부작위감별이자적신경전생리지표지일。방법 선취2005지2010년아원적PD환자34례작위PD조，MSA환자22례작위MSA조，년령성별상필배적정상건강자15례작위정상대조조。채용자자격쌍상지MEP작위관찰지표，비교3조정식역치(RMT)、중추전도시간(CMCT)、파폭(AMP)적변화급여병정엄중정도적관계。결과 PD조환자RMT교MSA조급정상대조조명현강저，차이구유통계학의의(P＜0.01)，MSA조RMT교정상대조조강저，차이유통계학의의(P＜0.01)；3조중추전도시간(CMCT)차이무통계학의의(P＞0.05)；PD조환자AMP명현고우MSA조화정상대조조，차이유통계학의의(P＜0.01)，MSA조AMP여정상대조조비교，차이무통계학의의(P＞0.05)。수PD환자병정가중，피질RMT진행성강저，CMCT진행성축단,AMP무명현변화；이MSA환자RMT、CMCT、AMP여병정엄중정도무관。결론 PD여MSA환자운동피질흥강성존재차이，쌍상지운동유발전위RMT화CMCT재감별PD화MSA상유일정삼고개치，파폭개변적림상의의상대진일보연구。
Objective To observe any differences in motor cortex excitability between Parkinson's disease (PD)patients and patients with multiple system atrophy (MSA) and to explore whether motor evoked potentials (MEPs) can be used as an electrophysiological indicator for differentiating the 2 diseases.Methods Thirty-four PD patients, 22 MSA patients and 15 age- and sex-matched healthy control subjeets were included in this study. Relaxed motor thresholds (RMTs), central motor conduction time (CMCTs) and MEP amplitudes (AMPs) were recorded in all three groups. The relationships of RMT, CMCT and AMP with the severity of the disease were observed.Results Average RMT in the PD group was significantly lower than that in the MSA and control groups. Average RMT in the MSA group was also significantly lower than that in the control group. There was no significant difference among the three groups with regard to CMCT. AMP in the PD group was significantly higher on average than in the MSA and control groups, but there was no significant difference between the MSA and control groups. RMT decreased and CMCT shortened progressively with the severity of the disease in the PD group, but not in the MSA group.Conclusions There were differences in motor cortex excitability between PD patients and MSA patients. MEP RMTs and CMCTs may be valuable for identifying PD and MSAc but the clinical significance of the amplitude differences remains to be further explored.