中华脑科疾病与康复杂志(电子版)
中華腦科疾病與康複雜誌(電子版)
중화뇌과질병여강복잡지(전자판)
CHINESE JOURNAL OF BRAIN DI8SEASES AND REHABILITATIN(ELECTRONIC EDITION)
2014年
1期
17-20
,共4页
斜颈%特发性震颤
斜頸%特髮性震顫
사경%특발성진전
Torticollis%Essential tremor
目的:对比痉挛性斜颈(CD)患者中存在头部震颤组[HT(+)组],无头部震颤组[HT (-)组]和特发性头部震颤组(ET组)三组患者的临床特点。方法用回顾性的方法观察自1982年8月至2012年10月期间就诊于天津医科大学总医院神经内科门诊的188例CD患者,其中HT(+)组57例,HT(-)组59例和72例ET病例的临床表现,病程发展过程和家族史。分组和诊断标准依据肌张力障碍性震颤和特发性震颤的诊断标准。使用χ2和方差分析进行统计学分析。结果三组患者中,其中HT(+)组女性患者发病率高于HT(-)组(χ2=5.872,P=0.019),HT(+)组颈痛率24.6%高于仅由震颤引起的颈痛率11.3%(χ2=4.060,P=0.041),HT(+)组56.1%患者以HT作为首发症状,HT发生后4.89年出现斜颈。26.7%CD患者同时存在手部震颤,HT(+)组显著性高于HT(-)组(χ2=16.800,P=0.000),ET组69%的患者存在手颤,显著性高于HT(+)组(χ2=7.651, P=0.005)。HT(-),HT(+)和ET三组患者中,HT(-)组具有家族史阳性率最低(10.2%),与HT (+)组相比有显著性差异(χ2=9.201,P=0.002),而ET组具有震颤的家族史阳性率最高(37.5%)。结论 HT和斜颈是头颈部肌张力障碍的两个重要体征,两者可先后出现,并相互转化,而HT有时是其早期唯一的表现,不易与ET区别,在与手颤和具有震颤或其他运动障碍的家族史的患者中更易发生,支持CD与特发性震颤在发病机制上具有一定的关联。
目的:對比痙攣性斜頸(CD)患者中存在頭部震顫組[HT(+)組],無頭部震顫組[HT (-)組]和特髮性頭部震顫組(ET組)三組患者的臨床特點。方法用迴顧性的方法觀察自1982年8月至2012年10月期間就診于天津醫科大學總醫院神經內科門診的188例CD患者,其中HT(+)組57例,HT(-)組59例和72例ET病例的臨床錶現,病程髮展過程和傢族史。分組和診斷標準依據肌張力障礙性震顫和特髮性震顫的診斷標準。使用χ2和方差分析進行統計學分析。結果三組患者中,其中HT(+)組女性患者髮病率高于HT(-)組(χ2=5.872,P=0.019),HT(+)組頸痛率24.6%高于僅由震顫引起的頸痛率11.3%(χ2=4.060,P=0.041),HT(+)組56.1%患者以HT作為首髮癥狀,HT髮生後4.89年齣現斜頸。26.7%CD患者同時存在手部震顫,HT(+)組顯著性高于HT(-)組(χ2=16.800,P=0.000),ET組69%的患者存在手顫,顯著性高于HT(+)組(χ2=7.651, P=0.005)。HT(-),HT(+)和ET三組患者中,HT(-)組具有傢族史暘性率最低(10.2%),與HT (+)組相比有顯著性差異(χ2=9.201,P=0.002),而ET組具有震顫的傢族史暘性率最高(37.5%)。結論 HT和斜頸是頭頸部肌張力障礙的兩箇重要體徵,兩者可先後齣現,併相互轉化,而HT有時是其早期唯一的錶現,不易與ET區彆,在與手顫和具有震顫或其他運動障礙的傢族史的患者中更易髮生,支持CD與特髮性震顫在髮病機製上具有一定的關聯。
목적:대비경련성사경(CD)환자중존재두부진전조[HT(+)조],무두부진전조[HT (-)조]화특발성두부진전조(ET조)삼조환자적림상특점。방법용회고성적방법관찰자1982년8월지2012년10월기간취진우천진의과대학총의원신경내과문진적188례CD환자,기중HT(+)조57례,HT(-)조59례화72례ET병례적림상표현,병정발전과정화가족사。분조화진단표준의거기장력장애성진전화특발성진전적진단표준。사용χ2화방차분석진행통계학분석。결과삼조환자중,기중HT(+)조녀성환자발병솔고우HT(-)조(χ2=5.872,P=0.019),HT(+)조경통솔24.6%고우부유진전인기적경통솔11.3%(χ2=4.060,P=0.041),HT(+)조56.1%환자이HT작위수발증상,HT발생후4.89년출현사경。26.7%CD환자동시존재수부진전,HT(+)조현저성고우HT(-)조(χ2=16.800,P=0.000),ET조69%적환자존재수전,현저성고우HT(+)조(χ2=7.651, P=0.005)。HT(-),HT(+)화ET삼조환자중,HT(-)조구유가족사양성솔최저(10.2%),여HT (+)조상비유현저성차이(χ2=9.201,P=0.002),이ET조구유진전적가족사양성솔최고(37.5%)。결론 HT화사경시두경부기장력장애적량개중요체정,량자가선후출현,병상호전화,이HT유시시기조기유일적표현,불역여ET구별,재여수전화구유진전혹기타운동장애적가족사적환자중경역발생,지지CD여특발성진전재발병궤제상구유일정적관련。
Objective To compare the clinical characteristics,natural history of patients with cervical dystonia(CD)with head tremor [HT (+)],without head tremor [HT (-)]and essential head tremor(ET).Methods We prospectively evaluated 188 consecutive patients of CD including HT(+)57 patients,HT(-)59 patients and 72 patients of ET with a detailed questionnaire who came to the department of neurology,General Hospital of Tianjin Medical University.We studied clinical characteristics,progress and family history.According to diagnostic standard of dystonia tremor and essential tremor,we divided the patients into 3 groups.Chi-square and One-Way ANOVA were employed for statistical analysis. Results There was higher prevalence of HT in women in HT (+)than in HT (-)(χ2 =5.872,P =0.019),the rate of pain on the neck in HT(-)was 28.8%,HT(+)was 24.6%,higher than the ET′s (1 1.3%,χ2 =4.060,P=0.041 ).56.1% of patients in HT(+)had tremor as one the first symptoms.CD would appear following HT after 4.89 years.26.7% CD patients had hand tremor,the rate of hand tremor in HT(+)was higher than that of HT(-)group(χ2 =16.800,P=0.000),and 69% in ET group had hand tremor was higher than HT(+)(χ2 =7.651,P=0.005).10.2%of HT(-)had the lowerest positive family history,there was a difference between HT(-)and HT(+)(χ2 =9.201,P=0.002)and 37.5% of ET had the highest family history.Conclusion HT and CD are two important vital signs in CD,they appear alternately and chang into each other.HT sometimes is the only sign,could not differ from ET easily.It is more commonly associated with hand tremor and family history of tremor or other movement disorders.This supports a possible pathogenesis association between CD and ET.