中华神经科杂志
中華神經科雜誌
중화신경과잡지
Chinese Journal of Neurology
2014年
9期
596-602
,共7页
张旭%王湘庆%王岩%于生元%马林%郎森阳
張旭%王湘慶%王巖%于生元%馬林%郎森暘
장욱%왕상경%왕암%우생원%마림%랑삼양
多系统萎缩%帕金森病%神经心理学测验%磁共振成像%诊断,鉴别
多繫統萎縮%帕金森病%神經心理學測驗%磁共振成像%診斷,鑒彆
다계통위축%파금삼병%신경심이학측험%자공진성상%진단,감별
Multiple system atrophy%Parkinson disease%Neuropsychological tests%Magnetic resonance imaging%Diagnosis,differential
目的 探讨神经心理学测验及功能成像在多系统萎缩帕金森综合征为主(MSA-P)型与多系统萎缩小脑性共济失调为主(MSA-C)型及原发性帕金森病鉴别中的作用.方法 收集2012年12月至2013年11月在解放军总医院神经内科门诊或住院的MSA-P型患者8例,MSA-C型患者13例,帕金森病患者13例.选择性别、年龄、受教育程度及生活环境相似的健康老年人13名,行神经心理学量表评估及弥散张量成像(DTI)检查,对获得的分值及参数进行比较.结果 (1)MSA-P组患者的连线测验耗时[(103.7±25.9)s]及图形-符号转换测验分值[(20.9±6.1)分]与MSA-C组[(80.9±29.1)s;(28.1 ±7.4)分]及帕金森病组[(72.1±19.6) s;(29.0±9.4)分]差异均存在统计学意义(均P ＜0.05).(2)MSA-P型患者的平均弥散率(MD)在双侧壳核(8.01 ±0.76、7.91±0.74),左侧黑质(8.31±0.43)、丘脑(8.30±0.69)、外囊(8.12±0.32)均与MSA-C型(7.27±0.42、7.34±0.31、7.58±0.81、7.81 ±0.34、7.70±0.44)、帕金森病患者(7.35±0.43、7.45±0.43、7.66±0.45、7.72±0.40、7.56±0.37)存在明显差异;MSA-C型患者的MD值在双侧桥臂(8.54±0.74、8.28±0.71)、延髓(8.32±0.61)均明显高于MSA-P型(8.54±0.74、8.28±0.71、8.32±0.61)、帕金森病患者(7.25±0.70、7.30±0.66、7.65±0.50)及对照组(6.94±0.39、7.08±0.32、7.44±0.41),差异有统计学意义(均P＜0.01).(3)MSA-P型患者的部分各向异性(FA)值在左侧外囊(0.45±0.35)及右侧丘脑(0.28±0.27)、枕叶(0.47±0.87)与MSA-C型患者(0.48±0.36、0.23±0.24、0.49 ±0.49)差异存在统计学意义(P＜ 0.05);FA值在左侧枕叶(0.46±0.10)与帕金森病患者(0.56±0.82)差异存在统计学意义(P＜0.01).结论 连线测验、图形-符号转换测验和弥散张量成像对临床鉴别MSA-P型与MSA-C型及帕金森病有一定辅助意义.
目的 探討神經心理學測驗及功能成像在多繫統萎縮帕金森綜閤徵為主(MSA-P)型與多繫統萎縮小腦性共濟失調為主(MSA-C)型及原髮性帕金森病鑒彆中的作用.方法 收集2012年12月至2013年11月在解放軍總醫院神經內科門診或住院的MSA-P型患者8例,MSA-C型患者13例,帕金森病患者13例.選擇性彆、年齡、受教育程度及生活環境相似的健康老年人13名,行神經心理學量錶評估及瀰散張量成像(DTI)檢查,對穫得的分值及參數進行比較.結果 (1)MSA-P組患者的連線測驗耗時[(103.7±25.9)s]及圖形-符號轉換測驗分值[(20.9±6.1)分]與MSA-C組[(80.9±29.1)s;(28.1 ±7.4)分]及帕金森病組[(72.1±19.6) s;(29.0±9.4)分]差異均存在統計學意義(均P ＜0.05).(2)MSA-P型患者的平均瀰散率(MD)在雙側殼覈(8.01 ±0.76、7.91±0.74),左側黑質(8.31±0.43)、丘腦(8.30±0.69)、外囊(8.12±0.32)均與MSA-C型(7.27±0.42、7.34±0.31、7.58±0.81、7.81 ±0.34、7.70±0.44)、帕金森病患者(7.35±0.43、7.45±0.43、7.66±0.45、7.72±0.40、7.56±0.37)存在明顯差異;MSA-C型患者的MD值在雙側橋臂(8.54±0.74、8.28±0.71)、延髓(8.32±0.61)均明顯高于MSA-P型(8.54±0.74、8.28±0.71、8.32±0.61)、帕金森病患者(7.25±0.70、7.30±0.66、7.65±0.50)及對照組(6.94±0.39、7.08±0.32、7.44±0.41),差異有統計學意義(均P＜0.01).(3)MSA-P型患者的部分各嚮異性(FA)值在左側外囊(0.45±0.35)及右側丘腦(0.28±0.27)、枕葉(0.47±0.87)與MSA-C型患者(0.48±0.36、0.23±0.24、0.49 ±0.49)差異存在統計學意義(P＜ 0.05);FA值在左側枕葉(0.46±0.10)與帕金森病患者(0.56±0.82)差異存在統計學意義(P＜0.01).結論 連線測驗、圖形-符號轉換測驗和瀰散張量成像對臨床鑒彆MSA-P型與MSA-C型及帕金森病有一定輔助意義.
목적 탐토신경심이학측험급공능성상재다계통위축파금삼종합정위주(MSA-P)형여다계통위축소뇌성공제실조위주(MSA-C)형급원발성파금삼병감별중적작용.방법 수집2012년12월지2013년11월재해방군총의원신경내과문진혹주원적MSA-P형환자8례,MSA-C형환자13례,파금삼병환자13례.선택성별、년령、수교육정도급생활배경상사적건강노년인13명,행신경심이학량표평고급미산장량성상(DTI)검사,대획득적분치급삼수진행비교.결과 (1)MSA-P조환자적련선측험모시[(103.7±25.9)s]급도형-부호전환측험분치[(20.9±6.1)분]여MSA-C조[(80.9±29.1)s;(28.1 ±7.4)분]급파금삼병조[(72.1±19.6) s;(29.0±9.4)분]차이균존재통계학의의(균P ＜0.05).(2)MSA-P형환자적평균미산솔(MD)재쌍측각핵(8.01 ±0.76、7.91±0.74),좌측흑질(8.31±0.43)、구뇌(8.30±0.69)、외낭(8.12±0.32)균여MSA-C형(7.27±0.42、7.34±0.31、7.58±0.81、7.81 ±0.34、7.70±0.44)、파금삼병환자(7.35±0.43、7.45±0.43、7.66±0.45、7.72±0.40、7.56±0.37)존재명현차이;MSA-C형환자적MD치재쌍측교비(8.54±0.74、8.28±0.71)、연수(8.32±0.61)균명현고우MSA-P형(8.54±0.74、8.28±0.71、8.32±0.61)、파금삼병환자(7.25±0.70、7.30±0.66、7.65±0.50)급대조조(6.94±0.39、7.08±0.32、7.44±0.41),차이유통계학의의(균P＜0.01).(3)MSA-P형환자적부분각향이성(FA)치재좌측외낭(0.45±0.35)급우측구뇌(0.28±0.27)、침협(0.47±0.87)여MSA-C형환자(0.48±0.36、0.23±0.24、0.49 ±0.49)차이존재통계학의의(P＜ 0.05);FA치재좌측침협(0.46±0.10)여파금삼병환자(0.56±0.82)차이존재통계학의의(P＜0.01).결론 련선측험、도형-부호전환측험화미산장량성상대림상감별MSA-P형여MSA-C형급파금삼병유일정보조의의.
Objective To investigate the role of the neuropsychological tests and functional imaging in differentiation between multiple system atrophy parkinsonism-predominant (MSA-P) and multiple system atrophy predominant cerebellar ataxia (MSA-C) or idiopathic Parkinson' s disease (PD).Methods We collected three groups of patients including MSA-P (n =8),MSA-C (n =13),idiopathic PD (n =13),and control group (n =13) between December 2012 and November 2013 in General Hospital of People's Liberation Army.We then compared the scores of neuropsychological assessment and parameters obtained from diffusion tensor imaging (DTI) examination among the four groups.Results (1) MSA-P group had longer time-consuming of trail-making test((103.7 ± 25.9) s) and lower graphic symbol test scores (20.9 ±6.1) than that of the MSA-P group ((80.9 ± 29.1) s ; 28.1 ± 7.4) and PD group ((72.0 ± 19.6) s ;29.0 ± 9.4 ; all P ＜ 0.05).(2) Mean diffusivity (MD) in both putamen (8.01 ± 0.76,7.91 ± 0.74) and the left substantia nigra (8.31 ± 0.43),thalamus (8.30 ± 0.69),external capsule (8.12 ± 0.32) of MSA-P group was significantly different from that of MSA-C group (7.27 ± 0.42,7.34 ± 0.3 1,7.58 ±0.81,7.81 ±0.34,7.70 ±0.44) and PD group (7.35 ±0.43,7.45 ±0.43,7.66 ±0.45,7.72 ±0.40,7.56 ± 0.37) ; Significantly higher MD in both middle cerebellar peduncle (8.54 ± 0.74,8.28 ± 0.71),medulla oblongata (8.32 ± 0.61) was demonstrated in MSA-C group than that of MSA-P group (8.54 ±0.74,8.28 ±0.71,8.32 ±0.61),PD group (7.25 ±0.70,7.30 ±0.66,7.65 ±0.50) and control group (6.94±0.39,7.08 ±0.32,7.44 ±0.41; all P＜0.01).(3) Fractional anisotropy (FA) in the left external capsule (0.45 ± 0.35) and right thalamus (0.28 ± 0.27),occipital lobe (0.47 ± 0.87) in MSA-P group was significantly different from that in MSA-C group (0.48 ± 0.36,0.23 ± 0.24,0.49 ± 0.49 ; P ＜0.05) ; FA in the left occipital lobe (0.46 ± 0.10) in PD group was significantly different from that in MSAP group (0.56 ± 0.82 ; P ＜ 0.01).Conclusion Trail-making test,graphic symbol test and DTI can be used to differentiate MSA-P type from MSA-C type or PD.
