不典型帕金森患者皮质脊髓束损害的电生理特点——三重刺激技术研究初探

Electrophysiological characteristics of cortico-spinal tract impairment in patients with atypical parkinsonism: clinical value of triple stimulation technique

摘要:

目的 分析三重刺激技术（TST）对评价不典型帕金森患者皮质脊髓束损害的临床应用价值。方法 病例组为2009年7月在北京协和医院就诊的6例不典型帕金森患者（多系统萎缩5例，进行性核上性麻痹1例），对照组为12例年龄匹配的正常人或非神经系统疾病患者。对受试者进行右上肢小指展肌TST和传统运动诱发电位（MEP）测定，分析TST波幅比（TST测试/TST对照）、中枢运动传导时间（CMCT）、静息运动阈值（RMT）、MEP潜伏期特点。对上述电生理指标进行与病程和年龄的相关性分析。结果 与对照组相比，不典型帕金森患者的TST波幅比明显降低[（40.7%±18.6%） vs （96.8%±3.0%），P＝0.001]，RMT明显升高[（63.3±5.2） vs （48.6±8.4），P＝0.001]，MEP潜伏期和CMCT在两组间差异无统计学意义（P＞0.05）。TST和传统MEP相关参数与病程或年龄之间均未见显著性相关，但是TST波幅比与病程呈现负相关趋势。结论 TST较传统MEP能更好地评价不典型帕金森患者的皮质脊髓束损害。

Abstract:

Objective To determine the clinical value of triple stimulation technique (TST) in the assessment of cortico-spinal tract impairment in patients with atypical parkinsonism. Methods Six patients with atypical parkinsonism (5 cases of parkinsonian variant of multiple system atrophy and 1 of progressive supranuclear palsy) admitted in our hospital in July 2009 were recruited in this study. Another 12 age-matched subjects (7 healthy volunteers and 5 non-central nervous system involvement patients) served as controls. All the subjects were examined with conventional motor evoked potential (MEP) test and TST at abductor digiti minimi. Resting motor threshold (RMT), central motor conduction time (CMCT), MEP latency and TST amplitude ratio (TSTtest/TSTcontrol) were assessed, and their correlation to the age and disease duration were analyzed. Results The TST amplitude ratio was significantly decreased [(40.7±18.6)% vs (96.8±3.0)%, P＝0.001] in atypical parkinsonism along with increased RMT [(63.3±5.2) vs (48.6±8.4), P＝0.001] when compared with controls. But there was no significant difference in CMCT and MEP latency between the 2 groups (P＞0.05). Neither conventional MEP nor TST showed significant correlation with age or disease duration, but TST amplitude ratio showed negative correlation trend with disease duration. Conclusion TST is superior to conventional MEP in the assessment of cortico-spinal tract impairment in atypical parkinsonism.