多种诱发电位检测对早期诊断帕金森病的评估价值

背景对帕金森病进行了多种神经电生理的观察,但还没有发现哪一种电生理指标对早期诊断帕金森病是敏感而又确切的.目的观察帕金森病早期体感诱发电位(SL-SEP)、脑干听觉诱发电位(BAEP)和棋盘格翻转视觉诱发电位(PR-VEP)的异常特征,寻找敏感可靠的诊断指标.设计以诊断为依据,病例对照研究.地点和对象对福建医科大学附属协和医院神经内科门诊和住院的52例Yahr分期为Ⅰ期的帕金森患者(病例组)和40例年龄匹配的健康自愿受试对照组进行3种诱发电位观测.干预对病例组和对照组进行SL-SEP,BAEP和PR-VEP检测.主要观察指标SL-SEP各主波峰潜伏期(PL)、峰间潜伏期(IPL)、波幅;BAEPⅠ,Ⅲ,Ⅴ波PL,Ⅰ-ⅢIPL,Ⅲ-VIPL,Ⅰ-Ⅲ/Ⅲ-Ⅴ比值;PR-VEPP100 PL.结果帕金森病早期SLSEP异常率为69.2%;BAEP的异常率为32.7%;PR-VEP的异常率为30.7%;病例组SL-SEP各主波峰潜伏期、峰间潜伏期与对照组比较差异有显著性意义(P＜0.01);病例组SL-SEP P25和N30波幅(2.4±1.9)μV,(1.5±1.5)μV]与对照组(3.4±2.3)μV,(2.4±1.1)μV]比较差异有显著性意义(P＜0.01);病例组SL-SEP N20和P22波幅(2.5±1.0)μV,(2.3±1.4)μV]与对照组(2.7±1.1)μV,(1.7±1.3)μV]比较差异无显著性意义(P＞0.05);病例组BAEPⅠ-ⅢIPL(2.27±0,33)m]、Ⅲ-ⅤIPL(1.96±0.24)ms、Ⅰ-Ⅲ/Ⅲ-Ⅴ比值(0.88±0.13)与对照组(2.21±0.16)m,(1.89±0.18)ms],0.86±0.10)]比较差异无显著性意义(P＞0.05);病例组PR-VEP的P100PL(97.85±11.6)ms]与对照组(95.13±5.16)ms]比较差异无显著性意义(P＞0.05).结论在帕金森病的早期,皮质感觉处理过程已受到干扰;体感诱发电位中央前成分以及顶成分P25是一个敏感的诊断指标.

Value of multitude evoked potentials for early diagnosis of Parkinson disease

BACKGROUND:Neuroelectrophysiological observation on Parkinson disease is performed, but there is not any neuroelectrophysiology index which can afford a sensitive and accurate diagnosis of early Parkinson disease.OBJECTIVE: To observe the abnormal characteristics of somatosensory evoked potentials(SL-SEP), brain stem auditory evoked potentials(BAEP)and pattern reversal visual evoked potentials(PR-VEP) in early stages of Parkinson disease, and find sensitive and reliable diagnosis index.DESIGN: Case-control trial based on diagnosis.SETTING and PARTICIPANTS: A total of 52 inpatients with Parkinson disease, whose Yahr stage was Class I, were selected from the Department of Neurology and Outpatient,the Affiliated Union Hospital of Fujian Medical University, and 40 health volunteers were selected as control group. All patients were observed with three kinds of evoked potentials.INTERVENTIONS: All patients in case group andcontrol group were tested with SL-SEP, BAEP and PR-VEP.MAIN OUTCOME MEASURES: Peak latency(PL), inter peak latency(IPL) and amplitude of dominant wave of SL-SEP; Ⅰ, Ⅲ, VPL, Ⅰ-Ⅲ IPL,Ⅲ -ⅤIPL, ratio of Ⅰ-ⅢIPL/Ⅲ-Ⅴ IPL of BAEP; P100 PL of PR-VEP.RESULTS: The abnormal rate of SL-SEP, BAEP and PR-VEP were 69.2%, 32.7% and 30. 7% in early stages of Parkinson disease respectively. The PL and IPL of dominant wave of SL-SEP in case group were significantly different from those in control group( P < 0. 01 ) . The amplitudes of P25(2.4 ± 1.9) μV and N30(1.5 ± 1.5) μV of SL-SEP in case group were significantly different from those (3.4 ±2.3) μV, (2.4 ± 1.1) μV] in control group( P < 0.01). The amplitudes of N20(2.5 ± 1.0) μV and P22(2. 3 ± 1.4) μV of SL-SEP in case group were not significantly different from those(2.7±1. 1) μV,(1.7±1.3) μV] incontrol group(P> 》 0.05) Ⅰ-ⅢIPL,Ⅲ - Ⅴ IPL and the ratio of Ⅰ- Ⅲ / Ⅲ- Ⅴ of BAEP in case group were (2.27±0.33) ms, (1.96±0.24) ms and(0.88±0.13) respectively,which were not significantly different from those (2.21 ±0. 16) ms, (1.89 ± 0. 18) ms and (0. 86 ± 0. 10) respectively in control group ( P > 0. 05).P100PL of PR-VEP(97.85 ± 11.6) ms in case group was not significantly different from that (95.13 ± 5.16) ms in control group( P> 0.05).CONCLUSION: The treating process of cortical sensation is interfered in the early stage of Parkinson disease. The pre-central component and parietal component P25 of SL-SEP is a sensitivelydiagnostic index.