帕金森病患者的肛门括约肌肌电图与自主神经功能障碍分析
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摘要
目的分析帕金森病(PD)患者的肛门括约肌肌电图(EAS-EMG)与自主神经功能障碍情况,探讨两者的相关性及两者与PD患者病情程度的相关性。方法选择2018年1～12月就诊于浙江省人民医院临床诊断为PD的50例患者作为观察组和19例健康对照者作为研究对象,两组均进行EAS-EMG检查及PD自主神经症状量表(SCOPA-AUT)评分,分析两组的检查结果及相关性。同时依据H&Y分期对PD患者进行病情分级,分析病情程度与EAS-EMG、SCOPA-AUT评分的相关性。结果观察组的EAS-EMG及SCOPA-AUT评分异常度均高于对照组(P<0.05)。PD患者SCOPA-AUT得分与EAS-EMG的平均时限呈正相关(r=0.46,P=0.00),与平均波幅及多相波百分比不相关(r=0.27,0.14;P=0.06,0.32)。PD患者病情程度与EAS-EMG的平均时限呈正相关(r=0.50,P=0.00),而与平均波幅及多相波百分比不相关(r=0.18,0.17;P=0.21,0.25);病情程度与SCOPA-AUT评分呈正相关(r=0.68,P=0.00)。结论 PD患者的EAS-EMG存在异常,且普遍存在自主神经功能障碍;PD患者的EASEMG异常程度越高,病情越重,出现的自主神经功能障碍症状越多、越频繁。
Objective To analyze the external anal sphincter electromyography(EAS-EMG) and autonomic dysfunction in patients with Parkinson's disease(PD), and to explore the correlation between them and their correlation with the severity of PD patients. Methods 50 patients with clinical diagnosis of PD were selected as the observation group and19 healthy controls were selected as the control group in Zhejiang Provincial People's Hospital from January 2018 to December 2018. The two groups underwent EAS-EMG examination and PD autonomic symptom scale(SCOPA-AUT)score. The findings and correlations between the two groups were analyzed. At the same time, patients with PD were graded according to H&Y staging, and the correlation between disease severity and EAS-EMG, SCOPA-AUT scores was analyzed. Results The abnormalities of EAS-EMG and SCOPA-AUT scores in the observation group were higher than those in the control group(P<0.05). The SCOPA-AUT score of PD patients was positively correlated with the mean time of EAS-EMG(r=0.46; P=0.00), and was not correlated with the mean amplitude and the percentage of polyphase waves(r=0.27, 0.14; P=0.06, 0.32). The severity of PD patients was positively correlated with the mean time of EASEMG(r=0.50, P=0.00), but not with the mean amplitude and percentage of polyphasic waves(r=0.18, 0.17; P=0.21, 0.25).The severity of disease was positively correlated with SCOPA-AUT score(r=0.68, P=0.00). Conclusion The EAS-EMG of PD patients is abnormal, and autonomic dysfunction is common.The higher the abnormality of EAS-EMG in PD patients,the more severe the disease,and the more and more frequent autonomic dysfunction symptoms appear.
Objective To analyze the external anal sphincter electromyography(EAS-EMG) and autonomic dysfunction in patients with Parkinson's disease(PD), and to explore the correlation between them and their correlation with the severity of PD patients. Methods 50 patients with clinical diagnosis of PD were selected as the observation group and19 healthy controls were selected as the control group in Zhejiang Provincial People's Hospital from January 2018 to December 2018. The two groups underwent EAS-EMG examination and PD autonomic symptom scale(SCOPA-AUT)score. The findings and correlations between the two groups were analyzed. At the same time, patients with PD were graded according to H&Y staging, and the correlation between disease severity and EAS-EMG, SCOPA-AUT scores was analyzed. Results The abnormalities of EAS-EMG and SCOPA-AUT scores in the observation group were higher than those in the control group(P<0.05). The SCOPA-AUT score of PD patients was positively correlated with the mean time of EAS-EMG(r=0.46; P=0.00), and was not correlated with the mean amplitude and the percentage of polyphase waves(r=0.27, 0.14; P=0.06, 0.32). The severity of PD patients was positively correlated with the mean time of EASEMG(r=0.50, P=0.00), but not with the mean amplitude and percentage of polyphasic waves(r=0.18, 0.17; P=0.21, 0.25).The severity of disease was positively correlated with SCOPA-AUT score(r=0.68, P=0.00). Conclusion The EAS-EMG of PD patients is abnormal, and autonomic dysfunction is common.The higher the abnormality of EAS-EMG in PD patients,the more severe the disease,and the more and more frequent autonomic dysfunction symptoms appear.
引文
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[19]王含,崔丽英,杜华,等.帕金森病、P型多系统萎缩及进行性核上性麻痹的肛门括约肌肌电图及相关自主神经功能障碍特点[J].中华神经科杂志,2011,44(1):52-55.
[20]De Pablo-Fernandez E,T ur C,Revesz T,et al.Association of autonomic dysfunction with disease progression and survival in Parkinson disease[J].JAMA Neurology,2017,74:970-976.
[2]Nakamura T,Sobue G.Autonomic dysfunction[J].Japanese Journal of Clinical Medicine,2017,75(1):95-100.
[3]Sakakibara R,Uchiyama T,Yamanishi T,et al.Sphincter EMG as a diagnostic tool in autonomic disorders[J].Clinical Autonomic Research,2009,19(1):20-31.
[4]Visser M,Marinus J,Stiggelbout AM,et al.Assessment of autonomic dysfunction in Parkinson's disease:The SCO-PA-AUT[J].Mov Disord,2004,19(11):1306-1312.
[5]中华医学会神经病学分会帕金森病及运动障碍学组.中国帕金森病的诊断标准(2016版)[J].中华神经科杂志,2016,49(4):268-271.
[6]赵蕾,崔丽英,杜华,等,健康人肛门括约肌肌电图参考值及影响因素[J].中华神经科杂志,2016,49(12):942-946.
[7]Rodriguez-Blazquez C,Forjaz MJ,Frades-Payo B,et al.Independent validation of the scales for outcomes in Parkinson’s disease-autonomic(SCOPA-AUT)[J].European Journal of Neurology,2010,17(2):194-201.
[8]Coon EA,Cutsforth-Gregory JK,Benarroch EE.Neuropathology of autonomic dysfunction in synucleinopathies[J].Movement Disorders,2018,33(3):349-358.
[9]Asahina M,Vichayanrat E,Low DA,et al.Autonomic dysfunction in parkinsonian disorders:Assessment and pathophysiology[J].Journal of Neurology,Neurosurgery&Psychiatry,2013,84(6):674-680.
[10]Braak.H,Del Tredici K,Rüb U,et al.Staging of brain pathology related to sporadic Parkinson’s disease[J].Neurobiol Aging,2003,24(2):197-211.
[11]Dayan E,Sklerov M,Browner N.Disrupted hypothalamic functional connectivity in patients with PD and autonomic dysfunction[J].Neurology,2018,90(23):2051-2058.
[12]Hill WG.Control of urinary drainage and voiding[J].Clinical Journal of the American Society of Nephrology,2015,10(3):480-492.
[13]Rodriguez Blazqueza C,Forjazb MJ,Frades Payo B.Independent validation of the scales for outcomes in Parkinson’s disease-autonomic(SCOPA-AUT)[J].European Journal of Neurology,2010,17(2):194-201.
[14]Ashraf-Ganjouei A,Majd A,Javinani A,et al.Autonomic dysfunction and white matter microstructural changes in drug-na vepatients with Parkinson's disease[J].Peer J,2018,6:5539
[15]Sakakibara R,Uchiyama T,Yamanishi T,et al.Sphincter EMG as a diagnostic tool in autonomic disorders[J].Clinical Autonomic Research,2009,19(1):20-31.
[16]Stocchi F,Carbone A,Inghilleri M,et al.Urodynamic and neurophysiological evaluation in Parkinson's disease and multiple system atrophy[J].J Neurol Neurosurg Psychiatry,1997,161(6):507-511.
[17]Linder J,Libelius R,Nordh E,et al.Anal sphincter electromyography in patients with newly diagnosed idiopathic parkinsonism[J].Acta Neurologica Scandinavica,2012,126(4):248-255.
[18]Evatt ML,Chaudhuri KR,Chou KL,et al.Dysautonomia rating scales in Parkinson's disease:Sialorrhea,dysphagia,and constipation[J].Movement Disorders,2010,24(5):635-646.
[19]王含,崔丽英,杜华,等.帕金森病、P型多系统萎缩及进行性核上性麻痹的肛门括约肌肌电图及相关自主神经功能障碍特点[J].中华神经科杂志,2011,44(1):52-55.
[20]De Pablo-Fernandez E,T ur C,Revesz T,et al.Association of autonomic dysfunction with disease progression and survival in Parkinson disease[J].JAMA Neurology,2017,74:970-976.