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| 早发型与晚发型帕金森病患者经颅超声检查黑质高回声异质性研究 |
| Study of heterogeneity of substantia nigra hyper-echogenicity by transcranial sonography between patients with early-onset and late-onset Parkinson's disease |
| 投稿时间：2025-09-26 |
| DOI：10.3969/j.issn.1000-0399.2026.07.013 |
| 中文关键词: 帕金森病 早发型 晚发型 经颅超声检查 黑质高回声 异质性 |
| 英文关键词: Parkinson's disease Early-onset Late-onset Transcranial sonography Substantia nigra hyperechogenicity Heterogeneity |
| 基金项目:海南省卫生健康科技创新联合项目(编号:SQ2023WSJK0032) |
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| 中文摘要: |
| 目的 探讨早发型帕金森病（EOPD）与晚发型帕金森病（LOPD）患者经颅超声检查（TCS）黑质高回声（SNH）的异质性。方法 选取2023年1月至2025年6月于海南医科大学第二附属医院确诊的帕金森病（PD）患者120例为PD组，并以50岁发病年龄为界分为EOPD组（n=39例）和LOPD组（n=81例）。另选取同期在本院确诊且年龄、性别匹配的原发性震颤（ET）患者60例为ET组，60例体检健康志愿者为对照组。所有受试者均接受TCS检查，黑质回声等级≥Ⅲ级被视为TCS阳性，否则为TCS阴性，并测量SNH面积。收集，并比较各组的人口统计学数据和疾病特征，以及TCS检查相关参数。分析不同亚型PD患者SNH面积与临床特征的相关性。采用受试者工作特征（ROC）曲线评估SNH面积对PD的诊断效能，并比较EOPD和LOPD患者的SNH面积诊断灵敏度。结果 PD组SNH面积、TCS阳性率大于/高于对照组和ET组（P<0.001），且3组间黑质回声强度分级情况比较差异有统计学意义（P<0.001）。LOPD组SNH面积、TCS阳性率大于/高于EOPD组（P<0.05），且两组患者黑质回声强度分级情况比较差异有统计学意义（P<0.001）。EOPD患者的SNH面积与年龄、起病年龄呈负相关（r=-0.382,-0.558,P均<0.05），而LOPD患者的SNH面积与年龄、起病年龄呈正相关（r=0.458,0.417,P均<0.05）。多元逐步线性回归分析结果显示，起病年龄（β=-0.016,95%CI:-0.022～-0.010,P<0.001）是EOPD患者SNH面积的影响因素，而年龄（β=0.008,95%CI:0.005～0.011,P<0.001）是LOPD患者SNH面积的影响因素。SNH面积诊断PD的ROC曲线下面积为0.804(P<0.05)，灵敏度为74.17%，特异度为83.33%，截断值为0.224 cm2。LOPD患者的SNH面积诊断灵敏度高于EOPD患者，差异具有统计学意义（P<0.05）。结论 SNH面积对PD诊断具有一定临床价值，EOPD与LOPD在TCS检查SNH方面存在明显异质性。 |
| 英文摘要: |
| Objective To explore the heterogeneity of substantia nigra hyperechogenicity(SNH) by transcranial sonography(TCS) between patients with early-onset Parkinson's disease(PD)(EOPD) and late-onset PD(LOPD). Methods A total of 120 patients with PD diagnosed at the Second Affiliated Hospital of Hainan Medical University from January 2023 to June 2025 were selected as the PD group, and these patients were further divided into the EOPD group(n=39) and LOPD group(n=81) based on a cutoff age of 50 years for disease onset. Additionally, 60 patients with essential tremor(ET) diagnosed in the same hospital during the same period and matched for age and gender were selected as the ET group, and 60 healthy physical examinees were recruited as the control group. All subjects were detected by TCS, when the intensity of the SN echoes≥grade Ⅲ was considered as positive for TCS, or else as negative for TCS, and the area of SNH was measured. The demographic data, and disease characteristics, as well as related parameters of TCS were collected and compared between groups. The correlation of the area of SNH in patients with different subtypes of PD with clinical characteristics was analyzed. The diagnostic efficacy of the area of SNH for PD was evaluated by constructing receiver operating characteristic(ROC) curves, and the diagnostic sensitivity of the area of SNH was compared between EOPD and LOPD. Results The area of SNH and the positive rate of TCS in the PD group were significantly larger/higher than those in the control group and ET group(P<0.001), and there was a statistically significant difference in the distribution of substantia nigra echogenicity classification among the three groups(P<0.001). The area of SNH and the positive rate of TCS in the LOPD group were significantly larger/higher than those in the EOPD group(P<0.05), and there was a statistically significant difference in the distribution of substantia nigra echogenicity classification between the two groups(P<0.001). The area of SNH in patients with EOPD patients was negatively correlated with age and onset age(r=-0.382,-0.558, P<0.05), while the area of SNH in patients with LOPD was positively correlated with age and onset age(r=0.458,0.417, P<0.05). The results of multiple stepwise linear regression analysis showed that the onset age(β=-0.016, 95%CI:-0.022～-0.010, P<0.001) was the influencing factor for the area of SNH in patients with EOPD, and while age(β=0.008, 95%CI: 0.005～0.011, P<0.001) was the influencing factor of the area of SNH in patients with LOPD. The area under the ROC curve for diagnosing PD by the area of SNH was 0.804(P<0.05), the sensitivity was 74.17%, the specificity was 83.33%, and the cut-off value was 0.224 cm2. The diagnostic sensitivity of the area of SNH in patients with LOPD was higher than that in patients with EOPD, and the differences were statistically significant(P<0.05). Conclusion The area of SNH has certain clinical value in the diagnosis of PD, and there is significant heterogeneity in aspect of SNH by TCS between EOPD and LOPD, which can provide basis for diagnosis and treatment of both in the future. |
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