摘要
目的探讨左旋多巴负荷试验诊断及鉴别诊断帕金森病的准确性,研究影响该试验结果的相关因素。方法收集具有帕金森综合征运动症状90例患者,给予美多芭125 mg/次,4次/d,连续7 d的改良左旋多巴负荷试验,并进行1 y随访,记录最终完成随访的85例患者的临床资料,以试验前后统一帕金森病评分量表(UPDRS)运动部分的改善率为指标,建立左旋多巴负荷试验的ROC曲线,评估该试验的灵敏度和特异度,应用Logistic回归分析引起该试验假阳性和假阴性结果的影响因素。结果左旋多巴负荷试验灵敏度达86.7%,特异度达76%,与随访后的临床诊断Kappa值为0.58,该试验诊断准确性可靠。H&Y分级、服用多巴胺能制剂时间是引起试验假阴性的独立影响因素(P<0.05);病程是引起试验假阳性的独立影响因素(P<0.05)。结论改良的左旋多巴负荷试验对帕金森病诊断的准确性高;帕金森病患者的疾病程度轻、服用多巴胺能制剂时间长对左旋多巴负荷试验的反应不明显;部分非帕金森综合征患者在疾病早期具有一定的多巴胺能反应性。
Objective To explore the accuracy of diagnosis and differential diagnosis of Parkinson＇s disease by Levodopa Challenge test and to study the relevant factors that affect the results of this test. Methods 90 patients with Parkinsonism＇s motor symptoms were collected and given Madopar 125 mg four times a day for 7 days. After one year of followup,85 patients were followed up. Collect the patient＇s clinical data. The ROC curve of the levodopa challenge test was calculated using the UPDRS partⅢ improvement rate as a diagnostic index. And the multivariate logistic regression was used to analysis the independent influencing factors of false positive and false negative results. Results The sensitivity and specificity of the test to predict clinical diagnosis of PD was 86. 7% and 76. 0% and the Kappa value of the test and the followup diagnosis was 0. 58. The diagnostic accuracy of the Levodopa Challenge test is reliable. H Y grade and longer dopamine treatment were the independent factors that causes false negative cases（P 0. 05）. The course of disease was the independent influencing factor of false positive cases（P 0. 05）. Conclusion The levodopa challenge test had high diagnostic accuracy for Parkinson＇s disease. The PD patients of milder clinical symptoms and long time of dopamine treatment have poor response of levodopa challenge test. Some patients with non-PD have a certain effect on dopaminergic responsiveness.
出处
《中风与神经疾病杂志》
北大核心
2017年第11期1013-1017,共5页
Journal of Apoplexy and Nervous Diseases
关键词
帕金森病
左旋多巴负荷试验
多巴胺能反应性
早期诊断
鉴别诊断
Parkinson’s disease
Levodopa challenge test
Dopaminergic responsiveness
Early diagnosis
Differential diagnosis
