静态平衡功能定量分析鉴别P型和C型多系统萎缩

目的 对多系统萎缩帕金森(MSA-P)型与多系统萎缩共济失调(MSA-C)型患者进行静态平衡功能定量分析,比较两者的差异.方法 分别选取MSA-P患者29例,MSA-C患者40例,同时纳入同龄正常人23例作为对照,利用SYNAPSYS姿势平衡仪对3组进行静态姿势平衡分析.在睁眼/闭眼、平板/软垫两种测试因素4种测试环境下监测重心偏移,力学数据经过傅里叶转换为能量值.比较3组感觉统合测试各项得分,跌倒和姿势性震颤的发生率,以及在检测中消耗能量的差异.结果 与对照组比较,MSA组体感、视觉、前庭觉得分及总分均明显减少(P<0.01).与MSA-P组相比,MSA-C组前庭觉得分更低,差异有统计学意义(P<0.05).与对照组比较,MSA组在闭眼软垫测试中跌倒次数明显增多,且MSA-C组跌倒次数明显多于MSA-P组(P<0.05).特征性的3 Hz姿势性震颤在97.5% MSA-C患者中出现,在24.1%的MSA-P患者中出现,在正常人中从不出现.在各项测试环境下,3组间3 Hz姿势性震颤的出现率均不同,两两比较差异均有统计学意义(P<0.05).与对照组比较,MSA患者在各个方向、各个测试环境、各个能量频段所消耗的能量都明显增多,差异有统计学意义(P<0.01).MSA-P组和MSA-C组的能量分布差异主要表现在各个测试环境中的高频段(2~20 Hz).随着测试难度增加,MSA-C组在各个频段耗能均明显高于MSA-P组(P<0.05).结论 在静态平衡测试中MSA-C和MSA-P均表现出严重的姿势平衡障碍,但在绝大多数MSA-C中可见典型的姿势性震颤,借助后者可对MSA进行准确分型.

Differentiate multiple system atrophy of parkinsonian type from multiple system atrophy of cerebellar type by static posturography study.

Objective To investigate the differences between patients with multiple system atrophy of parkinsonian type (MSA-P) and multiple system atrophy of cerebellar type (MSA-C) by static osturography analysis.Methods Static postural analysis was performed by the SYNAPSYS Posturography System (SPS) in 92 subjects, including 29 with MSA-P, 40 with MSA-C and 23 healthy controls.During the study, all subjects were engaged in a Sensory Organization Test (SOT), which consisted of four stance tasks of standing on a normal surface/foam support for 20 seconds with eyes open/closed separately.The amplitude of the postural sway was measured and transformed into energy by Fourier analyzer.SOT scores, the appearance of falls and typical 3-HZ postural tremors during the four tasks were recorded and compared.Energy of the three groups was also compared in different tasks, directions and frequencies.Results Compared with healthy controls, SOT scores were significantly lower in MSA groups (P<0.01).Compared with MSA-P, the vestibular scores were further reduced in MSA-C (P<0.05).Falls were more common in MSA group (especially in the MSA-C group) in the SOT4 task, and the difference between MSA-P and MSA-C was also significant (P<0.05).Typical 3-HZ postural tremor was observed in most MSA-C patients, a few MSA-P patients and none of the healthy controls.Compared with healthy controls, much more energy was consumed in every task, every direction and nearly every energy bands in MSA group.Energy of MSA-P was significantly lower than that of MSA-C mainly in the high frequency band (2 Hz-20 Hz).As the difficulty of the task increased, differences between the two groups were more common in all frequency bands.Conclusion Both MSA-P and MSA-C are characterized by severe postural dysfunction.However, typical postural tremor predominates in MSA-C, and extremely useful in the differential diagnosis of MSA-P and MSA-C.