Strijks E, van't Hof M, Sweep F, Lenders J W, Oyen W J, Horstink M W I M
Dept. of Neurology, University Medical Center, PO Box 9101, 6500 HB Nijmegen, The Netherlands.
J Neurol. 2002 Sep;249(9):1206-10. doi: 10.1007/s00415-002-0809-y.
Multiple System Atrophy (MSA) and idiopathic Parkinson's disease (PD) can be difficult to distinguish. There is an ongoing debate about the diagnostic value of the growth-hormone response to clonidine (CGH-test) in PD and MSA. We investigated whether the CGH-test can identify individual patients in the early stages of PD (n = 21) and Striatonigral Degeneration (SND, n = 11), a particular variety of MSA. Patients were diagnosed on the basis of clinical criteria and IBZM-SPECT. Clonidine induced a greater total serum growth-hormone production in PD than in SND (p = 0.01). However, taking the difference in prevalence of PD and SND into account, and because of the low likelihood ratios of the test, an increase of GH after clonidine increases the pre-test probability for PD by about only 5 %, while an absent response of GH also increases the pre-test probability for SND by about 5 %. We conclude that the CGH-test discriminates between groups of patients with PD and SND, but has little practical diagnostic value for identifying individual patients.
多系统萎缩（MSA）和特发性帕金森病（PD）可能难以区分。关于可乐定生长激素反应（CGH试验）在PD和MSA中的诊断价值一直存在争议。我们研究了CGH试验能否鉴别出处于PD早期（n = 21）和纹状体黑质变性（SND，n = 11，一种特殊类型的MSA）的个体患者。患者根据临床标准和碘苄胍单光子发射计算机断层扫描（IBZM-SPECT）进行诊断。与SND相比，可乐定在PD中诱导产生的血清总生长激素更多（p = 0.01）。然而，考虑到PD和SND的患病率差异，并且由于该试验的似然比很低，可乐定给药后生长激素增加仅使PD的检验前概率提高约5%，而生长激素无反应也仅使SND的检验前概率提高约5%。我们得出结论，CGH试验可区分PD和SND患者组，但对鉴别个体患者几乎没有实际诊断价值。
