进展性核上性麻痹及其亚型患者的定性平衡指标、动态姿势描记术和结构脑成像之间的相关性。

Correlation between qualitative balance indices, dynamic posturography and structural brain imaging in patients with progressive supranuclear palsy and its subtypes.

机构信息

Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India.

Department of Neurological Rehabilitation, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India.

出版信息

Neurol India. 2016 Jul-Aug;64(4):633-9. doi: 10.4103/0028-3886.185417.

DOI:10.4103/0028-3886.185417

PMID:27381106

Abstract

OBJECTIVES

To compare the clinical, balance, and radiological profile of progressive supranuclear palsy (PSP) of Richardson type (PSP-R) and Parkinsonian type (PSP-P).

MATERIALS AND METHODS

Twenty-nine patients with PSP (PSP-R: 17, PSP-P: 12) satisfying the probable/possible National Institute of Neurological Disorders and Stroke-PSP criteria were recruited and assessed with Unified Parkinson's Disease Rating Scale-III, PSP rating scale (PSPRS), Berg balance scale (BBS), Tinetti performance-oriented mobility assessment gait and total (TPG and TPT) score, dynamic posturography (DP), and magnetic resonance imaging. Data were compared with 30 age- and gender-matched healthy controls.

RESULTS

The mean ages of PSP-R, PSP-P, and controls were comparable (62.5 ± 6.6, 59 ± 8.9, and 59.8 ± 7.6 years). The PSP group had significantly poor DP scores and more radiological abnormalities than controls. The PSPRS, TPG, and TPT scores were significantly more impaired in PSP-R compared to PSP-P (P = 0.045, P = 0.031, and P = 0.037, respectively). In DP, the limits of overall stability were most significant (P < 0.001) and PSP-R had lower scores. PSP-R compared to PSP-P had more often "Humming Bird" sign (P < 0.001), "Morning Glory" sign (P < 0.008), and generalized cortical atrophy (P < 0.001). The area of midbrain (P < 0.002) and midbrain/pons ratio (P < 0.013) was significantly lower in PSP-R. In PSP-P, the overall balance index significantly correlated with BBS, TPG, and TPT (r = -0.79, P = 0.002; r = -0.772, P = 0.003; and r = -0.688, P = 0.013) and the midbrain axial anterior-posterior diameter significantly correlated with the TPG and TPT (r = 0.74, P = 0.01; r = 0.66, P = 0.018).

CONCLUSIONS

While balance and radiological abnormalities were more severe in PSP-R, the qualitative and quantitative measurements of severity of balance in PSP-P rather than PSP-R was a better reflection of the pathology of the midbrain.

摘要

目的

比较 Richardson 型（PSP-R）和帕金森型（PSP-P）进行性核上性麻痹（PSP）的临床、平衡和影像学特征。

材料和方法

招募了 29 名符合可能/可能的国立神经病学与中风 PSP 标准的 PSP 患者（PSP-R：17 例，PSP-P：12 例），并使用统一帕金森病评定量表-III、PSP 评定量表（PSPRS）、伯格平衡量表（BBS）、Tinetti 表现导向的移动评估步态和总评分（TPG 和 TPT）、动态姿势描记术（DP）和磁共振成像进行评估。将数据与 30 名年龄和性别匹配的健康对照进行比较。

结果

PSP-R、PSP-P 和对照组的平均年龄相当（62.5±6.6、59±8.9 和 59.8±7.6 岁）。与对照组相比，PSP 组的 DP 评分明显较差，且影像学异常较多。PSPRS、TPG 和 TPT 评分在 PSP-R 中明显较 PSP-P 差（P=0.045、P=0.031 和 P=0.037）。在 DP 中，整体稳定性的极限差异最大（P<0.001），且 PSP-R 评分较低。与 PSP-P 相比，PSP-R 更常见“蜂鸟”征（P<0.001）、“晨露”征（P<0.008）和广泛的皮质萎缩（P<0.001）。PSP-R 的中脑面积（P<0.002）和中脑/脑桥比（P<0.013）明显降低。在 PSP-P 中，整体平衡指数与 BBS、TPG 和 TPT 显著相关（r=-0.79，P=0.002；r=-0.772，P=0.003；r=-0.688，P=0.013），中脑轴向前后径与 TPG 和 TPT 显著相关（r=0.74，P=0.01；r=0.66，P=0.018）。