Li Jun, Jin Miao, Wang Li, Qin Bin, Wang Kang
Department of Senior Ward, China-Japan Friendship Hospital, Beijing, China.
Department of Neurology, China-Japan Friendship Hospital Beijing, 2 Yinghua Dongjie, Hepingli, Beijing, 100029, China.
J Neurol. 2017 Mar;264(3):476-481. doi: 10.1007/s00415-016-8370-2. Epub 2016 Dec 26.
The Movement Disorder Society Clinical Diagnostic Criteria for Parkinson's disease (MDS-PD Criteria) was introduced by the Movement Disorder Society in 2015 for research purposes. However, its use for clinical diagnosis of Parkinson disease still needs further revision. This study compares the UK-Criteria versus MDS-PD Criteria in the clinical diagnosis of Parkinson disease referred to the China-Japan Friendship Hospital of Beijing, China. To compare the MDS-PD Criteria with the UK-Criteria and discuss the feasibility of the clinical application of MDS-PD Criteria as a general guide to clinical diagnosis of PD in Chinese PD patients. 150 patients of neurology clinic of China-Japan Friendship Hospital of Beijing were recruited in our research. They were divided into three groups: UK-Criteria group, MDS-PD Criteria group and a combined group of UK and MDS-PD Criteria. Clinical history was collected while physical and auxiliary examinations were done by a trained neurologist according to the corresponding criteria. An interrater reliability analysis using the Kappa statistic claimed substantial agreement (κ = 0.626) between the MDS-PD Criteria and the UK-Criteria. The differences between the diagnostic results of these two criteria were statistically significant by paired Chi-square test (p = 0.000). It was found that levodopa-induced dyskinesia had a good positive predictive value, while early bulbar impairment and inspiratory dysfunction presented a negative predictive value. The MDS-PD Criteria emphasize the importance of non-motor symptoms, keeping the motor symptoms as the core for the clinical diagnosis of PD, and establish categories of diagnosis features and levels of certainty which are more complete and organized to be used and replicated by non specialized physicians to evaluated patients with Parkinsonism. The higher sensitivity of MDS-PD Criteria compared with UK-Criteria is worth being widely used in clinical work.
运动障碍协会帕金森病临床诊断标准(MDS - PD标准)由运动障碍协会于2015年推出用于研究目的。然而,其在帕金森病临床诊断中的应用仍需进一步修订。本研究在中国北京中日友好医院对帕金森病临床诊断中英国标准与MDS - PD标准进行比较。比较MDS - PD标准与英国标准,并探讨MDS - PD标准作为中国帕金森病患者临床诊断通用指南临床应用的可行性。北京中日友好医院神经内科门诊的150例患者被纳入本研究。他们被分为三组:英国标准组、MDS - PD标准组以及英国和MDS - PD标准联合组。由一名经过培训的神经科医生根据相应标准收集临床病史并进行体格检查和辅助检查。使用Kappa统计量进行的评分者间信度分析表明MDS - PD标准与英国标准之间存在高度一致性(κ = 0.626)。通过配对卡方检验,这两个标准诊断结果之间的差异具有统计学意义(p = 0.000)。发现左旋多巴诱导的异动症具有良好的阳性预测价值,而早期延髓损害和吸气功能障碍呈现阴性预测价值。MDS - PD标准强调非运动症状的重要性,以运动症状作为帕金森病临床诊断的核心,并建立了更完整且有条理的诊断特征类别和确定性水平,可供非专科医生用于评估帕金森综合征患者并进行重复使用。与英国标准相比,MDS - PD标准具有更高的敏感性,值得在临床工作中广泛应用。