| Objective To investigate the clinical application value of transcranial ultrasound(TCS)in Parkinson’s disease,and to analyze whether substantia nigra(SN)hyperechogenicity can be used to evaluate the severity of PD.Methods 77 patients with Parkinson’s disease were selected as the case group and 39healthy adults as the control group.TCS was performed to determine whether substantia nigra was echo-enhanced.The area of bilateral SN hyperechogenicity and midbrain cross-section were measured,and the ratio of the area of bilateral SN hyperechogenicity to the area of midbrain cross-section(hyper-substantia nigra/midbrain,S/M)was calculated,when the area of SN hyperechogenicity is more than 0.2cm2 and/or S/M is more than 7%,it is considered as TCS scan positive(SN+),otherwise it is negative(SN-).PD group was divided into SN+group(n=48)and SN-group(n=29).General information such as gender,age,age of onset,course of disease,time of onset-start of medication and form of onset of disease were collected,and scales of motor symptoms,non-motor symptoms and motor complications of patients were collected.The scales of motor symptoms:MDS-Unified Parkinson’s Disease Rating Scale(MDS-UPDRS),Hoehn&Yahr(H-Y)staging scale and frozen gait scale.The scales of non-motor Symptoms:Non-Motor Symptoms Scale(NMSS),Scales for Outcomes in Parkinson’s Disease-Autonomic(SCOPA-AUT),Mini-Mental State Examination(MMSE),Hamilton Depression Rating Scale(HAMD),Parkinson’s disease Sleeping Scale(PDSS),Rapid-eye-movement Sleep Behavior Disorder Questionnaire Hongkong(RBDQ-HK),Restless leg syndromes(RLS)Rating Scale,Parkinson’s Fatigue Scale(PFS-16),Sleepiness Scale,Olfactory Rating Scale.The scales of Motor complications:end-of-dose phenomena questionnaire,dyskinesia Assessment scale.Analyze whether there were differences in the general information and clinical symptoms of the two groups of patients,and whether the area of SN hyperechogenicity and the raito size of S/M were correlated with the general information and clinical symptoms of the patients.Results 1.The TCS positive proportion,the area of SN hyperechogenicity and S/M ratio in the group of PD were higher than those in healthy control group,and the differences were statistically significant(P<0.05).2.here were statistically significant differences between the group of SN+and the SN-in gender and whether tremor was the form of onset(P<0.05),while there were no statistically significant differences in age,age of onset,course of disease,time of onset-start of medication and early onset between groups(P>0.05).The disease course in the group of SN+was positively correlated with the area of SN hyperechogenicity and the ratio of S/M(P<0.05),and the Spearman correlation coefficients r_swere 0.349 and 0.325,respectively.There was no correlation between sex,age,age of onset,time from onset to start of medication,early onset or form of onset and the area of SN hyperechogenicity and S/M ratio(P>0.05).3.There was no significant difference in MDS-UPDRSⅢscore,H-Y stage and frozen gait between the group of SN+and the SN-(P>0.05).The tremor score of the group of SN+was significantly higher than that of the SN-(P<0.05),but there was no significant difference in the scores of other motor symptoms between the two groups(P>0.05).There was no correlation between UPDRSⅢscore,H-Y stage,frozen gait score,tremor score,posture instability/gait disorder score,myotonia score and the area of SN hyperechogenicity and S/M ratio in the group of SN+(P>0.05).4.The differences in SCOPA-AUT score and PFS-16 score between the group of SN+and the SN-were statistically significant(P<0.05).There were no significant differences in NMSS score,PDSS score,MMSE score,HAMD score,sleepiness score,hyposmia,RBD and RLS between the two groups(P>0.05).PFS-16 score was positively correlated with the area of SN hyperechogenicity(P<0.05),and its r_svalue was 0.288.NMSS score,SCOPA score,PDSS score,MMSE score,HAMD score,sleepiness score,hyposmia,RBD,RLS had no correlation with the area of SN hyperechogenicity(P>0.05).HAMD score was positively correlated with the ratio of S/M(P=0.041)and r_svalue was 0.296,while NMSS score,SCOPA score,PDSS score,MMSE score,PFS-16 score,sleepiness score,hyposmia,RBD,RLS and the ratio of S/M were not correlated(P>0.05).5.There was no significant difference between the group of SN+and the SN-(P>0.05).6.Logistic regression analysis showed that the onset form was the influence factor ofSubstantia nigra hyperechogenicity(P<0.05).Conclusion The sensitivity and specificity of TCS in diagnosing PD were 62%and 90%,and positive TCS scan can be used as one of the supporting criteria for PD diagnosis.The PD patients with male and onset of static tremor are more likely to have substantia nigra hyperechogenicity;The longer the course of disease,the greater the S/M ratio of the area of hyperechoic substantia nigra.Substantia nigra hyperechogenicity could not evaluate the overall severity of motor symptoms and non-motor symptoms in PD.The higher the S/M ratio,the higher the degree of depression.Substantia nigra hyperechogenicity was not associated with gait freezing or sleep disturbance. |
