帕金森病的早期诊断2016.pptVIP

PD早期诊断困难 Hughes等通过尸检发现约24%PD诊断不正确，最常误诊为：进行性核上性麻痹（PSP）、多系统萎缩（MSA）和Alzheimer‘s 病。还可误诊为皮质基底节变性、路易体痴呆、特发性震颤、肌张力障碍性震颤、血管性帕金森综合症、药物诱导帕金森综合症等。 Hughes et al found that nearly 24% of PD diagnoses were incorrect (when confirmed by autopsy), with the most common misdiagnoses including progressive supranuclear palsy (PSP), multiple system atrophy (MSA), and Alzheimers disease. PD早期诊断困难 下列六个特征“不支持” 帕金森病的诊断： （1）早期反复跌倒发作；（2）对L-DOPA治疗反应差；（3）症状对称发病；（4）病情迅速进展（3年达Hoehn and Yahr 3期）；（5）缺少震颤；（6）早期严重植物神经功能障碍（尿便失禁、尿储留需要导尿、持续勃起障碍、症状性体位性低血压）。 The following clinical features in early stages of disease should be considered to distinguish PD from other parkinsonian syndromes: 1) falls at presentation and early in the disease course, 2) poor response to levodopa, 3) symmetry at onset, 4) rapid progression (to Hoehn and Yahr stage 3 in 3 years), 5) lack of tremor, and 6) dysautonomia (urinary urgency/incontinence and fecal incontinence, urinary retention requiring catheterization, persistent erectile failure, or symptomatic orthostatic hypotension) (Level B) PD早期诊断困难 PD平均发病年龄为62.4岁；MSA为55.9岁。 PD症状出现到死亡平均时间为13.2年； MSA为6.8年 The mean age of patients in the MSA group was 55.9 years compared with 62.4 years in the PD group, and there was a significant difference in mean disease duration prior to death. MSA patients survived an average of 6.8 years after symptom onset compared with 13.2 years in patients with PD (P .0005). MSA与PD鉴别 下列四项特点有利于“MSA”的诊断： （1）早期严重的植物神经功能障碍； (defined as symptomatic postural hypotension, urinary urge incontinence, fecal incontinence, urinary retention requiring catheterization, or persistent erectile failure), （2）早期对左旋多巴治疗反应差（poor initial response to levodopa） （3）早期出现运动症状波动（early motor fluctuations） （4）以肢体强直起病（initial rigidity）. The presence of any 2 of these features provided a sensitivity of 87.1% and a specificity of 70.5% for distinguishing MSA from PD. 脊髓小脑共济失调 Progress in PD 过去十年间，对于PD的临床前期及临床研究集中在三个方面： 首先，个体化治疗方法临床试验的评估，目的是获取针对特定发病机制的疾病修饰作用药物。