2019 年第 10 期 第 14 卷

头颈部CT血管成像联合颈动脉彩色多普勒超声对老年血管性帕金森综合征的诊断价值

Diagnostic value of head and neck CT angiography combined with carotid color Doppler ultrasound in senile patients with vascular Parkinson syndrome

作者：冀学红岳术义李瑞莲许伟恒冯志霞李美杰姚丽娜纪利利时伟张丽娜郭书琴车雅男

英文作者：

单位：072750河北省保定市第二中心医院重症医学科（冀学红、许伟恒、冯志霞、李美杰、姚丽娜、纪利利、时伟、张丽娜、郭书琴、车雅男），老年病科（岳术义）；072750河北省涿州市第二人民医院一分院妇产科（李瑞莲）

英文单位：

关键词：老年血管性帕金森综合征；帕金森病；CT血管成像；颈动脉彩色多普勒超声

英文关键词：

• 摘要：

• 【摘要】目的    探究头颈部CT血管成像联合颈动脉彩色多普勒超声对老年血管性帕金森综合征（VPS）的诊断价值。方法    选取2016年7月至2018年7月河北省保定市第二中心医院神经内科收治的老年VPS1、2型患者各15例分别作为VPS1、VPS2组，选择同期收治的老年帕金森病患者30例作为帕金森病组。入院后分别行颈动脉彩色多普勒超声、头颈部CT血管成像检测，对头颈部病变位置、颈动脉狭窄程度进行对比，从而探究帕金森病组、VPS1组与VPS2组病变部位、性质的差异，进而判断头颈部CT血管成像联合颈动脉彩色多普勒超声对老年VPS的诊断价值。结果    患者头颈部CT血管成像显示，VPS2组基底节区腔隙性脑梗死改变、中重度脑萎缩所占比例明显低于VPS1组［33.3%（5/15）比53.3%（8/15）、13.3%（2/15）比40.0%（6/15）］，而二者皆明显高于帕金森病组［10.0%（3/30）、13.3%（4/30）］，差异均有统计学意义（均P＜0.05）。而VPS1组与VPS2组患者皮质下白质缺血改变所占比例差异无统计学意义［46.7%（7/15）比46.7%（7/15）］（P＞0.05），但皆高于帕金森病组［6.7%（2/30）］，差异均有统计学意义（均P＜0.05）。颈动脉彩色多普勒超声结果显示，VPS1组和VPS2组大血管狭窄程度明显高于帕金森病组，而VPS2组较VPS1组轻微，差异均有统计学意义（均P＜0.05）。CT血管成像与颈动脉彩色多普勒超声二者联合诊断VPS的敏感度（83.87%）、特异度（83.33%）分别高于单独使用CT血管成像或颈动脉彩色多普勒超声，差异均有统计学意义（均P＜0.05）。结论    头颈部CT血管成像联合颈动脉彩色多普勒超声在诊断老年VPS中，可以根据病变位置的定位以及血管硬化的程度与帕金森病相鉴别，同时也可根据病变位置的不同，进行老年发病、隐匿性起病的分型诊断，临床意义较大。

• 【Abstract】Objective    To explore the diagnostic value of head and neck CT angiography combined with carotid color Doppler ultrasound in senile patients with vascular Parkinson syndrome(VPS). Methods    From July 2016 to July 2018, 15 cases of senile type 1 VPS (VPS1), 15 cases of senile type 2 VBS (VPS2) and 30 cases of senile Parkinson disease were enrolled in the Second Central Hospital of Baoding City, Hebei Province. Head and neck CT angiography and carotid color Doppler ultrasound were performed to determine the site and characteristic of lesions and the severity of carotid artery stenosis. Diagnostic value of CT angiography combined with color Doppler ultrasound for VPS was analyzed. Results    Head and neck CT angiography showed that the proportions of basal ganglia lacunar infarction and moderate to severe brain atrophy increased among Parkinson disease, VPS2 and VPS1 patients［10.0%（3/30）, 33.3%（5/15） vs 53.3%（8/15）;13.3%（4/30）, 13.3%（2/15） vs 40.0%（6/15）］(all P<0.05); the proportion of subcortical white matter ischemia in VPS1 and VPS2 patients was significantly higher than that in Parkinson disease patients［6.7%（2/30）］(P<0.05), but there was no significant difference between them［46.7%（7/15） vs 46.7%（7/15）］(P>0.05). Carotid artery color Doppler ultrasound showed that the severity of macrovascular stenosis increased among Parkinson disease, VPS2 and VPS1 patients(all P<0.05). Combined detection of CT angiography and ultrasound showed higher sensitivity (83.87%) and specificity (83.33%) in diagnosing VPS than separate diagnosis(all P<0.05). Conclusions    Combined detection of head and neck CT angiography and carotid color Doppler ultrasound can identify the site of lesions and the severity of arteriosclerosis and help to differentiate senile VPS with Parkinson disease. The joint diagnostic method can also contribute to the sub-type diagnosis for atypical VPS.