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多巴胺转运体功能显像正常几乎(97%)可以排除是帕金森病

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[第1楼 PID5512] 2009-05-06 14:36 Sunset 写道:

多巴胺转运体功能显像正常几乎(97%)可以排除是帕金森病

  
以下是被引用的内容:
典型的帕金森病确诊并不困难,但不典型的患者诊断还是经常会遇到困难。新近英国的研究表明(Nuclear Medicine Communications 2006, 27:933–937),多巴胺转运体功能显像对于这部分不典型患者的诊断非常有帮助。通常,帕金森病在疾病的早期就会有多巴胺转运体的显著下降,但临床上有时候会碰到临床表现符合帕金森病的诊断标准,但脑多巴胺转运体功能显像正常的患者,该研究小组对150例这样的患者进行了长达2.4年的多巴胺转运体功能显像的随访,结合临床症状的随访和多巴制剂的疗效再判断,结果发现,146例(97%)患者症状无进展,其中有27例患者已经接受了多巴制剂的治疗,但撤药后25例患者病情无恶化,这些结果均提示:对于症状不典型的怀疑是帕金森病的患者,检查多巴胺转运体并复查均正常的话,几乎可以肯定排除帕金森病。
  来源:帕金森病专题  2009.05.06
  出处:http://www.parkinsonism.cn/
[第2楼 PID5512] 2012-08-20 19:27 Robot :

多巴胺转运体功能显像正常几乎(97%)可以排除是帕金森病 相关

[第3楼 PID5513] 2009-05-06 14:37 Sunset 写道:

多巴胺转运体功能显像正常几乎(97%)可以排除是帕金森病原始英文

  Two year follow up in 150 consecutive cases with normal dopamine transporter imaging



Background and aims Functional pre-synaptic dopamine brain imaging is generally abnormal when parkinsonism is degenerative (such as in idiopathic Parkinson’s disease) and normal in patients with non-degenerative movement disorder (such as essential tremor). However, some patients diagnosed as early Parkinson’s disease have normal presynaptic dopamine imaging. Follow-up of patients with normal imaging should help determine whether such patients truly have degenerative parkinsonism (and therefore represent false negative imaging results), or emerge as cases of non-degenerative parkinsonism (and therefore represent initial clinical over-diagnosis of Parkinson’s disease).



Methods and results One hundred and fifty cases with normal 123I-FP-CIT SPECT undertaken during routine care over a 3-year period were reviewed 2.4 years (interquartile range, 2.2–3.1 years) after SPECT. Diagnosis after follow-up was non-degenerative parkinsonism or tremor in 146 (97%), who did not progress clinically, and degenerative parkinsonism in four (3%), in whom clinicial progression was noted. Anti-Parkinson therapy was used in 36, and withdrawn in 27 with no deterioration in 25. Patients strictly fulfilling Brain Bank criteria (part 1) were more likely to undergo a trial of anti-Parkinson therapy (P <0.05) but were no more likely to maintain or respond to anti-Parkinson therapy than those not fulfilling criteria.



Conclusion The clinical profile and therapy response during follow-up of patients with normal presynaptic dopamine imaging supports the diagnosis of a non-degenerative movement disorder in nearly all cases. Nucl Med Commun 27:933–937 _c 2006 Lippincott Williams & Wilkins.
[第4楼 PID5523] 2009-05-08 12:01 唐都医院神经外科 写道:

回复: 多巴胺转运体功能显像正常几乎(97%)可以排除是帕金森病

确诊帕金森
——确诊帕金森
作者:佚名 来源:本站整理 点击数:38 更新时间:2009-05-05
 
 一般来说,确诊帕金森病主要靠临床症状和体征,即医生的询问、观察和检查。症状的出现和发展可以非常缓慢,没有一定顺序,有些震颤或运动障碍甚至在几年后才引起重视。主要症状和体征的特点:
  (1)震颤(颤抖)。并不是所有的帕金森病患者都有震颤,但可能发生轻微或明显震颤如手呈搓丸样动作,通常首发于一只手或手、臂、腿。震颤很可能发生于患者休息或行走时,以及心情焦虑或兴奋时。一些患者可能为此感到难为情,但轻微震颤通常不影响正常的动作行为。实际上,当手或手臂工作时,颤抖通常会暂时的减轻或消失。约有15%的患者始终无震颤;另有15%的患者是发生在单纯性震颤的基础之上。
  (2)肌肉僵硬。肌肉僵硬感常是帕金森病的早期症状之一。四肢呈“铅管样”或“齿轮样”强直;在转身、从座位上站起、解钮扣和其它的日常动作逐渐变得缓慢、越来越困难。有时肌肉僵直会而疼痛、难以形容的不适。
  (3)动作迟缓。动作迟缓是早期患者的另一个常见症状。表现为行走起步困难、走路会越来越费力,有时行走中一旦停下,再次起步会非常困难。主动运动和伴随动作减少。
  (4)姿势不稳定。姿势不稳定表现为患症者下意识调节身躯和四肢方位的能力障碍。可发现患者保持直立姿势、弯腰摸脚、行走中摆动双臂、碰撞时保持身体平衡均有困难。有特殊的姿势,如头前倾屈曲,肘及膝关节屈曲“三曲姿势”等,转弯时容易跌倒。
  (5)书写困难和步态障碍。明显震颤会影响写字,连续写几行字,字体会逐渐变小或潦草难以辨认。步态障碍表现如小碎步、步态慌张、前冲步态或单侧下肢拖曳。

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