加速度测量和表面肌电图检测对帕金森病震颤与特发性震颤的鉴别诊断价值
Value of acceleration and surface electromyogram signals in discriminating tremor between Parkinson’s disease and essential tremor

目的 ·探讨加速度测量技术和表面肌电图对帕金森病（PD)震颤和特发性震颤（ET）的鉴别诊断价值。 方法 ·对24例帕金森病患者和20例特发性震颤患者进行加速度测量和肌肉电信号测量，对一种新姿势（称为姿势1）下测量的混合震颤信号以及传统姿势（称为姿势2）下测量的震颤信号进行记录，并对震颤的幅度和频率、肌电爆发模式进行分析。 结果 ·分析加速度信号的结果显示：震颤幅度方面，姿势1中，PD和ET的加速度信号在log尺度下的绝对平均值的可信区间分别为0.75～2.40和0.81～3.11（90% CI），尽管两者间相互混叠，但其差异具有统计学意义（F=51.1，P=0.000）；而在姿势2中，PD和ET的加速度信号在log尺度下的绝对平均值的可信区间分别为0.92～3.38和1.43～2.96（90% CI），两者间相互混叠且其差异无统计学意义（F=0.14，P=0.709）。震颤频率方面，2种姿势中的2种震颤频率比较，差异均具有统计学意义（F1=97.2，P1=0.000；F2=15.2，P2=0.000），但姿势1中2种震颤的区分系数达到0.67，而姿势2中区分系数仅为0.27；相对于后者，前者的区分系数增大了148.1%。分析肌电图信号结果显示，受试者震颤的肌电信号爆发模式为同步或是异步，PD和ET患者的肌电信号爆发模式的差异无统计学意义。 结论 ·新的测量姿势能更加有效地提高PD震颤和ET的区分度。
： Objective · To investigate the clinical value of acceleration and surface electromyogram (sEMG) signals in discriminating tremor between Parkinson’s disease (PD) and essential tremor (ET). Methods · Twenty-four patients with Parkinson’s disease and 20 patients with ET were enrolled and tested with a new posture for tremor measurement (i.e, Posture 1), which the results were compared with those of anothertraditional posture (i.e, Posture 2). The comparing characteristics included amplitude, frequency and burst pattern of tremor. Results · As regarding amplitude of tremor, for Posture 1, the confidence intervel of mean value of tremor amplitude of PD and ET in the log scale was 0.75-2.40 and 0.81-3.11 with significant diffierence (F=51.1, P=0.000), respectively. While for Posture 2, there was 0.92-3.38 and 1.43-2.96 between PD and ET, respectively, without significant difference (F=0.14, P=0.709). For tremor frequency, there were significant difference between both postures (F1=97.2, P1=0.000; F2=15.2, P2=0.000). However, the coefficient for discrimination increased by 148.1% from 0.27 to 0.67 when Posture 2 comparing to Posture 1. As for burst pattern of sEMG signals, there was no significant difference between PD and ET in sychronous or asychronous muscle activation pattern in both postures. Conclusion · The new posture for tremor measurement could improve tremor discrimination between PD and ET