Postvoid residual predicts the diagnosis of multiple system atrophy in Parkinsonian syndrome
Postvoid residual predicts the diagnosis of multiple system atrophy in Parkinsonian syndrome
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DOI：
10.1016/j.jns.2017.08.3262
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发表时间：
2017-10-15
影响因子：
4.4
通讯作者：
Kuwabara, Satoshi
中科院分区：
文献类型：
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作者：
Yamamoto, Tatsuya;Asahina, Masato;Kuwabara, Satoshi
目的：多系统萎缩(MSA)与帕金森病(PD)至少在早期难以鉴别。尿动力学检查(UDS)有助于鉴别MSA和PD。方法：回顾273例患者，对182例MSA和91例PD患者进行UDS和肛门外括约肌肌电图(EAS-EMG)检查。我们分析了在EAS-EMG中UDS参数，包括尿空残留物、逼尿肌过度活动、膀胱收缩程度和平均运动单位电位时程(MUPS)在区分MSA和PD方面的作用。结果：自由流研究中PVR>；150ml对MSA而不是PD有很强的诊断价值(OR 8.723，95%CI 2.612~29.130，P<；0.001)。‘虚弱逼尿肌’也提示存在逼尿肌萎缩，但不是一个有统计学意义的指标(OR 10.598，95%CI 0.359-312.473，p=0.172)。DO和EAS-EMG的神经源性改变(MUPs和Gt；平均持续时间10ms)。结论：自由流状态下PVR>；150ml在临床鉴别MSA和PD方面可能比其他UDS参数更有价值。
Objective: It is difficult to differentiate multiple system atrophy (MSA) from Parkinson's disease (PD) at least in the early stage. Urodynamic study (UDS) is useful in differentiating MSA from PD. We aimed to clarify which UDS parameter was useful in differentiating MSA from PD.Methods: We retrospectively reviewed 273 cases and performed UDS and external anal sphincter electromyography (EAS-EMG) in patients with MSA (n = 182) and PD (n = 91). We analyzed the utility of UDS parameters, including postvoid residuals (PVR), detrusor overactivity (DO), degree of bladder contraction, and mean duration of motor unit potentials (MUPs) in EAS-EMG, for differentiating MSA from PD.Results: PVR > 150 ml during free-flow study strongly indicated MSA rather than PD (OR 8.723, 95% CI 2.612-29.130, p < 0.001). 'Weak detrusor' also suggested MSA, but it was not a statistically significant indicator (OR 10.598, 95% CI 0.359-312.473, p = 0.172). DO and neurogenic changes in EAS-EMG (mean duration of MUPs > 10 ms). did not significantly contribute to the differentiation of MSA from PD.Conclusions: PVR > 150 ml during free-flow study might be more useful than other UDS parameters in clinically differentiating MSA from PD.