The Diagnostic Value Of Transcranial Sonography In Parkinson’s Disease And Influencing Factors Of Substantia Nigra Hyperchogenicity

Objective To determine the best indicators and cut-off values of Transcranial sonography(TCS)for the diagnosis of Parkinson’s disease(PD),to investigate the correlation between abnormal echo area and clinical characteristics of Substania nigra(SN)in PD patients.At the same time,multi-factor analysis was conducted on the factors that may affect the size of SN’s abnormal hyperechoic area,in order to find its risk factors and protective factors,and provide a basis for the prevention and treatment of PD.Methods Part 1: The diagnostic value and clinical relevance of TCS in PD Clinical data of 197 patients were prospectively collected.122 PD patients clinically confirmed in our hospital were included in the PD group.Seventy-five patients with Parkinson’s syndrome,Parkinson’s syndrome,and essential tremor were enrolled in the control group.All the enrolled patients were measured by TCS to record the left and right SN hyperechoic area,the large side area of hyperechoic area.And the ratio of the left and right sides,the large side area and the two sides total hyperechoic area in its related total midbrain area was calculated by TCS,respectively.Statistical analysis was conducted to demonstrated the diagnostic efficacy and optimal cut-off value of the above indicators.And the best index of TCS diagnosis of PD was obtained by comparison among groups.Correlation analysis was conducted to determine the correlation between abnormal SN echo area of PD patients and clinical characteristics such as the course of the disease,age of onset,clinical classification of disease,initial side of onset,and severity of the disease.Part 2: Study on influencing factors of SN abnormal high echo under TCS In 122 PD patients and 75 controls,the optimal truncation value of 0.20cm2 calculated according to the TCS measurement values in the first part of this paper was taken as the standard.≧0.20cm2 was classified as the abnormal high echo of the SN group and marked as the TCS+ group;<0.20cm2 was classified as a normal echo of the SN group and marked as TCS-group.Collection of both groups respectively demographic characteristics(age,gender,BMI,level of education),life habits(smoking,drinking,probiotic diet,daily physical exercise),disease history,history of hypertension,coronary heart disease,diabetes,history of history,history of cerebral infarction or hemorrhage,tumor),family history of PD,biochemical indices(blood lipid,uric acid,blood homocysteine,alanine aminotransferase,and glutamic oxalacetic transaminase,creatinine,glycosylated hemoglobin),non-motor symptoms of PD(subjective hyposmia,constipation,anxiety,and depression,sleep,and cognition),and multi-factor analysis of the collected information was conducted to find out the possible risk factors and protective factors of SN abnormal hyperechoic,which provides a basis for early clinical intervention of PD.Results Part 1There were significant differences between the PD group and control group on left,right,larger side,and bilateral total high echo area(P<0.001).Compared with the control group,the ratio of left,right,larger,and bilateral total hyperechoic area to corresponding midbrain area in the PD group was also statistically significant(P<0.001).ROC curves were drawn using the left,right,larger,and bilateral total hyperechoic areas of SN.The areas under the curve were 0.753,0.756,0.837,and0.793,respectively,The sensitivity was 68%,66%,88.7%,89.7%,and the specificity was 87.5%,85.7%,82.1%,and 60.7%,respectively.And the best truncation values were 0.20cm2.ROC curves were drawn using the ratio of the left,right,larger side,and bilateral total SN hyperechoic area to the corresponding midbrain area,and the areas under the curve were 0.745,0.748,0.809,and 0.807,respectively,with a sensitivity of 69.1%,64.9%,83.5%,and 80.4%,the specificity was 80.4%,80.4%,75%,and 75%,and the best truncation values were about 0.07,0.07,0.08 and 0.07,respectively.The study showed that each index had a good diagnostic value,and it was found that the larger side SN high echo area was the best diagnostic index,with the highest sensitivity and specificity.Pearson correlation analysis showed that the SN hyperechoic area of PD patients was not correlated with its clinical characteristics,such as the course of the disease,age of onset,clinical type of disease,side of onset,and severity of disease(R <0.5,P>0.05).Part 2There were statistically significant differences in gender,education level,constipation,and other indicators between the TCS+ group and the normal SN echo group(P<0.05).The two groups in age,BMI,smoking history,drinking history,probiotic diet,daily physical activity history,history of hypertension,coronary heart disease,diabetes mellitus,history of cerebral infarction or hemorrhage,tumor history,family history of PD,total cholesterol,triglyceride,low-density lipoprotein cholesterol(LDL-c),high-density lipoprotein cholesterol(HDL-c),uric acid,blood homocysteine,alanine and aspartate aminotransferase,creatinine,glycosylated hemoglobin,subjective hyposmia,anxiety and depression(HAMA,HAMD scale),sleep(Pittsburgh Sleep Quality Index),cognition(MMSE,MCOA scale)and other factors had no significant differences(P>0.05).Whether the SN hyperechoic area reached the truncation value was taken as the dependent variable,and statistically significant variables(gender,education level,constipation)in the univariate analysis were taken as independent variables,and the multivariate binary logistic regression analysis was conducted.The OR values of the tested factors with significant differences were as follows: Constipation(OR=0.359,95%CI:0.147 0.874).If the OR value of constipation was less than 1,it indicates that constipation(logistic regression analysis with constipation as the reference value)was negatively correlated with abnormal substantia nigra hyperechoic,therefore,the patients with constipation and SN hyperechoic area were more likely to reach the truncated value.However,gender and education level may not be the influencing factors of SN high echo(P>0.05).Conclusion1、The index with the best diagnostic efficiency is the SN high-echo area of the larger side,the best truncation value is 0.20cm2.2、The SN hyperechoic area of PD patients was not correlated with the course of the disease,age of onset,clinical type of disease,initial side of onset,and severity of the disease.3、Constipation may be the influencing factor of abnormal high SN echo in PD patients,and SN echo positive is more likely in PD patients with constipation symptoms.