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目的探讨快速眼动睡眠期行为障碍患者经颅脑实质超声改变。方法符合睡眠障碍国际分类第2版快速眼动睡眠期行为障碍诊断标准的15例患者(RBD组)和15例正常对照受试者,于多导睡眠图监测后通过经颅脑实质超声检查并测量中脑黑质高回声、基底节高回声、第三脑室宽度;简易智能状态检查量表(MMSE)和蒙特利尔认知评价量表(MoCA)评价认知功能。结果快速眼动睡眠期行为障碍患者具有典型的临床表现和电生理学改变。RBD组黑质高回声(6/15)、基底节高回声(7/15)阳性检出率,与正常对照组(1/15和2/15)之间差异无统计学意义(P=0.080,0.109)。RBD组伴与不伴黑质高回声患者MoCA评分差异无统计学意义(P=0.075);但RBD组伴基底节高回声患者MMSE评分高于不伴基底节高回声患者(P=0.021)。结论快速眼动睡眠期行为障碍作为突触共核蛋白病前驱期,经颅脑实质超声可表现为黑质和基底节高回声,且伴不同结局。经颅脑实质超声可以检测出脑亚临床改变,评价突触共核蛋白病风险。
Objective To investigate the transcranial echocardiographic changes in patients with behavioral disorders during rapid eye movement sleep. Methods Fifteen patients (RBD group) and 15 normal control subjects who meet diagnostic criteria for REM sleep disability in the International Classification of Sleep Disorders, 2nd edition, were examined by polysomnography and then examined by transcranial parenchyma Hyperintensities of substantia nigra in the midbrain, hyperechogenic basal ganglia and third ventricle width were measured; MMSE and MoCA were used to assess cognitive function. Results Patients with rapid eye movement sleep disturbance had typical clinical manifestations and electrophysiological changes. There was no significant difference between the RBD group and the normal control group (1/15 and 2/15) in the substantia nigra hyperechocia (6/15) and basal ganglia hyperechoic (7/15) (P = 0.080 , 0.109). There was no significant difference in MoCA score between RBD group and non-substantia nigra hyperechoic group (P = 0.075). However, MMSE score of RBD group with basal ganglia hyperechoic patients was higher than that without basal ganglia hyperechoic group (P = 0.021). Conclusion As a precursor of synucleinopathies, rapid oculomotion sleep disturbance may be characterized by hyperintensities of the substantia nigra and basal ganglia by transcranial parenchymal ultrasound with different outcomes. Transcranial ultrasound can detect subclinical changes in the brain to assess the risk of synucleinopathies.