Abstract:

Objective: To explore the gait characteristics prior to the step initiation in patients with early Parkinson's disease (PD). Methods: A total of 20 patients diagnosed with early PD admitted to Tianjin Huanhu Hospital from July 2020 to June 2021, and 22 normal controls with normal cognitive and motor function matched by gender, age, body mass index (BMI) and education were included. The gait characters in the initial step stage[anticipatory postural adjustments (APAs) duration, fowward APAs peak, lateral APAs peak] and the first step period (first step duration, first step swing angle), as well as the gait characters in the walking stage (step speed and stride length) during the 7 m Stand and Walk Test (7MSAW) were recorded by gait analyzer. Receiver operating characteristic (ROC) curve was plotted to evaluate the value of gait characteristics in diagnosis of early PD. Results: The APAs duration in early PD group was longer than that in control group (Z=-4.853, P=0.000), and the forward APAs peak was lower than that in control group (Z=-5.253, P=0.000). The cut-off value of APAs duration was 0.440 s, the area under the curve (AUC) was 0.947 (95%CI: 0.885-1.000, P=0.000), the sensitivity was 95%, the specificity was 77.30%, and the Youden index was 0.723. The cut-off value of forward APAs peak was 0.445 m/s², the AUC was 0.974 (95%CI: 0.936-1.000, P=0.000), the sensitivity was 85%, the specificity was 95.50%, and the Youden index was 0.805. The cut-off value of the combination was 0.540, the AUC was 0.974 (95%CI: 0.936-1.000, P=0.000), the sensitivity was 90%, the specificity was 90.10%, and the Youden index was 0.801. Conclusions: The APAs in the initial step stage is abnormal in patients with early PD, the related parameters have high sensitivity and specificity, which can assist clinicians in early screening of diseases.

Key words: Parkinson disease, Gait analysis, ROC curve

摘要：

目的: 探讨早期帕金森病患者迈步起始阶段和行走过程中的步态特征。方法: 选择2020年7月至2021年6月天津市环湖医院收治的20例早期帕金森病患者以及性别、年龄、体重指数、受教育程度相匹配的22例认知功能和运动功能正常对照者，采用步态分析仪记录7米站立行走测验中迈步起始阶段参数，包括预期性姿势调整期持续时间、前后向最大加速度、侧向最大加速度和首步执行期首步延时、首步摆动角度，以及行走过程中参数，包括步速、步长；绘制受试者工作特征（ROC）曲线，评价步态参数对早期帕金森病的诊断价值。结果: 早期帕金森病患者预期性姿势调整期持续时间长于对照者（Z=-4.853，P=0.000），前后向最大加速度小于对照者（Z=-5.253，P=0.000）；预期性姿势调整期持续时间、前后向最大加速度及二者联合预测早期帕金森病的曲线下面积分别为0.947（95% CI：0.885~1.000，P=0.000）、0.974（95% CI：0.936~1.000，P=0.000）、0.974（95% CI：0.936~1.000，P=0.000），灵敏度和特异度为95%和77.30%、85%和95.50%、90%和90.10%，Youden指数为0.723、0.805、0.801，截断值为0.440 s、0.445 m/s²、0.540。结论: 早期帕金森病患者迈步起始阶段预期性姿势调整期在疾病早期即出现异常，相关步态参数具有较高的敏感性和特异性，可辅助临床医师对疾病进行早期筛查。

关键词: 帕金森病, 步态分析, ROC曲线