Real-time Shear Wave Elastography in Evaluating Changes in Muscle and Tendon Tone of the Quadriceps in Parkinson's Disease Patients
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摘要:
目的 运用实时剪切波弹性成像（SWE）技术测量帕金森患者的股四头肌（股直肌、股中间肌、股外侧肌、股内侧肌）各肌肉及肌腱的杨氏模量值，分析帕金森患者肌肉肌腱肌张力的变化。 方法 选取2023年4月至2024年4月在云南大学附属医院经临床确诊的帕金森病（PD）患者共60例纳入研究组，根据帕金森病评定量表的评分及评级，分为A组（症状明显侧，n = 60）、B组（症状较轻侧，n = 60），并选取同期健康受试者60例纳入对照组。采用美国西门子公司的ACUSON Sequoia型超声诊断仪剪切波弹性成像功能，测量放松状态下股四头肌肌肉及肌腱的杨氏模量值（kPa），分析对比股四头肌肌肉及肌腱肌张力的变化。 结果 A组、B组股四头肌（股直肌、股中间肌、股外侧肌、股内侧肌）肌肉的杨氏模量值高于对照组（均 P < 0.05）； A组股中间肌、股外侧肌肌肉的杨氏模量值高于B组（均 P < 0.05）；A组、B组股四头肌肌腱的杨氏模量值高于对照组（均P < 0.05）；A组股四头肌肌腱的杨氏模量值高于B组（均P < 0.05）。 结论 帕金森病患者股四头肌肌肉及肌腱肌张力增高。其中，患者症状明显侧股中间肌、股外侧肌的肌张力高于症状较轻侧，而症状明显侧与较轻侧股直肌、股内侧肌的肌张力无差异。 Abstract:Objective To measure the Young's modulus values of the quadriceps muscles （rectus femoris, vastus intermedius, vastus lateralis, vastus medialis） and tendons in Parkinson's disease （PD） patients using real-time shear wave elastography （SWE） technology, and to analyze the changes in muscle and tendon tone. Methods A total of 60 clinically diagnosed PD patients from Yunnan University Affiliated Hospital between April 2023 and April 2024 were included in the study group. Based on the scores and ratings of PD rating scale, patients were divided into Group A （symptomatic side, n = 60） and Group B （less symptomatic side, n = 60）. An additional 60 healthy subjects were selected as the control group. The shear wave elastography function of the ACUSON Sequoia ultrasound diagnostic device from Siemens USA was used to measure the Young's modulus values （kPa） of the quadriceps muscles and tendons in a relaxed state, and to analyze and compare the changes in muscle and tendon tone. Results The Young's modulus values of quadriceps muscles （rectus femoris, intermedius femoris, vastus lateralis, vastus medialis） in groups A and B were higher than those in control group （P < 0.05）. The Young's modulus values of the intermediate and lateral femoris muscles in group A were higher than that in group B （all P < 0.05）. The Young's modulus values of quadriceps tendon in groups A and B were higher than that in control group. （P < 0.05）. The Young modulus value of quadriceps tendon in group A was higher than that in group B （P < 0.05）. Conclusion Patients with Parkinson's disease exhibit increased muscle and tendon tone in the quadriceps. Notably, the muscle tone of the vastus intermedius and vastus lateralis on the symptomatic side is higher than that on the less symptomatic side, while there is no significant difference in muscle tone between the rectus femoris and vastus medialis on the symptomatic and less symptomatic sides. -
Key words:
- Real-time shear wave elastic imaging /
- Parkinson's disease /
- Quad riceps /
- Muscular tone
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图 1 A组、B组、对照组股直肌杨氏模量值声像图
A：A组杨氏模量值：13.0 kPa；B：B组杨氏模量值：12.1 kPa；C：对照组杨氏模量值：5.5 kPa。
Figure 1. Ultrasound images of the Young's modulus values of femoris rectus muscle in group A，group B and control group
图 2 A组、B组、对照组股中间肌杨氏模量值声像图
A：A组杨氏模量值：17.4 kPa；B：B组杨氏模量值：13.4 kPa；C：对照组杨氏模量值：5.2 kPa。
Figure 2. Ultrasound images of the Young's modulus values of femur intermediate muscle in group A，group B and control group
图 3 A组、B组、对照组股外侧肌杨氏模量值声像图
A：A组杨氏模量值：13.0 kPa；B：B组杨氏模量值：10.6 kPa；C：对照组杨氏模量值：5.0 kPa。
Figure 3. Ultrasound images of the Young's modulus values of lateral femur muscle in group A，group B and control group
图 4 A组、B组、对照组股内侧肌杨氏模量值声像图
A：A组杨氏模量值：11.5 kPa；B：B组杨氏模量值：12.2 kPa；C：对照组杨氏模量值：5.0 kPa。
Figure 4. Ultrasound images of the Young's modulus values of medial femur muscle in group A，group B and control group
图 5 A组（症状明显侧）、B组（症状较轻侧）、对照组股四头肌肌肉杨氏模量值箱型图
A：股直肌；B：股中间肌；C：股外侧肌；D：股内侧肌；***P < 0.001。
Figure 5. Box plot of the Young's modulus values of the quadriceps muscle in group A （side with prominent symptoms），group B （side with milder symptoms），and the control group
图 6 A组、B组、对照组股四头肌肌腱杨氏模量值声像图
A：A组杨氏模量值：70.0 kPa；B：B组杨氏模量值：55.2 kPa；C：对照组杨氏模量值：23.2 kPa。
Figure 6. Ultrasound images of the Young's modulus values of the quadriceps tendon in group A，group B，and the control group
图 7 A组（症状明显侧）、B组（症状明显侧）、对照组股四头肌肌腱杨氏模量值箱型图
***P < 0.001。
Figure 7. Box plot of Young's modulus value of quadriceps tendon in group A （symptomatic side），group B （symptomatic side） and control group
表 1 帕金森病组与对照组基线资料对比（$ \bar x \pm s $）
Table 1. Comparison of baseline data between Parkinson's disease group and control group（$ \bar x \pm s $）
组别 性别（男/女） 年龄（岁） 帕金森病组 31/29 （67.00 ± 8.93） 对照组 30/30 （66.75 ± 5.00） χ2 / t 0.033 −0.188 P 0.855 0.852 
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表 2 A组、B组、对照组股四头肌各肌肉杨氏模量值比较[（$ \bar x \pm s $ ），kPa]
Table 2. Comparison of Young's modulus of quadriceps muscles in group A，group B and control group[（$ \bar x \pm s $），kPa]
分组 股直肌
杨氏模量值股中间肌
杨氏模量值股外侧肌
杨氏模量值股内侧肌
杨氏模量值A组（n = 60） 12.99 ± 2.88△ 16.75 ± 3.73△# 14.13 ± 3.34△# 10.84 ± 2.30△ B组（n = 60） 13.15 ± 3.09△ 12.94 ± 2.86△ 11.34 ± 2.79△ 10.78 ± 2.13△ 对照组（n = 60） 5.39 ± 0.27 5.45 ± 0.29 5.30 ± 0.38 5.18 ± 0.35 F 197.294 267.978 191.963 191.460 P < 0.001 * < 0.001 * < 0.001 * < 0.001* 与对照组比较，△P < 0.05；A组与B组比较，#P < 0.05；*P < 0.05。
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表 3 A组、B组与对照组股四头肌肌腱杨氏模量值比较[（$ \bar x \pm s $ ），kPa]
Table 3. Comparison of Young's modulus of quadriceps tendon in groups A，B and control group[（$ \bar x \pm s $ ），kPa]
分组 股四头肌肌腱杨氏模量值 A组（n = 60） 61.40 ± 12.27△# B组（n = 60） 48.70 ± 10.87△ 对照组（n = 60） 30.81 ± 4.80 F 145.811 P < 0.001* 与对照组比较，△P < 0.05；A组与B组比较，#P < 0.05；*P < 0.05。
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