伴睡眠周期性肢动的帕金森病患者临床特点分析  

The clinical characteristics of Parkinson′s disease patients with concomitant periodic limb movements in sleep

作　　者：赵惠卿[1] 马骏[2] 张宁[2] 冯涛[1] Zhao Huiqing;Ma Jun;Zhang Ning;Feng Tao(Department of Movement Disorders,Centre of Neurology,Beijing Tiantan Hospital,Capital Medical University,Beijing 100071,China;Department of Clinical Psychology and Sleep,Beijing Tiantan Hospital,Capital Medical University,Beijing 100071,China)

机构地区：[1]首都医科大学附属北京天坛医院神经病学中心运动障碍性疾病科,北京100071 [2]首都医科大学附属北京天坛医院临床心理科睡眠中心,北京100071

出　　处：《中华医学杂志》2023年第23期1793-1796,共4页National Medical Journal of China

基　　金：国家自然科学基金(81771367)

摘　　要：探讨伴睡眠周期性肢动(PLM)的帕金森病(PD)患者的临床特点。收集2018年10月至2022年7月在天坛医院进行多导睡眠监测(PSG)的36例PD患者的临床资料,使用帕金森病统一评定量表3.0版和Hoehn-Yahr(H-Y)分期评定PD患者症状严重程度,以睡眠周期性肢动事件指数(PLMSI)15次/h为界分成两组:睡眠周期性肢动(PLMS)+组(PLMSI≥15次/h)、PLMS-组(PLMSI<15次/h)。比较两组之间的临床特点。PLMS+组患者15例(42%),PLMS-组患者21例(58%),其中PLMS+组患者伴有快速眼动睡眠障碍(RBD)为12例(12/15),PLMS-组患者伴有快速眼动睡眠障碍为9例(42.9%),PLMS+组合并RBD比率高于PLMS-组(P<0.05)。两组患者的血液叶酸含量[M(Q_(1),Q_(3)),PLMS-组6.20(5.14,11.70)ng/ml,PLMS+组4.41(3.07,5.64)ng/ml]比较差异有统计学意义(P<0.01),PLMS+组患者更多见叶酸缺乏;而同型半胱氨酸及铁蛋白含量比较差异无统计学意义(均P>0.05)。4/15的PLMS+组患者有跌倒经历,而PLMS-组发生跌倒的患者比例为14.3%(3/21),PLMS+组患者更容易出现跌倒。PLMS+组患者PSG的觉醒指数[M(Q_(1),Q_(3)),21.50(19.35,29.90)次/h]高于PLMS-组[11.90(9.10,15.80)次/h](P<0.05);两组间其他睡眠参数差异无统计学意义(均P>0.05),其中两组患者呼吸暂停低通气指数(AHI)均高于正常值(<5次/h),其中PLMS-组AHI为[M(Q_(1),Q_(3))]9.80(4.70,22.20)次/h,PLMS+组为8.20(1.70,11.15)次/h,提示PD患者更容易出现睡眠中的呼吸暂停和低通气现象。PD-PLMS+组患者常合并叶酸缺乏,更加容易发生跌倒;伴周期性肢动的PD患者存在睡眠觉醒指数高,睡眠碎片化程度高,RBD患病率更高。The current study aimed to investigate the clinical characteristics of Parkinson′s disease(PD)patients with concomitant periodic limb movements in sleep(PLMS).The clinical data of 36 PD patients who underwent polysomnography(PSG)in Beijing Tiantan Hospital from October 2018 to July 2022 were collected.Unified Parkinson′s Disease Rating Scale 3.0 and Hoehn&Yahr(H-Y)stage were used to evaluate the disease severity.Patients were divided into two groups:the PLMS+group periodic limb movements in sleep index[(PLMSI)≥15 times/h]and the PLMS-group(PLMSI<15 times/h),using the PLMSI 15 times/h as the cut-off value.The clinical characteristics between the two groups were compared.There were 15 patients(42%)in the PLMS+group and 21 patients(58%)in the PLMS-group,among which 12 patients(12/15)in the PLMS+group and 9 patients(42.9%)in the PLMS-group had rapid eye movement sleep behavior disorder(RBD).The rate of RBD in PLMS+group was higher than that in PLMS-group(P<0.05).There was statistically significant difference in the blood folate level between the PLMS-group and PLMS+group[6.20(5.14,11.70)ng/ml vs 4.41(3.07,5.64)ng/ml](P<0.01).Folate deficiency was more common in the PLMS+group,while no statistically significant differences were found in homocysteine and ferritin levels(both P>0.05).Four patients in the PLMS+group had falling experience,while 14.3%(3/21)patients in the PLMS-group had falling experience.Patients in the PLMS+group were more likely to fall.The PLMS+group had higher arousal index according to PSG[PLMS-group:11.90(9.10,15.80)times/h;PLMS+group:21.50(19.35,29.90)times/h](P<0.05).No statistically significant differences in other sleep parameters were detected between the two groups(all P>0.05).Meanwhile,the apnea-hypopnea index(AHI)in both groups was higher than normal(<5 times/h),of which the PLMS-group was 9.80(4.70,22.20)times/h and the PLMS+group was 8.20(1.70,11.15)times/h,indicating that PD patients were more likely to experience sleep apnea and hypopnea.PD patients with PLMS had lower folate leve

关 键 词：帕金森病 睡眠周期性肢动 多导睡眠图 快速眼动睡眠障碍 横断面研究 

分 类 号：R742.5[医药卫生—神经病学与精神病学]