早期帕金森病患者健康相关生活质量  

Health related quality of life in patients with early Parkinson＇ s disease

作　　者：秦朝晖[1] 陈彪[1] 张丽燕[1] 樊文辉[1] 孙菲[2] 方向华[1] 孟琛 Caroline Tanner 

机构地区：[1]首都医科大学宣武医院北京市老年病研究所神经生物学研究室,100053 [2]首都医科大学流行病与社会医学部 [3]The Parkinson' s Institute and Clinical Center,CA 94085, Sunnyvale, USA

出　　处：《中华神经科杂志》2009年第8期514-519,共6页Chinese Journal of Neurology

基　　金：基金项目：国家科技部“十五”攻关项目（2004BA702802）;国家科技部“十一五”科技攻关项目（863）（2006AA02A408）志谢感谢中国帕金森病协作组的全体成员.特别感谢：中南大学附属湘雅医院神经内科（唐北沙、严新翔）;中山医科大学第一医院神经内科（刘焯霖）,神经科ICU（陈玲）;上海交通大学医学院附属瑞金医院神经内科（陈生弟、王瑛）;卫生部北京医院神经内科（陈海波）;北京大学第一医院神经内科（孙相如）;首都医科大学附属北京友谊医院神经内科（赵伟秦、赵亚明）;解放军总医院南楼神经内科（王鲁宁、王振福）;中国医学科学院北京协和医院神经内科（万新华）;天津医科大学总医院神经内科（张本恕）;华中科技大学同济医学院附属协和医院神经内科（孙圣刚、乔娴）;四川大学华西医院神经内科（彭蓉、徐严明）;首都医科大学附属北京天坛医院神经内科（管小亭、张小英）;青岛大学医学院附属医院神经内科（谢安木）;哈尔滨医科大学附属第二医院神经内科（王维治、张丽梅）;吉林大学第二医院神经内科（胡国华、陈秋慧）;广州医学院第一附属医院神经内科（邵明）;广东省人民医院神经内科（徐书雯）;北京世纪坛医院神经内科（张国平、薛萍）;广州军区广州总医院神经内科（邹海强）;解放军白求恩国际和平医院老年病科（于宝成）;上海交通大学医学院附属新华医院神经内科（刘振国）;首都医科大学宣武医院神经内科（赵利杰）,神经生物学教研室（丁晖、杨静芳、宣叶菁、张燕莉、安静）

摘　　要：目的研究中国早期帕金森病（PD）患者健康相关生活质量（healthrelatedqualityoflife，HR—QOL）的特点；探讨运动症状和非运动症状对早期PD患者HR—QOL的影响。方法在全国范围内共筛选出391例早期PD患者入组。采用统一帕金森病评分表（UPDRS）和Hoehn—Yahr评价运动症状，采用流行病学研究中心编制的抑郁量表（CES—D）、匹兹堡睡眠质量指数（PSQI）、疲劳量表（rss）、阿尔茨海默病评定量表的认知部分（ADAS—Cog）和便秘量表分别对抑郁、睡眠障碍、疲劳、认知功能和便秘等非运动症状进行评价；采用36条目简化医疗结局调查问卷（SF-36）评价HR—QOL。比较PD患者与同龄健康老年人SF-36分值的差异。采用逐步多元线性回归分析深入探讨各种运动及非运动症状变量对HR-QOL的影响。结果早期PD患者除SF-36躯体疼痛维度外，其余各维度分值较同龄健康老年人均下降。UPDRS第3部分分值（23．8±11．8）、Hoehn—Yahr分期（2．0±0．7）和强直分值（4．4±3．1）仅能解释SF-36总分变化的18．9％（R2=0．189）。CES—D、FSS和PSQ1分值等非运动症状变量引入回归方程后，SF-36总分可被解释的部分由18．9％增加至61．7％（R2=0．617）。并且，引入CES-D分值后，SF-36总分可被解释的部分增加了43．3％（R2=0．433）。结论PD症状严重影响早期患者的HR—QOL。运动症状对HR—QOL存在影响，但影响作用有限。抑郁、疲劳和睡眠障碍这3个非运动症状是导致早期PD患者HR—QOL恶化的主要原因。其中，抑郁症状是HR-QOL恶化的最强预测因素。临床上，应重视非运动症状，运动和非运动症状兼治，才能真正提高疗效显著改善患者的HR—QOL。Objective To investigate the characteristics of health related quality of life（HR-QOL） in Chinese patients with early Parkinson＇ s disease （ PD）, to identify the motor and non-motor factors that are associated with a poorer quality of life in patients with early PD. Methods All 391 patients with early PD were identified in a clinical-based study. Motor functions were measured by Unified Parkinson＇ s Disease Rating Scale （UPDRS） and Hoehn-Yahr Scale. Non-motor variables were assessed by Center of Epidemiological Survey Depression Scale （CES-D） for depressive symptoms, Pittsburg Sleep Quality Index （PSQI） for sleep disturbance, Fatigue Severity Scale （FSS） for fatigue, Alzheimer＇ s Disease Assessment Scale-Cognitive Sections （ADAS-Cog） for cognitive function, and Constipation Severity Scale for constipation. HR-QOL was measured by SF-36. Motor and non-motor variables were collected at the baseline assessment of a clinical trial and determined during a structured interview and by clinical examination by movement disorder specialists. The results were compared with those in healthy elderly people. Multiple regression analyses were used to determine which variables were strongly associated with lower levels of quality of life. Results Patients with early PD had a lower score on all dimensions of SF-36, except bodily pain dimension. Motor factors, particular physical disability and disease severity, contributed to decreased HR-QOL, but to a lesser extent. The motor score of the UPDRS （23.8 ± 11.8）, Hoehn-Yahr stage（2. 0 ± 0. 7）, together with the rigidity score（4. 4±3.1 ）, only accounted for 18. 9% （R2 =0. 189） of the variance of SF-36 total score. The variables that most strongly predicted a low total SF-36 score were non-motor factors, particularly depressive symptoms, sleep disorders and fatigue. When the CES-D, FSS, and PSQI score were included in the model, the R2 increased from 0. 189 to 0. 617, indicating that 61.7% of the variance in HR-QOL could be explained

关 键 词：帕金森病 生活质量 抑郁 疲劳 睡眠障碍 

分 类 号：R686[医药卫生—骨科学]