早期帕金森病患者疲劳的研究  

Fatigue in early Parkinson＇s disease

作　　者：秦朝晖[1] 陈彪[2] 张丽燕[2] 樊文辉[2] 孙菲[3] 方向华[3] 

机构地区：[1]北京积水潭医院神经内科,100035 [2]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 [3]首都医科大学宣武医院流行病与社会医学部

出　　处：《中华老年医学杂志》2012年第9期823-825,共3页Chinese Journal of Geriatrics

摘　　要：目的调查早期帕金森病（PD）疲劳的患病率、特点及其影响因素。方法在入组“金灵芝试验”的391例PD患者中进行筛选早期、非抑郁患者204例接受进一步评价：采用疲劳量表（FSS）评价疲劳，FSS〉4界定为疲劳；采用统一帕金森病评分表（UPDRS）及Hoehn＆Yahr评价运动障碍及疾病严重程度，采用匹兹堡睡眠质量指数（PSQ-I）评价睡眠状况，阿尔茨海默病评定量表（ADAS-Cog）评价认知，36条目简化医疗结局调查问卷（SF-36）评价生活质量。结果204例参与疲劳评价患者中，82例（40．2％）存在疲劳。与非疲劳组比较，疲劳组UPDRS三部分评分，包括智能、精神、情感（P％0．05）、日常生活（P〈0．01）和运动（P〈0．01）均提高；SF-36分值明显降低（P〈0．01）。多元回归分析显示：UPDRS运动评分是FSS的预测因素，能预测出6．4％FSS分值的变化（β值=0．039，95％CI：0．019～0．059）；而左旋多巴剂量、PSQ-I、及ADAS-Cog分值对FSS分值均无预测意义。结论超过40％早期PD患者存在疲劳。疲劳与运动障碍有限相关，与左旋多巴剂量不相关，多巴胺能系统可能部分参与疲劳的发生。Objective To investigate the prevalence, characteristics and risk factors of fatigue in a large cohort of subjects with early Parkinson＇s disease （PD）. Methods A total of 391 individuals with PD, recruited in Linzhi trial, were re-screened. Early, non-depressed subjects [Center for epidemiological survey depression scale （CES-D）〈 16] underwent further fatigue assessment. Subjects who scored〉4 on fatigue severity scale （FSS） were classified as fatigue. Motor symptoms and PD severity were assessed using the unified Parkinsonrs disease rating scale （UPDRS） and Hoehn-Yahr scale. Other clinical measures, including sleep disorder by Pittsburg sleep quality index （PSQ-I）, mental function by Alzheimer＇s Disease assessment scale-cognitive sections （ADAS-Cog） and quality of life by medical outcomes study short form 36 （SF-36） were also evaluated. Results Among 204 subjects who completed fatigue measures, 82 （40.2 %） were classified as fatigue. The fatigue group had significantly more neurological impairment by higher scores on each subsets of UPDRS including mentation （P〈0.05）, activities of daily living （P〈0.01） and motor （P〈0.01）, while the subjects with fatigue had worse scores on SF-36 （P〈0.01）. Multiple regression analyses showed that motor subset of UPDRS was the variable that had the predictive value for FSS score. The full model explained 6.4% of the variance of the FSS score （β=0. 039,95% CI：0. 019-0. 059）. However, other factors, including levodopa dosage, PSQ-I, and ADAS-Cog score did not significantly contribute to the model. Conclusions Fatigue is a frequent symptom in early, non-depressed patients with PD, affecting over 40% of the patients in this cohort. The small correlation between fatigue and motor score, and the lack of association with dosage of dopaminergic treatment suggest that dopaminergic pathways might be only moderately involved in pathogenesis of fatigue.

关 键 词：帕金森病 疲劳 

分 类 号：R742.5[医药卫生—神经病学与精神病学]