伴发疼痛的帕金森病患者正中神经感觉阈值及疼痛耐受阈值的变化  

Current perception threshold and pain tolerance threshold of median nerve of Parkinson＆#39;s disease patients associated with pain

作　　者：李巳艽 毛成洁[1] 陈怡[1] 张惠钧 李洁[1] 胡伟东[1] 李玲[1] 郭莎莎[1] 刘春风[1] 

机构地区：[1]苏州大学附属第二医院神经内科,215004

出　　处：《中华神经科杂志》2015年第5期395-399,共5页Chinese Journal of Neurology

基　　金：江苏省临床医学科技专项基金资助项目（BL2014042）;苏州市科技发展计划资助项目（SZS201205）;苏州市临床重点病种诊疗技术专项资助项目（LCZX201304）

摘　　要：目的 评价伴发疼痛的帕金森病患者正中神经感觉阈值、痛觉耐受阈值变化,以此探讨外周神经在帕金森病相关性疼痛发生中的作用.方法 采用感觉神经定量检测仪检测64例帕金森病患者及30名年龄、性别与之相匹配的健康人依次以2 000、250、5 Hz的频率测试时双手正中神经的感觉阈值及疼痛耐受阈值.并对帕金森病患者进行统一帕金森病评分量表（UPDRS）、Hoehn-Yahr（H-Y）分级、简易精神状态检查、蒙特利尔认知评估量表（MoCA）、汉密尔顿抑郁量表（HAMD）、视觉模拟量表（VAS）评估.结果 帕金森病组右手正中神经2 000、250、5 Hz的感觉阈值较健康对照组升高（315.3±58.7与290.1±38.6,t=-2.137,P=0.035;112.3±29.3与100.7±12.6,t=-2.701,P =0.008;80.7±29.2与71.1±15.1,t=-2.102,P=0.038）.双手正中神经在2 000、250、5Hz的痛觉耐受阈值较健康对照组降低（左手：15.6±2.6与16.7±2.3,t=1.933,P=0.056;8.9±2.7与10.0±1.7,t =2.445,P=0.017;12.1±4.1与13.6±1.9,t=2.395,P=0.019;右手：14.6±3.5与16.1±2.4,t =2.383,P =0.020;8.9±2.3与9.7±1.0,t =2.365,P =0.020;11.5±4.5与13.6±4.0,t=2.191,P=0.032）.在帕金森病不伴疼痛组、帕金森病伴有疼痛组二组比较中,伴发疼痛的帕金森病患者双手正中神经在2 000、250、5 Hz的痛觉耐受阈值较帕金森病不伴疼痛患者下降更明显（左手：14.7±2.4与16.6±2.6,t=3.041,P=0.003;8.1±2.3与9.9±2.7,t=2.766,P=0.007;10.9±4.7与13.4±3.0,t=2.439,P=0.018;右手：13.5±3.1与15.8±3.6,t =2.647,P=0.010;8.1±2.0与9.8±2.4,t=3.052,P=0.003;10.3±3.9与13.0±4.7,t=2.546,P=0.013）,差异均有统计学意义.与不伴发疼痛的帕金森病患者相比,伴发疼痛的帕金森病患者的UPDRSⅢ、H-Y、HAMD分数更高,MoCA分数更低,差异有统计学意义.结论 帕金森病患者存在正中神经感觉受损及痛觉耐受阈值下降,且伴发疼痛患者双手痛觉耐受阈值下降较明显,表明周围神经感觉异常可能也参与了帕Objective To explore the role of current perception threshold and pain tolerance threshold of median serve of Parkinson＆#39; s disease （PD） patients associated with pain.Methods Sixty-four PD patients and 30 healthy controls were enrolled in the study.Using the Neurometer CPT,current perception threshold and pain tolerance threshold testing at 2 000,250,5 Hz was performed on median nerves of both hands.PD patients were assessed by the following rating scales：Unified Parkinson＆#39;s Disease Rating Scale （UPDRS）,Hoehn-Yahr Scale （H-Y）,Hamilton Depressive Scale （HAMD）,Visual Analogue Scale （VAS）,Montreal Cognitive Assessment （MoCA）,and Mini Mental State Examination.Results PD patients had increased current perception threshold at 2 000,250,5 Hz of right hand as compared with control group （315.3 ±58.7 vs 290.1 ±38.6,t =-2.137,P =0.035; 112.3 ±29.3 vs 100.7 ± 12.6,t=-2.701,P=0.008; 80.7 ±29.2 vs 71.1 ± 15.1,t =-2.102,P =0.038） and had reduced pain tolerance threshold at 2 000,250,5 Hz of both hands（left hand：15.6 ± 2.6 vs 16.7 ± 2.3,t =1.933,P=0.056; 8.9 ±2.7 vs 10.0 ± 1.7,t =2.445,P =0.017; 12.1 ±4.1 vs 13.6 ± 1.9,t =2.395,P =0.019; right hand：14.6 ±3.5 vs 16.1 ±2.4,t =2.383,P=0.020; 8.9±2.3 vs 9.7 ±1.0,t =2.365,P=0.020; 11.5±4.5 vs 13.6 ±4.0,t =2.191,P=0.032）.PD patients with pain had lower pain tolerance threshold at 2 000,250,5 Hz of both hands,compared with PD patients without pain （left hand：14.7±2.4vs 16.6±2.6,t=3.041,P=0.003; 8.1 ±2.3 vs9.9±2.7,t=2.766,P=0.007; 10.9±4.7 vs 13.4 ±3.0,t =2.439,P=0.018; right hand：13.5 ±3.1 vs 15.8 ±3.6,t =2.647,P=0.010;8.1 ±2.0 vs 9.8 ±2.4,t =3.052,P=0.003; 10.3 ±3.9 vs 13.0 ±4.7,t =2.546,P=0.013）.Compared with the PD patients without pain,PD patients with pain had higher scores of UPDRS,H-Y,HAMD and lower scores of MoCA.Conclusions In PD patients,the current perception threshold and pain tolerance threshold are abnormal,especially in the PD patients with pain.The sensory nerve function impairment m

关 键 词：帕金森病 疼痛 正中神经 痛阈 感觉阈 试验预期值 

分 类 号：R742.5[医药卫生—神经病学与精神病学]