早期帕金森病患者非运动症状的临床表现  

Clinical manifestations of nonmotor symptoms in early Parkinson＆#39;s disease

作　　者：李振光[1] 于占彩[1] 于成勇[2] 张金彪[1] 王鹏飞[1] 孙超[1] 张勇[1] 张江山[1] 

机构地区：[1]山东省威海市立医院神经内科,264200 [2]潍坊医学院附属文登中心医院检验科

出　　处：《中华神经科杂志》2015年第8期672-676,共5页Chinese Journal of Neurology

基　　金：山东省医药卫生科技发展计划资助项目（2007HW020）

摘　　要：目的 观察新诊断的早期帕金森病患者中非运动症状（NMS）的发生率和临床特征.方法 共收集2008年6月至2013年12月就诊于山东省威海市立医院神经内科的158例早期PD患者及102名年龄性别相匹配的健康对照,纳入本研究.应用帕金森病非运动症状调查问卷（NMSQuest）筛查NMS.其他的评价包括运动障碍疾病协会修订的统一帕金森病评定量表（MDS-UPDRS）、Hoehn-Yahr分级、老年抑郁量表及全面认知功能测定[简易精神状态检查量表（MMSE）及蒙特利尔认知评估量表（MoCA）].结果 与对照组相比,帕金森病组NMS总个数显著升高[8.6（4.1）比2.7（2.4）,Z=-9.87,P＜0.01].帕金森病组最常见的NMS包括：流涎、遗忘、尿急、嗅觉减退和便秘.帕金森病组中MDS-UPDRS第Ⅲ部分评分较高的患者,NMS数量随之增加（Spearman ρ=0.352,P＜0.01）.与不确定型相比,姿势异常步态障碍（PIGD）优势型具有更多数量的NMS（9.5±4.0比7.3±4.1,95％ CI6.3～8.5,P=0.003）;与震颤优势型相比,PIGD优势型具有更多数量的NMS（9.5±4.0比6.7±3.8,95％ CI5.8 ～7.8,P=0.002）.PIGD优势型PD患者MMSE评分[（27.12±1.42）分]及MoCA评分[（23.85±2.31）分]均低于震颤优势型[分别为（28.95±1.38）、（25.11±2.40）分,t=-5.03、-4.65,均P＜0.01].结论 NMS在早期帕金森病患者中较常见,提示帕金森病是累及多系统的神经系统变性病,即使对于极早期帕金森病患者,NMS仍可影响患者的功能状态和生存质量.Objective Nonmotor symptoms （NMS） are common in patients with established Parkinson＇ s disease （PD）,but their frequency in early PD has not been extensively studied.This study aimed to determine the frequency of NMS in a cohort of patients with newly diagnosed PD.Methods A total of 158 patients with early PD and 102 healthy controls participated in this study.NMS were screened for using the Nonmotor Symptom Questionnaire （NMSQuest）.Other assessments included measures of motor disability （Movement Disorders Society-revised Unified Parkinson＇ s Disease Rating Scale,MDS-UPDRS）,disease severity （Hoehn-Yahr staging）,depression （Geriatric Depression Scale）,and global cognitive function （Mini-Mental State Examination and Montreal Cognitive Assessment）.Results The PD group reported a significantly greater number of NMS compared with controls （8.6 （4.1） vs 2.7 （2.4）,Z=-9.87,P 〈0.01）.In the PD group,the most commonly experienced NMS were excessive saliva,forgetfulness,urinary urgency,hyposmia,and constipation.Patients with higher MDS-UPDRS Ⅲ scores experienced a greater number of NMS （Spearman ρ =0.352,P 〈 0.01）,and compared with tremordominant PD,those with the postural instability gait difficulty （PIGD）-dominant type had a greater number of NMS （9.5 ±4.0 vs 6.7 ± 3.8,95% CI 5.8-7.8,P =0.002）.The MMSE scores in PIGD-dominant type PD（27.12 ± 1.42） were significantly lower than in tremor-dominant PD （28.95 ± 1.38,t =-5.03,P 〈0.01）,and the MoCA scores in PIGD-dominant type PD （23.85 ± 2.31） were significantly lower than in tremor-dominant PD（25.11 ±2.40,t =-4.65,P〈0.01）.Conclusions NMS are common in early PD and reflect the multisystem nature of the disorder.Even in the earliest stages of PD,NMS may be detrimental to functional status and quality of life in patients.

关 键 词：帕金森病 流涎 遗忘 记忆障碍 问卷调查 

分 类 号：R742.5[医药卫生—神经病学与精神病学]