帕金森病远期生活质量分析及治疗策略探讨  

Quality of life and treatment profile of Parkinson＇s disease patients with long-term duration

作　　者：李艳[1] 周明珠[1] 干静[1] 万赢[1] 罗懿[1] 朱莹莹[1] 陆丽霞[1] 何海燕[1] 吴佳英[1] 刘振国[1] 

机构地区：[1]上海交通大学医学院附属新华医院神经内科,200092

出　　处：《中华神经科杂志》2016年第4期277-281,共5页Chinese Journal of Neurology

基　　金：国家自然科学基金资助项目（81471148,81171203）

摘　　要：目的调查帕金森病患者远期生活质量及其影响因素。方法对112例病程≥10年的帕金森病患者生活质量进行调查分析。采用远期生活质量问卷（PDQ-39）评估患者的生活质量，评估患者基本特征（年龄、起病年龄、病程）、运动症状、非运动症状、运动并发症以及治疗等各方面对帕金森病患者远期生活质量的影响。结果病程≥10年的帕金森病患者统一帕金森病评分量表第三部分（UPDRSⅢ）得分为（35．8±19．0）分，PDQ-39总分为（47．5±30．7）分，Hoehn-Yahr（H—Y）分级≥3．0级的比例为67．0％（75／112）。影响PDQ-39得分的独立危险因素包括UPDRSⅢ评分（r=0．272，P=0．007）、H．Y分级（r=0．351，P=0．000）、汉密尔顿焦虑量表评分（r=0．358，P=0．000）。其中年龄（r=0．228，P=0．002）、起病年龄（r=0．207，P=0．027）、症状波动（r=0．282，P=0．002）为影响UPDRSⅢ评分和H-Y分级的3个关键因素。在早发型帕金森病患者，左旋多巴起始最大剂量与远期行动能力的降低呈正相关（r=0．990，P=0．000），在晚发型帕金森病患者中呈负相关（r=-0．480，P=0．044）。结论帕金森病患者远期（病程≥10年）生活质量与患者长期运动症状控制程度及早期治疗方案有关。对于早发型帕金森病患者需考虑推迟或减少左旋多巴的使用预防运动并发症，对于晚发型帕金森病患者，需考虑足够剂量的左旋多巴对改善患者远期生活质量的意义。Objective To investigate the quality of life and its related factors in Parkinson＇s disease （PD） patients with long-term duration. Methods The quality of life in 112 PD patients with long-term disease duration （duration≥ 10 years） was investigated and analyzed. The quality of life in PD patients was measured with the 39-Item Parkinson＇s Disease Questionnaire （PDQ-39）. The effects of age, age of onset, disease duration, motor symptoms, non-motor symptoms, dyskinesia and treatment on the long-term life quality of PD patients were evaluated. Results The mean Unified Parkinson＇s Disease Rating Scale part Ⅲ （ UPDRS m） score was 35.8 ±19. 0, and mean PDQ-39 score was 47.5 ±30. 7 in PD patients with 10 years of disease duration and beyond. However, the cases with Hoehn-Yahr stage ≥ 3.0 accounted for 67. 0% （75/112） in the total sample. The independent risk factors of PDQ-39 score included UPDRS Ⅱ score （ r = 0. 272, P = 0. 007 ）, Hoehn-Yahr stage （ r = 0. 351, P = 0. 000）, and Hamilton Anxiety Scale （r = 0. 358, P = 0. 000）. Age （ r = 0. 228, P = 0. 002）, age of onset （ r = 0. 207, P = 0. 027）, and motor fluctuations （ r = 0. 282, P = 0. 002） were three key associated factors for UPDRS 111 score and Hoehn-Yahr stage. In early onset PD, the initial maximum dose of levodopa was positively correlated with worse long-term motor function （r = 0. 990, P = 0. 000）. The negative correlation was observed between the initial maximum dose of levodopa and long-term motor function in late onset PD （ r = - 0. 480, P = 0. 044 ）. Conclusions The long-term （duration~〉10 years） quality of life in PD patients was determined by the management of motor symptom and the treatment strategies in early stage. In early onset PD patients, delaying or reducing the use of levodopa is needed to prevent dyskinesia. To ensure a better quality of life, higher levodopa dosage should be applied in the late onset PD patients.

关 键 词：帕金森病 生活质量 疾病影响状态调查 问卷调查 左旋多巴 

分 类 号：R742.5[医药卫生—神经病学与精神病学]