帕金森病患者便秘临床特点及相关因素分析  

Clinical characteristics and correlative factors of constipation in patients with Parkinson＇s disease

作　　者：李雪莲[1] 陈先文[1] 王尚培 蒋曼丽 冯爱君[1] 杨倩[1] 胡盼盼[1] 

机构地区：[1]安徽医科大学第一附属医院神经内科,合肥230022

出　　处：《中华神经科杂志》2016年第4期282-287,共6页Chinese Journal of Neurology

摘　　要：目的探讨帕金森病患者便秘的临床特点及相关影响因素。方法研究对象为安徽医科大学第一附属医院神经内科门诊就诊的帕金森病患者193例，根据便秘情况将患者分为便秘组和非便秘组，详细记录患者的一般资料和临床资料，采用统一帕金森病评定量表第三部分（UPDRSⅢ）、Hoehn—Yahr（H-Y）分级、Bristol粪便形状评分表、Cleveland便秘量表、帕金森病自主神经症状量表、食物频率调查表、汉密尔顿抑郁量表（HAMD）及简易精神状态检查量表对患者进行评估。根据罗马Ⅲ功能性便秘诊断标准将患者分为便秘组和非便秘组，分析便秘的症状特点和影响因素。根据便秘与运动症状发生的先后将便秘患者分为早发便秘和晚发便秘两个亚组，比较其便秘影响因素有无差异。对其中41例帕金森病患者药物调整前后便秘严重程度进行了调查分析，以了解不同抗帕金森病药物对便秘的影响是否存在个体差异。结果193例帕金森病患者中发生便秘109例，便秘发生率为56．4％，其中重度便秘占21．1％（23／109）。帕金森病患者慢性便秘症状谱中最常见的症状为排便费力（89．9％，98／109），其他症状包括排便不尽感（67．9％，74／109）、排便次数减少（〈3次／周，63．3％，69／109）及大便干硬（60．5％，66／109）等。便秘组的年龄、帕金森病起病年龄、病程、H—Y分级、左旋多巴等效剂量（LED）、左旋多巴日剂量、UPDRSⅢ评分、HAMD评分及排尿障碍显著高于非便秘组，而日常蔬菜摄入量及饮水量显著低于非便秘组，其中年龄和HAMD评分是便秘发生的独立危险因素（OR=1．049，95％CI1．014—1．086，P=0．006；OR=1．316，95％CI1．185—1．461，P=0．000）。便秘严重程度与帕金森病病程、H-Y分级、UPDRSnI评分、LED评分、HAMD评分呈正相关（r=0．269、0．338、0．315、0．341及0．371，�Objective To investigate the characteristics and the correlative factors of constipation in Parkinson＇s disease （PD） patients. Methods The demographic information, clinical features and history of medications of 193 patients with idiopathic PD consulting in the outpatient department of the First Affiliated Hospital, Anhui Medical University were collected. Patients were evaluated using following scales：Unified Parkinson＇s Disease Rating Scale Ⅲ（ UPDRS Ⅲ）, Hoehn-Yahr stage, Bristol Scoring Scale, Cleveland Constipation Scoring Scale （CCS）, Scale for Outcomes in PD-autonomic for Autonomic Symptoms, Simple Food Frequency Questionnaire, Hamilton Depression Scale （HAMD）, Mini Mental State Examination. The patients were divided into constipation group and non-constipation group based on Rome Ⅲ Criteria for Diagnosis of Functional Constipation, and the correlative factors of constipation were compared and analyzed between the two groups. The severity of constipation and influencing factors were also compared between patients with early onset constipation （occurred before present of motor symptoms） and patients with late onset constipation （occurred after present of motor symptoms ）. The impacts of anti-PD medication adjustments on constipation were assessed by observing the alteration of constipation severity in 41 PD patients. Results The incidence of constipation was 56.4% （109/193） in our cohort of PD patients, and 21.1% （23/109） of constipation was severe according to the assessing by CCS. The spectrum of constipation symptoms included defecation straining （ 89. 9% , 98/109 ） , poor stool output （ 67. 9%, 74/ 109）, reduced stool frequency （63.3% ,69/109） and dryness of stool （60.5%, 66/109）. The age, disease duration, scores of Hoehn-Yahr stage, UPDRS m and HAMD, levodopa equivalent dose （LED） , frequency of urination disturbance in constipation group were significantly higher than those in non- constipation group, while the daily quantities of vegetabl

关 键 词：帕金森病 便秘 抑郁 疾病影响状态调查 临床对照试验 

分 类 号：R742.5[医药卫生—神经病学与精神病学]