帕金森病与疲劳  

Parkinson's disease and fatigue

作　　者：李蒙燕[1] 张惠丽[1] 郑浩[1] 

机构地区：[1]广州市第一人民医院神经科,广州510180

出　　处：《中国实用神经疾病杂志》2017年第10期4-9,共6页Chinese Journal of Practical Nervous Diseases

摘　　要：目的探讨异质性帕金森病(Parkinson’s disease,PD)患者出现疲劳的临床特征及疲劳与运动及非运动症状的关联,明确症状的归属,以期寻找缓解症状的治疗方法。方法连续收集2014-04-2016-06就诊于广州市第一人民医院神经科运动障碍疾病门诊及住院的144例PD患者的病历资料,按帕金森病异质分组原则分组,全部患者采用疲劳严重程度(fatigue severity scale,FSS)和疲劳量表(fatigue scale,FS-14)评价疲劳,同时完成PD运动症状(motor symptoms,MS)、非运动症状(nomotor symptoms,NMS)、日常生活能力及质量相关的量表分析。结果 144例PD患者中,有疲劳症状60例(41.47%),疲劳组中早期PD且无其他NMS症状10例。异质性帕金森病不同组别比较显示强直为主型、女性及中晚期PD患者发生疲劳机会增加。单因素分析示,PD患者年龄、病程、H-Y分级、运动症状评分(UPDRS评分Ⅲ(R)、UPDRS评分Ⅲ总分)及UPDRSⅣ部分得分疲劳组得分均高于非疲劳组;非运动症状评分(NMSS)提示,疲劳组患者的NMS出现程度及频率均较非疲劳组严重,差异有统计学意义(P<0.05);疲劳组精神情绪总体状况(UPDRSⅠ)、抑郁(HAMD)、焦虑(HAMA)、白天嗜睡(ESS)均明显高于非疲劳组;MMSE评分证实2组患者智能正常,差异无统计学意义(P>0.05),但疲劳组较非疲劳组MMSE得分有下降趋势;疲劳组日常生活动能力(UPDRSⅡ)和生活质量PDQ39评分均显著高于非疲劳组,英格兰日常生活能力量表Schwab显著低于非疲劳组,差异均有统计学意义(P<0.05)。多重线性回归分析,NMSS程度、焦虑、抑郁评分与疲劳显著相关。结论 PD患者疲劳的发生率高;异质性帕金森病发生疲劳几率不同;单因素分析疲劳组PD患者病程更长,运动症状及病情更严重,NMS更多、更重,生活质量更差;NMSS的程度、焦虑、抑郁是导致疲劳的主要原因;部分疲劳组患者的疲劳发生与MS及NMS无关,提示疲劳可能是PD病程中的独立�Objective To explore the clinical characteristics of fatigue in patients with heterogeneous Parkinson＇s disease （PD） and the associations of fatigue with motor and non-motor symptoms to identify the ascription of symptoms,in order to hunt for therapeutic strategies to relieve symptoms. Methods We collected clinical data of one hundred and forty-four PD out-patients who visited the neurology department or in-patients in our hospital from April 2014 to June 2016. All patients were grouped based on heterogeneous principles of classification and were evaluated by fatigue scale-14 （FS-14）,fatigue severity scale （FSS）, motor symptoms （MS） scale,non-motor symptoms （NMS） scale and activities of daily living （PDQ39） scale. Results Of all 144 eases taking part in fatigue evaluation, 60 cases （41.4 % ） had fatigue symptom among whom there were 10 eases （6.9 %） identified at the early stage of PD without other NMS symptoms. According to comparisons between different groups in heterogeneous PD pa- tients, our study showed that late-onset type, stiffness as chief symptom, female and patients at moderate and advanced stage of rigidity type, the female and the middle and late stage. Univariate analysis showed that age,PD duration, H-Y grade, MS scores （in- eluding the total scores of UPDRS part Ⅲ and scores of UPDRS part Ⅳ） in fatigue group were significantly higher than those in non-fatigue group （P〈0.05）. NMSS scores showed that the degree and frequency of NMS in the fatigue group were significantly higher than those in the non-fatigue group, and there were significant differences between the two groups （P 〈0.05）. Furthermore, the fatigue group indieated higher levels in mental state （UPDRS part Ⅰ ）, depression （HAMD）, anxiety （HAMA） and daytime sleepiness （ESS） than the non-fatigue group （P〈0.05）. Although MMSE scores verified normal intelligence in both two groups without statistical difference （P〉0.05）,the fatigue group showed the decreasing

关 键 词：帕金森病 疲劳 异质性 运动症状 非运动症状 

分 类 号：R742.5[医药卫生—神经病学与精神病学]