帕金森病患者幻觉相关因素研究  

Clinical analysis of hallucinations in patients with Parkinson's disease

作　　者：李春雨[1] 欧汝威 刘辉[1] 侯炎冰 魏倩倩[1] 曹蓓[1] 宋伟[1] 赵璧[1] 商慧芳[1] 

机构地区：[1]四川大学华西医院神经内科,四川成都610041

出　　处：《中国实用内科杂志》2017年第8期726-730,共5页Chinese Journal of Practical Internal Medicine

基　　金：国家自然科学基金(81571247)

摘　　要：目的探究幻觉在帕金森病(PD)患者中的发生率及其临床相关因素。方法连续纳入2013年6月到2016年11月四川大学华西医院神经内科就诊的PD患者518例。收集详细的临床资料,并进行一系列量表评估,包括统一帕金森病评估量表(UPDRS)、帕金森病生活质量问卷-39(PDQ-39)、非运动症状评估量表(NMSS)、汉密尔顿抑郁量表(HAMD)、汉密尔顿焦虑量表(HAMA)、额叶功能评估量表(FAB)及蒙特利尔认知功能评估量表(MoCA)。将患者分成幻觉组和非幻觉组,比较两组患者的人口统计学资料、临床资料及各个量表的评分并进行多因素分析。结果 49例(9.5%)PD患者出现幻觉症状;幻觉组患者的年龄、病程、左旋多巴等效日剂量、多巴胺受体激动剂的使用率、UPDRS运动评分、H&Y分级及症状波动和异动症的发生率均显著高于非幻觉组(P<0.05);而校正相关混杂因素后,幻觉组患者的NMSS总分及各亚项评分、HAMD总分、HAMA总分及PDQ-39总分均显著高于非幻觉组(P<0.05),但两组FAB总分和MoCA总分差异无统计学意义;向前的二元Logistic回归模型显示,病程(OR=1.142,P<0.001)、NMSS量表中的泌尿系统症状评分(OR=1.058,P=0.001)及HAMA评分(OR=1.058,P=0.009)与PD患者幻觉的发生有关。结论 PD患者出现幻觉并不少见,其出现可能会降低患者生活质量;病程较长的PD患者更容易出现幻觉;PD患者出现幻觉与运动症状无关,可能与某些非运动症状(如泌尿系统症状及焦虑)有关。Objective To explore the prevalence and clinical factors of hallucination in patients with Parkinson＇s disease （PD）. Methods A cross-sectional analysis of 518 patients with PD was included. Unified PD Rating Scale （UPDRS）, Non-Motor Symptoms Scale （NMSS）, Hamilton Depression Scale （HAMD）, Hamilton Anxiety Scale （HAMA）, Frontal Assessment Battery （FAB）, and Montreal Cognitive Assessment （MoCA） were used to assess the motor and non-motor symptoms. PD Questionnaire-39 （PDQ-39） was applied to assess the Q.oL. The patients were divided into two groups： with-hallucination group and without-hallucination group. Compare the statistical information, clinical data and the scores of those scales, and make a multivariate analysis. Results Forty- nine PD patients （9.5%） reported hallucinations. Patients with hallucinations had older age, longer disease duration, higher levodopa equivalent daily doses, higher prevalence of dopamine receptor agonist use, higher incidences of motor fluctuation and dyskinesia, higher media H＆Y degree, higher scores for the UPDRS part IIL NMSS, HAMD, HAMA and PDQ：39 than patient without hallucinations （P〈0.05）. After the related factors were adjusted, the NMSS score, HAMD score and PDQ-39 score were significantly higher in with- hallucination group than in without-halhicination group（P〈0.05）, whereas the FAB and MoCA scores were not different between the two groups. The binary logistic regression analysis indicated that disease duration （OR=1.142, P〈0.001）, urinary symptoms score in NMSS （OR=1.058, P=0.001）, and HAMA score （OR=1.058, P=0.009） were associated with the presence of hallucinations in PD patients. Conclusions Hallucinations are not rare in PD patients, which may decrease the Q oL of PD patients. Patients with longer disease duration, more severe urinary symptoms and anxiety are likely to experience hallucinations.

关 键 词：帕金森病 幻觉 泌尿系统症状 焦虑 

分 类 号：R741[医药卫生—神经病学与精神病学]