非运动症状对于帕金森病鉴别诊断的价值  

The value of non-motor symptoms in the differential diagnosis of Parkinson's disease

作　　者：张娟利[1] 商苏杭 党君亮 陈晨[1] 邓永宁[1] 屈秋民[1] ZHANG Juan-li;SHANG Su-hang;DANG Jun-liang;CHEN Chen;DENG Yong-ning;QU Qiu-min(Department of Neurology,The First Affiliated Hospital of Xi'an Jiaotong University,Xi'an 710061,China)

机构地区：[1]西安交通大学第一附属医院神经内科,陕西西安710061

出　　处：《西安交通大学学报（医学版）》2018年第5期733-737,共5页Journal of Xi’an Jiaotong University（Medical Sciences）

基　　金：西安交通大学第一附属医院研究生创新基金~~

摘　　要：目的比较帕金森病(PD)、特发性震颤(ET)、非典型帕金森症(PD-plus)患者非运动症状(NMS)的差异,探讨NMS对于PD鉴别诊断的价值。方法 2015年3月—2016年6月对本院神经内科门诊和住院的PD、ET、PD-plus患者进行面对面问卷调查,详细了解NMS发生的时间、频率、严重程度及与运动症状的关系,分析NMS对于PD鉴别诊断的价值。结果 (1)共入组PD 226例(男109例,48.2%),ET 71例(男30例,42.3%),PD-plus 56例(男32例,57.1%)。(2)PD组有NMS 209例(92.3%),前3位依次为便秘106例(46.9%)、多梦100例(44.2%)、夜尿增多95例(42.0%);ET组有NMS 54例(76.1%),前3位依次为夜尿增多22例(31.0%)、多梦20例(28.2%)、焦虑18例(25.4%);PD-plus组有NMS 56例(100%),前3位依次为多梦32例(64.3%)、睡眠行为紊乱(RBD)29例(51.8%)、便秘33例(58.9%)。PD组和PD-plus组的NMS显著高于ET组(P<0.05)。(3)PD组嗅觉减退、便秘、流涎、吞咽困难、近记忆障碍、性欲改变、容易摔倒、睡眠障碍及不安腿均显著高于ET组(P<0.05);PD-plus组流涎、吞咽困难、抑郁焦虑、体位性低血压、容易摔倒及睡眠障碍显著高于PD组(P<0.05)。(4)逐步多因素Logistics回归显示,PD组与ET组有统计学差异的NMS为嗅觉减退、排便异常、RBD、不安腿,其并联诊断灵敏度为70.8%,特异度69.0%。PD组与PDplus组有统计学差异的NMS为吞咽困难、体位性低血压、容易摔倒、RBD,其并联诊断灵敏度为100%,特异度为53.5%。结论 PD和PD-plus NMS显著高于ET,嗅觉减退、便秘、RBD和不宁腿对于PD与ET鉴别具有一定的价值;吞咽困难、体位性低血压、容易摔倒、RBD对于PD和PD-plus鉴别有一定的价值。Objective To compare Parkinson s disease(PD),essential tremor(ET)and atypical Parkinson disease(PD-plus)in patients with non-motor symptoms(NMSs)so as to explore the value of NMSs in differential diagnosis of PD.Methods A face-to-face questionnaire survey was conducted among PD,ET,and PD-plus inpatients and outpatients of Department of Neurology,The First Affiliated Hospital of Xi'an Jiaotong University,during March 2015 and June 2016.We tried to understand the relationship of NMS occurrence time,frequency and severity with motor symptoms,and analyze the value of NMSs in differential diagnosis of PD.Results We recruited 226 PD patients(109 males,48.2%),71 ET ones(30 males,42.3%),and 56 PD-plus ones(32 males,57.1%).In PD group,there were 209 cases(92.3%)of NMSs,followed by 106 cases(46.9%)of constipation,100 cases(44.2%)of frequent dreams,and 95 cases(42%)of nocturia.In ET group,there were 54 cases(76.1%)of NMSs,followed by nocturia in 22 cases(31%),frequent dreams in 20 cases(28.2%)and anxiety in 18 cases(25.4%).In PD-plus group,there were 56 cases(100%)of NMSs,followed by frequent dreams in 32 cases(64.3%),sleep behavior disorders in 29 cases(51.8%),and constipation in 33 cases(58.9%).NMSs were significantly higher in PD and PD-plus groups than in ET group(P<0.05).In PD group,hyposmia,constipation,salivation,dysphagia,recent memory disorders,altered sexual desire,inclination to fall,sleep disorder and restless legs were significantly higher than those in ET group(P<0.05).Salivation,dysphagia,depression,anxiety,postural hypotension,inclination to fall and sleep disorder were more frequent in PD-plus group than in PD group(P<0.05).Logistics multivariable stepwise regression showed that PD group and ET group differed significantly in NMS such as hyposmia,abnormal defecation,RBD,and restless legs;the diagnostic sensitivity was 70.8%and the specificity was 69%.PD group and PD-plus group had significant differences in NMSs including dysphagia,postural hypotension,inclination to fall,RBD,and the diagnostic sensitivity

关 键 词：帕金森病 特发性震颤 非典型帕金森症 鉴别诊断 非运动症状 

分 类 号：R742.5[医药卫生—神经病学与精神病学]