帕金森病伴发嗅觉障碍及其与临床症状的关系  

Olfactory dysfunction and its relationship with clinical symptoms in Parkinson's disease

作　　者：王瑞丹[1] 李丹凝 左丽君[2] 郭鹏[2] 连腾宏 扈杨 刘丽[2] 余舒扬[2] 陈泽颉 余秋瑾 金朝[1] 赵慧[2] 李丽霞[2] 朴英善[2] 张巍[1,2,3,4,5,6] WANG Ruidan;LI Danning;ZUO Lijun;GUO Peng;LIAN Tenghong;HU Yang;LIU Li;YU Shuyang;CHEN Zejie;YU Qiujin;JIN Zhao;ZHAO Hui;LI Lixia;PIAO Yingshan;ZHANG Wei(Department of Neurology and Geriatrics,Beijing Tiantan Hospital,Capital Medical University,Beijing 100050,China;China National Clinical Research Center for Neurological Diseases,Beijing 100050,China;Key Laboratory for Neurodegenerative Disorders of the Ministry of Education,Capital Medical University,Beijing 100069,China;Center of Parkinson Disease,Beijing Institute for Brain Disorders,Beijing 100053,China;Beijing Key Laboratory on Parkinson Disease,Beijing 100053,China)

机构地区：[1]首都医科大学附属北京天坛医院神经病学中心,100050 [2]首都医科大学附属北京天坛医院老年病科,100050 [3]国家神经系统疾病临床医学研究中心,100050 [4]教育部神经退行性疾病重点实验室,100069 [5]北京市脑重大疾病研究院帕金森病研究所,100053 [6]北京市帕金森病重点实验室,100053

出　　处：《中国神经免疫学和神经病学杂志》2018年第5期321-326,共6页Chinese Journal of Neuroimmunology and Neurology

基　　金：国家重点研发计划(2016YFC1306000;2016YFC1306300);国家自然科学基金资助项目(81571229;81071015;30770745);北京市自然科学基金重点项目(kz201610025030;4161004;7082032);首都临床特色应用研究资助项目(z12110700100000;z121107001012161);北京市保健办科研课题资助项目(京15-2)

摘　　要：目的探讨帕金森病(PD)伴发嗅觉障碍(OD)的临床特征,分析OD与病程、病情严重程度、运动症状及非运动症状的关系。方法连续收集2013-08—2017-05就诊于北京天坛医院的PD患者192例,采用Sniffin'Sticks嗅觉检测法评价患者的嗅觉察觉阈值(THR)、嗅觉辨别(DIS)和嗅觉鉴别(ID)能力,以上三部分评分之和为嗅觉功能总分(TDI),根据TDI总分将患者分为PD不伴OD(PD-NOD)组和PD伴OD(PD-OD)组,比较两组Hoehn-Yahr分期、统一帕金森病评定量表第Ⅲ部分(UPDRSⅢ)评分、蒙特利尔认知评估量表(MoCA)、改良淡漠评定量表(MAES)、汉密尔顿抑郁量表(HAMD)、汉密尔顿焦虑量表(HAMA)、快速眼动期睡眠行为障碍筛查问卷(RBDSQ)、匹兹堡睡眠质量指数量表(PSQI)、爱泼沃斯思睡量表(ESS)、不宁腿综合征评定量表(RLSRS)、疲劳评定量表(FS)-14项版本和疲劳严重程度量表(FSS)评分差异,并分析TDI、THR、DIS及ID与患者运动症状和非运动症状的相关性。结果 (1)192例PD患者中117例(60.9%)存在OD。(2)和PD-NOD组相比,PD-OD组的TDI、THR、DIS和ID评分均明显降低(P<0.01)。(3)PD-OD组与PD-NOD组起病年龄、病程、起病侧别、Hoehn-Yahr分期及运动并发症的发生率无统计学差异(P>0.05)。(4)PD-OD组认知障碍、淡漠、RBD、日间思睡及总体睡眠质量下降的发生率均高于PD-NOD组(P<0.05或P<0.01);两组抑郁、焦虑、不宁腿综合征及疲劳的发生率无明显差异(P>0.05)。(5)PD患者TDI、DIS及ID评分与MoCA量表评分呈显著正相关,与MAES和RBDSQ量表评分均呈显著负相关;THR与MoCA、MAES及RBDSQ量表评分无相关性。结论 PD患者OD的发生率较高,表现为嗅觉察觉、辨别和鉴别能力全面减退,PD-OD与认知障碍、淡漠、RBD、日间思睡及总体睡眠质量下降明显相关。Objective To investigate the clinical features of Parkinson s disease(PD)with olfactory dysfunction(OD),and to explore the relationship between OD and the duration,severity,motor symptoms,and non-motor symptoms of PD.Methods 192 PD patients from Beijing Tiantan Hospoital from August,2013 to May,2017 were consecutively recruited.Olfactory threshold(THR),discrimination(DIS)and identification(ID)were evaluated by Sniffin Sticks.Based on the sum of the THR,DIS,and ID scores(threshold,discrimination and identification,TDI),the patients were divided into a PD with OD(PD-OD)group and a PD with no OD group(PD-NOD).Hoehn-Yahr(H-Y)stage,Unified Parkinson s disease Rating Scale(UPDRS)Ⅲ,Montreal Cognitive Assessment(MoCA),Modified Apathy Estimate Scale(MAES),Hamilton Depression Scale(HAMD),Hamilton Anxiety Scale(HAMA),Rapid Eye Movement Sleep Behavior Disorder(RBD)Screening Questionnaire(RBDSQ),Epworth Sleepiness Scale(ESS),Restless Leg Syndrome Rating Scale(RLSRS),Fatigue Scale(FS)-14 and Fatigue Severity Scale(FSS)were used to assess the RLS symptoms of PD.Moreover,the difference of TDI,THR,DIS,ID and the scores of scales above between the two groups were assessed.Results (1)117 out of the 192 PD patients(60.9%)were with OD.(2)The scores of TDI,THR,DIS and ID of the PD-OD group were significantly lower than those of the PD-NOD group(P<0.01).(3)The age of onset,duration,lateralization,H-Y stage and the rate of motor complications exhibited no significant difference between the two groups(P>0.05).(4)The frequency of cognitive impairment,apathy,RBD,daytime sleepiness and the compromised overall sleep quality were all significantly higher in PD-OD than those in PD-NOD group,while there was no significant difference in the frequency of depression,anxiety,RLS and fatigue between the two groups(P>0.05).(5)The scores of TDI,DIS and ID were positively correlated with the score of MoCA,and were negatively correlated with the scores of MAES and RBDSQ,while THR score was not correlated with the scores of scales above.Conclusions The

关 键 词：帕金森病 嗅觉障碍 认知障碍 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]