通过国王帕金森病疼痛量表分析帕金森病患者疼痛的临床特点  

Analysis of the clinical characteristics of Parkinson’s disease related pain by King’s Parkinson’s disease pain scale

作　　者：高靓[1] 蔡来生 李小兵[1] 黄经纬[1] GAO Liang;CAI Lai-sheng;LI Xiao-bing(Department of Neurology,the First Affiliated Hospital of Nanchang University,Nanchang 300006,China)

机构地区：[1]南昌大学第一附属医院神经内科,330006 [2]江西省人民医院神经内科

出　　处：《临床神经病学杂志》2020年第2期112-116,共5页Journal of Clinical Neurology

基　　金：江西省教育厅科学技术研究项目(170009,180045);江西省卫生计生委科技计划项目(20175079,20181021)。

摘　　要：目的应用国王帕金森病疼痛量表(KPPS)对帕金森病(PD)患者的疼痛症状进行评估和分类,分析其临床特点。方法收集200例在南昌大学第一附属医院就诊的原发性PD患者的临床资料。运用KPPS量表评估患者的疼痛症状,运用统一PD评分量表第三部分(UPDRSⅢ)、Hoehn-Yahr分级(H-Y)、MMSE、汉密尔顿焦虑量表(HAMA)、汉密尔顿抑郁量表(HAMD)、日常生活能力量表(ADL)、匹兹堡睡眠质量指数(PSQI)分别评估患者的运动功能、症状的严重程度、认知功能、焦虑状况、抑郁状况、生活自理能力及睡眠情况。将患者分为PD伴疼痛组和不伴疼痛组,对两组进行分析比较,并且寻找PD伴疼痛的相关影响因素。结果PD伴发疼痛的发生率为44.5%,平均KPPS评分为(41.2±26.8)分。患者疼痛部位多为下肢(60.7%)、上肢(22.5%)及腰部(21.3%),其中24例(27%)患者伴两种及两种以上部位疼痛;疼痛类型多为骨骼肌疼痛(61.8%)和肌张力障碍性疼痛(27%),其中伴多种类型疼痛患者17例(19.1%)。PD伴疼痛组与PD不伴疼痛组相比,其病程更长(P=0.022)、左旋多巴等效日剂量更大(P=0.008)、UPDRSⅢ评分更高(P=0.018)、H-Y等级更高(P=0.003)、HAMD评分更高(P<0.001)、HAMA评分更高(P<0.001)、ADL评分更低(P=0.046)以及PSQI评分更高(P<0.001)。多因素Logistic逐步回归分析显示,PD伴发疼痛分别与H-Y分级评分[轻度(OR=1.000),中度(OR=2.394,95%CI:1.281~4.473,P=0.006),重度(OR=3.184,95%CI:1.128~8.986,P=0.029)]和PSQI评分相关(OR=2.068,95%CI:1.129~3.786,P=0.019)。结论PD患者疼痛部位多位于四肢及腰部,最常见的疼痛类型是骨骼肌疼痛。PD伴有疼痛的患者病程更长,病情更严重。KPPS量表可对PD疼痛进行评估及分类,有助于更精准治疗方案的制定。Objective To evaluate and classify the pain symptoms of patients with Parkinson’s disease(PD)by King’s Parkinson’s Pain Scale(KPPS),and to analyze its clinical characteristics.Methods Clinical data of 200 patients with primary PD in the first affiliated hospital of Nanchang university were collected.Pain symptoms were assessed by KPPS scale.Unified PD score scale Ⅲ(UPDRSⅢ),Hoehn-Yahr scale(H-Y)and MMSE,Hamilton anxiety scale(HAMA),Hamilton depression scale(HAMD),activity of daily life scale(ADL)and Pittsburgh sleep quality index(PSQI)were used to assess the motor function,severity of symptoms,cognitive function,anxiety,depression,self-care ability and sleep status of patients.The patients were divided into PD with pain group and without pain group,and were analyzed to search the related factors.Results The incidence of Parkinson’s disease related pain was 44.5%.The average KPPS score was(41.2±26.8).Most of the pain sites were lower limbs(60.7%),upper limbs(22.5%)and lumbar(21.3%).24 patients(27%)suffered from two or more kinds of pain.Most of the pain types were skeletal muscle pain(61.8%)and dystonia pain(27%).Among them,17 patients(19.1%)suffered from multiple types of pain.Compared with group of PD without pain,group of PD with pain had longer course(P=0.022),higher equivalent daily dose of levodopa(P=0.008),higher UPDRSⅢ score(P=0.018),higher H-Y score(P=0.003),higher HAMD score(P<0.001),higher HAMA score(P<0.001),lower ADL score(P=0.046)and higher PSQI score(P<0.001).Multivariate logistic regression analysis showed that PD related pain was correlated with H-Y score[mild(OR=1.000),moderate(OR=2.394,95%CI:1.281-4.473,P=0.006),severe(OR=3.184,95%CI:1.128-8.986,P=0.029)]and PSQI score(OR=2.068,95%CI:1.129-3.786,P=0.019).Conclusions Pain is mostly located in the limbs and waist in patients with PD,and the most common type of pain is Skeletal muscle pain.PD patients with pain have a longer course and are more severely affected.KPPS scale can be used to evaluate and classify PD pain,which is helpful

关 键 词：帕金森病 疼痛 临床特点 

分 类 号：R742.5[医药卫生—神经病学与精神病学]