早中期不同运动亚型帕金森病的平衡功能对比研究  

A comparative study on balance of different motor subtypes of Parkinson's disease in early and middle stages

作　　者：甄巧霞[1] 刘翠[1] 齐琳[1] 闫红娇 王丛笑 方伯言[1] ZHEN Qiaoxia;LIU Cui;QI Lin;YAN Hongjiao;WANG Congxiao;FANG Boyan(不详;Neurological Rehabilitation Center,Parkinson Medical Center,Beijing Rehabilitation Hospital,Capital Medical University,Beijing 100144,China)

机构地区：[1]首都医科大学附属北京康复医院神经康复中心帕金森医学中心,100144 [2]首都医科大学附属北京康复医院康复诊疗中心,100144

出　　处：《中国神经免疫学和神经病学杂志》2021年第4期323-328,共6页Chinese Journal of Neuroimmunology and Neurology

基　　金：国家重点研发计划(No.2018YFC0115405);首都医科大学附属北京康复医院重大项目(No.2017-001);首都医科大学附属北京康复医院科技发展专项(No.2019-040)。

摘　　要：目的比较不同运动亚型原发性帕金森病(PD)早中期平衡功能的差异。方法选择年龄小于75岁、认知初筛正常的临床确诊的早中期〔改良Hohen&Yahr(H-Y)分期1~3期〕原发性PD患者75例,纳入前已在神经内科接受专病医师规范化药物治疗。采集患者一般资料及左旋多巴等效剂量(levodopa equivalent dose,LED)、H-Y分期(评估病情的严重程度)、国际运动障碍协会-统一帕金森病评定量表(movement disorder society-unified Parkinson’s disease rating scale,MDS-UPDRS)第二部分(MDS-UPDRS-Ⅱ)、第三部分(MDS-UPDRS-Ⅲ)分值(MDS-UPDRS-Ⅱ、Ⅲ评分确定PD运动亚型,MDS-UPDRS-Ⅲ评分评估PD运动功能)等。根据PD患者运动症状分型分为震颤为主型(tremor dominant,TD)、姿势不稳/步态异常亚型(postural instability/gait difficulty,PIGD)和混合型(indeterminate patients)。选择TD亚型和PIGD亚型患者,分别在服抗PD药物状态下使用仪器评定其静态和动态平衡定量参数,使用Berg平衡量表观察PD患者功能性活动以评估动静态平衡,比较两组患者静态和动态定量平衡参数、Berg平衡量表评分差异。结果两组患者共55例进入研究,其中TD亚型23例、PIGD亚型32例。两组患者在病程、改良H-Y分期、MDS-UPDRS-Ⅲ和LED方面差异均无统计学意义(P>0.05)。在静态平衡方面,PIGD亚型较TD亚型的一字站压力中心(center of pressure,COP)平均运动速度均值明显增大〔4.50(3.66,5.49)cm/s比3.60(3.07,4.29)cm/s,Z=-2.691,P=0.009〕;单腿站测试时,PIGD亚型较TD亚型COP平均运动速度增快〔6.51(4.74,6.95)cm/s比6.08(4.65,9.52)cm/s,Z=-2.103,P=0.035〕,PIGD亚型的COP运动椭圆面积、运动轨迹长度、双足站立时COP前后平均运动速度、左右平均运动速度较TD亚型差异无统计学意义(P>0.05)。动态平衡测试参数和Berg平衡评分两组间差异无统计学意义(P>0.05)。结论早中期原发性PD患者PIGD亚型较TD亚型静态平衡功能下降。定量平衡测�Objective To evaluate the difference of balance between the tremor dominant(TD)subtype and postural instability/gait difficulty(PIGD)subtype in Parkinson’s disease(PD).Methods 75 PD inpatients younger than 75-year old with normal cognition(modified Hohen&Yahr stageⅠ-Ⅲ)were included.They had received standard anti-PD drug treatment from neurologists before inclusion.We collected general data of the patients,levodopa equivalent dose(LED),Movement Disorder Society-unified Parkinson’s disease rating scale-Ⅱ,Ⅲ(MDS-UPDRS-Ⅱ,Ⅲ)score and modified Hohen&Yahr(HY)stage scale scores.Modified HY stage was used to evaluate the severity of PD,MDS-UPDRS-Ⅲscore was used to evaluate the motor function,MDS-UPDRS-ⅡandⅢscores were used to identify the PD subtypes.All the PD patients were classified into TD subtype,PIGD subtype and indeterminate subtype according to UPDRS TD/PIGD radio.TD subtype and PIGD subtype were selected.Static and dynamic balance parameters,Berg Balance Scale were measured during on-drug phase.Berg balance scale was used to evaluate balance function through observing functional action.The differences of static and dynamic quantitative balance parameters and Berg Balance Scale scores between TD and PIGD subypes were compared.Results There were no statistically significant differences in disease duration,modified HY stage,MDS-UPDRSⅢor LED between the two groups.In terms of static balance,the mean velocity of center of pressure(COP)of tandem stance in the PIGD subtype was higher compared to that of the TD subtype[4.50(3.66,5.49)cm/s vs.3.60(3.07,4.29)cm/s,Z=-2.691,P=0.009],the mean velocity of COP of single leg stance of the PIGD subtype was higher than that of the TD subtype[6.51(4.74,6.95)cm/s vs.6.08(4.65,9.52)cm/s,Z=-2.103,P=0.035].While the elliptical area of motion,trajectory length of COP,the mean velocity of COP of both legs standing in the PIGD subtype and the TD subtype had no statistically significant differences(all P>0.05).There were no statistically significant difference betwe

关 键 词：帕金森病 运动亚型 平衡功能 

分 类 号：R742.5[医药卫生—神经病学与精神病学] R493[医药卫生—临床医学]