步态特征改变在帕金森病进展过程中的临床价值研究  

Clinical value of changes of gait characteristics in the progression of Parkinson′s disease

作　　者：干静[1] 赵嘉豪 万赢[1] 宋璐[1] 吴娜[1] 张煜[1] 刘振国[1] Gan Jing;Zhao Jiahao;Wan Ying;Song Lu;Wu Na;Zhang Yu;Liu Zhenguo(Department of Neurology,Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine,Shanghai 200092,China)

机构地区：[1]上海交通大学医学院附属新华医院神经内科,上海200092

出　　处：《中华神经科杂志》2022年第7期706-714,共9页Chinese Journal of Neurology

基　　金：国家重点研发计划“重大慢性非传染性疾病防控研究”重点专项(2017YFC1310300);国家自然科学基金(81974173);上海医学引导类科技支撑项目(19401932100);上海市卫生健康委员会卫生行业临床研究专项计划(201940021)。

摘　　要：目的通过检测帕金森病不同阶段步态特征改变,明确疾病进展演变过程中变化的特异性步态参数,为疾病监测提供参考依据。方法本项横断面研究共纳入2019年1月至2021年9月于上海交通大学医学院附属新华医院帕金森病专病门诊就诊或住院的276例帕金森病患者[Hoehn-Yahr(H-Y)分级1~3级]和63名性别、年龄匹配的健康对照,采用便携式惯性测量单元系统记录步态时空变量,并进行探索性因子分析,获得代表不同步态特征的步态域。采用单因素方差分析评估健康对照和H-Y分级1~3级帕金森病患者中各步态变量及步态域之间的差异,并根据运动分型进一步细分各参数之间的差异;比较不同步态变量及步态域在评估不同阶段帕金森病患者步态障碍严重程度的敏感度。结果对采集的11项步态时空变量归纳出4种步态域:步伐(步长、步速、跨步长)、节奏时相(步频、跨步时长、双支撑相时长)、步伐相关变异性/不对称性(步长变异系数、步长不对称性、步速变异系数)和节奏时相相关变异性/不对称性(摆动相时长变异系数及摆动相不对称性)。随着疾病进展,4个步态域在震颤型帕金森病患者中与非震颤型帕金森病患者中的总体变化趋势一致。相对于健康对照,帕金森病患者步伐参数在H-Y分级2级患者出现中度受损(效应量0.64;标准化分值0.12±0.80与0.64±0.81,P<0.05),以非震颤型帕金森病患者为明显,而H-Y分级1级患者较健康对照无改变(P>0.05);步伐相关变异性/不对称性在H-Y分级3级帕金森病患者出现明显异常(效应量0.62;标准化分值0.27±1.12与-0.27±0.52,P<0.05),而H-Y分级1级和2级帕金森病患者改变不明显(均P>0.05);节奏时相相关变异性/不对称性在H-Y分级1级帕金森病患者即开始出现轻度损害(效应量0.42;标准化分值-0.03±0.69与-0.33±0.49,P<0.05),其中摆动相不对称性在震颤型帕金森病患者中更为突出。Objective To determine the evolution of gait impairment over the course of Parkinson′s disease(PD)by assessing the changes of gait characteristics in different disease stages,which could be helpful for disease monitoring.Methods A total of 276 PD patients[PD group,Hoehn-Yahr(H-Y)stage 1-3]and 63 healthy controls(control group)enrolled in Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from January 2019 to September 2021 were included in this cross-sectional study.The gait spatiotemporal variables were recorded by a portable inertial measurement unit system.Exploratory factor analysis was performed to obtain gait domains representing different gait characteristics.One way analysis of variance was used to evaluate the differences of gait variables and gait domains among the control group and 3 different H-Y stages of the PD group,as well as the differences among the control group and 2 motor subtypes of PD in different stages.The sensitivity of different gait variables and gait domains in evaluating the severity of gait impairments at different disease stages was compared.Results Eleven gait spatiotemporal variables were grouped in 4 gait domains:pace(step length,gait speed and stride length),rhythm/phase(cadence,stride time and double support time),pace-related variability/asymmetry[step length coefficient of variation(CV),gait speed CV and step length asymmetry]and rhythm/phase-related variability/asymmetry(swing time CV and swing time asymmetry).As the disease progresses,most evolution trends of the 4 gait domains in the tremor-dominant PD patients were consistent with those in the non-tremor-dominant subtype.Compared with the control group,PD patients at H-Y stage 1 began to show the mild impairment of rhythm/phase-related variability/asymmetry(effect size 0.42;standardized score-0.03±0.69 vs-0.33±0.49,P<0.05),especially swing time asymmetry in tremor-dominant patients;the pace domain was damaged moderately in PD patients at H-Y stage 2(effect size 0.64;standardized score 0.12

关 键 词：帕金森病 步态障碍 神经性 步态时空参数 可穿戴传感器 

分 类 号：R742.5[医药卫生—神经病学与精神病学]