初诊未服药帕金森病患者的抑郁特点及危险因素分析  

Clinical characteristics and risk factors of depression in newly diagnosed untreated patients with Parkinson disease

作　　者：华平[1] 李丽 张洪燕[2] 姚燕[1] 于翠玉[1] 刘卫国[1] Hua Ping;Li Li;Zhang Hongyan;Yao Yan;Yu Cuiyu;Liu Weiguo(Department of Neurology,Affiliated Nanjing Brain Hospital,Nanjing Medical University,Nanjing 210029,China;Department of Early Intervation,Affiliated Nanjing Brain Hospital,Nanjing Medical University,Nanjing 210029,China)

机构地区：[1]南京医科大学附属脑科医院神经内科,210029 [2]南京医科大学附属脑科医院早期干预科,210029

出　　处：《神经疾病与精神卫生》2022年第10期709-714,共6页Journal of Neuroscience and Mental Health

基　　金：国家重点研发计划项目(2017YFC1310302)。

摘　　要：目的探讨初诊未服药的帕金森病(PD)患者抑郁的临床特征及危险因素。方法回顾性收集2010年10月至2019年12月在南京医科大学附属脑科医院神经内科运动障碍门诊初诊未服药的218例PD患者(PD组)和171名年龄、性别相匹配的健康对照者(对照组)的资料。采用统一PD评定量表(UPDRS)第Ⅱ、Ⅲ、Ⅴ部分评估PD患者的运动症状,采用PD睡眠量表(PDSS)、蒙特利尔认知评估量表(MoCA)和非运动症状问卷(NMSQ)评估PD患者的非运动症状。采用24项汉密尔顿抑郁量表(HAMD-24)和汉密尔顿焦虑量表(HAMA)评估受试者的抑郁、焦虑程度。比较PD组和对照组抑郁发作的发病率、临床资料的差异,比较帕金森病抑郁(dPD)和非帕金森病抑郁(n-dPD)患者临床症状的差异。采用多因素Logistic回归分析初诊未服药PD患者抑郁的危险因素。结果PD组HAMD-24评分为8.0(4.0,13.0)分,dPD的发病率为12.4%(27/218),其中轻度、中度和重度抑郁患者分别为5例、18例和4例。对照组HAMD-24评分2.0(0,2.0)分,抑郁发作的发病率为6.4%(11/171),其中轻度、中度和重度抑郁患者分别为5名、5名和1名。两组抑郁程度和抑郁发病率比较,差异有统计学意义(P<0.05)。dPD组患者的HAMD-24总分及各因子评分、HAMA评分、NMSQ评分高于n-dPD组,运动分期为早期、姿势异常步态不稳(PIGD)亚型的患者比例高于n-dPD组,UPDRS-Ⅱ评分和PDSS评分低于n-dPD组(P<0.05)。HAMA评分高(OR=1.167,95%CI=1.077~1.265)、NMSQ评分高(OR=1.235,95%CI=1.052~1.449)和PIGD运动障碍亚型(OR=2.024,95%CI=1.053~3.891)是PD患者发生抑郁的危险因素(P<0.05),PDSS评分高(OR=0.971,95%CI=0.945~0.997)是PD患者发生抑郁的保护因素(P<0.05)。结论初诊未服药PD患者的抑郁程度以中度抑郁为主,焦虑、非运动症状多、睡眠质量差和PIGD型PD患者更易患抑郁。Objective To investigate the clinical features and risk factors of depression in newly diagnosed untreated people with Parkinson disease(PD).Methods The data of a total of 218 newly diagnosed untreated PD patients in dyskinesia outpatient of Neurology Department of Affiliated Nanjing Brain Hospital,Nanjing Medical University from October 2010 to December 2019 and 171 age-and gendermatched healthy controls were retrospectively collected.The Unified PD Rating Scale(UPDRS)PartⅡ,ⅢandⅤwere used to examine the motor symptoms of PD patients.The PD Sleep Scale(PDSS),Montreal Cognitive Assessment Scale(MoCA)and Non-Motor Symptom Quest(NMSQ)were used to assess nonmotor symptoms in PD patients.The degree of depression and anxiety in PD group and control group were evaluated using the 24-item Hamilton Depression Scale(HAMD)and Hamilton Anxiety Scale(HAMA).The incidence rate and clinical data were compared between the PD and control groups.The clinical symptoms of PD patients with depression(dPD)and those without depression(n-dPD)were compared.Multivariate Logistic regression was used to analyze the risk factors of depression in newly diagnosed and untreated PD patients.Results The HAMD score of PD group was 8.0(4.0,13.0),and the incidence of dPD was 12.4%(27/218),with 5 cases of mild depression,18 cases of moderate depression,and 4 cases of severe depression.The HAMD score of control group was 2.0(0,2.0),and the rate of depressive episode was 6.4%(11/171),with 5 cases of mild depression,5 cases of moderate depression,and 1 case of severe depression.The differences in severity and incidence rate of depression between the two groups were statistically significant(P<0.05).The total score of HAMD-24 and each factor score,HAMA score and NMSQ score in dPD group were higher than those in n-dPD group.The proportion of patients in early stage,with aberrant posture instability and gait difficulty(PIGD)subtype in dPD group was higher than that in n-dPD group.The scores of UPDRS-PartⅡand PDSS in dPD group were lower than those i

关 键 词：帕金森病 初诊未服药 抑郁 危险因素 

分 类 号：R742.5[医药卫生—神经病学与精神病学]