帕金森病患者疼痛影响因素的系统评价  

Factors Affecting Pain in Patients with Parkinson’s Disease:a Systematic Review

作　　者：章雨桐 王秋琴[1] 徐语晨 翁恒 梁咏琪 汪露露 王庆[1] 徐桂华[1] ZHANG Yutong;WANG Qiuqin;XU Yuchen;WENG Heng;LIANG Yongqi;WANG Lulu;WANG Qing;XU Guihua(School of Nursing,Nanjing University of Traditional Chinese Medicine,Nanjing 210023,China)

机构地区：[1]南京中医药大学护理学院,江苏省南京市210023

出　　处：《中国全科医学》2023年第14期1766-1774,共9页Chinese General Practice

基　　金：江苏省自然科学面上项目(19KJB360014)—基于NF-κB信号通路探讨铜砭刮痧治疗帕金森病的机制研究;江苏省研究生实践创新计划项目(SJCX22_0812)—铜砭刮痧干预帕金森病患者运动症状的临床疗效研究。

摘　　要：背景 疼痛是帕金森病(PD)患者常见的非运动症状之一,且对患者生活质量造成严重影响,目前学者对PD患者发生疼痛的影响因素进行了探讨,但研究结果存在差异。目的 系统评价PD患者疼痛的影响因素。方法 计算机检索中国知网、万方数据知识服务平台、维普网、中国生物医学文献服务系统(SinoMed)、Web of Science、PubMed、Medline、Embase、Cochrane Library数据库有关PD患者疼痛影响因素的研究,检索时间为建库至2022-04-12。由2名研究者独立筛选文献,并提取相关资料。采用美国卫生保健质量研究机构(AHRQ)编制量表和纽卡斯尔-渥太华量表(NOS)分别对横断面研究和病例对照研究进行偏倚风险评价。对所有涉及的影响因素进行描述性分析,并采用RevMan 5.3软件对PD患者疼痛的影响因素进行Meta分析。结果 共纳入16项研究,总样本量为2 855例,共涉及24种影响因素。描述性分析结果可知有2项保护因素和22项危险因素;Meta分析结果可知:女性[OR=3.73,95%CI(1.75,7.96),P=0.000 7]、病程长[OR=1.35,95%CI(1.15,1.60),P=0.000 3]、抑郁情绪[OR=1.14,95%CI(1.07,1.22),P<0.000 01]、统一帕金森病评定量表(UPDRS)Ⅲ评分高[OR=1.07,95%CI(1.03,1.11),P=0.000 2]、Hoehn-Yahr分级高[OR=2.28,95%CI(1.28,4.04),P=0.005]、非运动症状评价量表(NMSS)评分高[OR=1.68,95%CI(1.46,1.93),P<0.000 01]是PD患者发生疼痛的危险因素。GRADE分级结果显示性别、NMSS评分是中等质量证据,病程、抑郁情绪、UPDRSⅢ评分是低质量证据,Hoehn-Yahr分级是极低质量证据。结论女性、病程长、抑郁情绪、运动障碍、Hoehn-Yahr分级高以及其他非运动症状(睡眠障碍、疲劳)程度重是PD患者疼痛的危险因素,未来需要更大样本、高质量研究进一步验证。Background Pain is a common non-motor symptom in patients with Parkinson’s disease(PD),which has a serious impact on patients’ quality of life. Current scholars have explored the factors influencing the occurrence of pain in patients with PD,but there is some variability in the findings. Objective To evaluate the influencing factors of pain in PD patients. Methods We searched the CNKI,Wanfang Data,VIP,SinoMed,Web of Science,PubMed,Medline,Embase and Cochrane Library databases for studies on factors influencing pain in patients with PD from database establishment to April 12,2022. Two researchers independently conducted literature screening and relevant information extraction. We used the Agency for Healthcare Research and Quality(AHRQ) Scale and the Newcastle-Ottawa Scale(NOS) to evaluate the risk of bias in cross-sectional studies and case-control studies,respectively. We performed a descriptive analysis of all influencing factors of pain,and implemented a meta-analysis of these influencing factors using RevMan 5.3. Results Sixteen studies were finally included,with a total sample size of 2 855 cases,and 24 influencing factors of pain identified. There were two protective factors and 22 risk factors in descriptive analysis. The meta-analysis showed that,female[OR=3.73,95%CI(1.75,7.96),P=0.000 7],long duration of PD[OR=1.35,95%CI(1.15,1.60),P=0.000 3],depressed mood [OR=1.14,95%CI(1.07,1.22),P<0.000 01],high UPDRS Ⅲ score[OR=1.07,95%CI(1.03,1.11),P=0.000 2],advanced Hoehn-Yahr stages[OR=2.28,95%CI(1.28,4.04),P=0.005],and high NMSS score[OR=1.68,95%CI(1.46,1.93),P<0.000 01] were risk factors for pain in PD patients. The GRADE analysis showed that the quality of evidence for the effects of gender and NMSS score on pain was moderate,and that for the effects of duration of PD,depressed mood and UPDRS Ⅲ score on pain was low,and that for the effect of Hoehn-Yahr stage on pain was very low. Conclusion Female,long duration of PD,depressed mood,motor impairment,advanced Hoehn-Yahr stages and other severe non-moto

关 键 词：帕金森病 疼痛 非运动症状 影响因素分析 横断面研究 病例对照研究 系统评价 

分 类 号：R742.5[医药卫生—神经病学与精神病学]