早中期帕金森病患者睡眠障碍影响因素分析及中医证型分布特点研究  

Analysis of factors influencing sleep disorders and the distribution characteristics of traditional Chinese medicine syndromes in people with early-or mid-stage Parkinson’s disease

作　　者：李慧[1] 袁晓蕾[1] 叶青[1] 袁灿兴[1] 高晨[1] 胡钰卿 LI Hui;YUAN Xiaolei;YE Qing;YUAN Canxing;GAO Chen;HU Yuqing(Longhua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine,Shanghai 200032,China)

机构地区：[1]上海中医药大学附属龙华医院,上海200032

出　　处：《上海中医药杂志》2023年第3期21-25,共5页Shanghai Journal of Traditional Chinese Medicine

基　　金：上海市卫健委科研项目(20204Y0168)。

摘　　要：目的研究早中期帕金森病(PD)患者睡眠障碍的影响因素及中医证型分布特点。方法根据PD睡眠量表(PDSS)评分,将87例早中期PD患者分为PD睡眠障碍组(46例)和PD不伴睡眠障碍组(41例),分析比较两组性别、年龄、发病年龄、病程、Hoehn-Yahr分级等基线资料,以及PD综合评分量表(UPDRS)、自主神经症状量表(SCOPA-AUT)、汉密尔顿抑郁量表(HAMD)、汉密尔顿焦虑量表(HAMA)、简易智力状态检查量表(MMSE)、PD生活质量问卷(PDQ-39)评分。对所有患者行中医辨证分型,观察中医证型分布规律,比较不同中医证型早中期PD患者的睡眠情况。采用线性回归分析或Logistic回归法检验PDSS总分与各变量之间的线性趋势,探讨早中期PD患者睡眠障碍的影响因素。结果①两组基线资料比较,差异无统计学意义(P>0.05);与PD不伴睡眠障碍组比较,PD伴睡眠障碍组SCOPA-AUT、HAMA、HAMD、PDQ-39及UPDRS各部分(Ⅰ精神、行为和情绪,Ⅱ日常活动,Ⅲ运动功能)评分升高(P<0.05)。②本研究收集的87例早中期PD患者中,气血不足证22例、气滞血瘀证21例、痰热动风证15例、肝肾不足证29例;PD伴睡眠障碍组和PD不伴睡眠障碍组患者的中医证型分布差异有统计学意义(P<0.05),PD伴睡眠障碍组的常见中医证型为肝肾不足证(43.50%),PD不伴睡眠障碍组则以气滞血瘀证(41.50%)多见。③不同中医证型早中期PD患者PDSS总分比较,差异有统计学意义(P<0.05),其中肝肾不足证PDSS总分最低。④PDSS总分与年龄、UPDRSⅠ、UPDRSⅡ、UPDRSⅢ、SCOPA-AUT、HAMA、HAMD、PDQ-39评分呈负相关(r<0,P<0.05),其中UPDRSⅠ、UPDRSⅡ、SCOPA-AUT、HAMA、HAMD、PDQ-39是危险因素(P<0.05)。结论高龄早中期PD患者更容易合并睡眠障碍,运动症状和自主神经功能症状亦更为严重,容易出现焦虑、抑郁情绪,从而影响生活质量;早中期PD伴睡眠障碍患者的常见中医证型为肝肾不足证,此类患者的睡眠障碍程度�Objective To investigate the factors influencing sleep disorders and the distribution characteristics of traditional Chinese medicine(TCM)syndromes in patients with early-or mid-stage Parkinson’s disease(PD).Methods Based on the Parkinson’s Disease Sleep Scale(PDSS)score,87 patients with early-or mid-stage PD were divided into the PD sleep disorder group(n=46)and the PD without sleep disorder group(n=41).Baseline data such as gender,age,age of onset,duration of illness,Hoeln-Yahr Stage,and scores of the Unified Parkinson Disease Rating Scale(UPDRS),Scales for Outcomes in Parkinson’s disease-Autonomic(SCOPA-AUT),Hamilton Depression Scale(HAMD),Hamilton Anxiety Scale(HAMA),Minimum Mental State Examination(MMSE)and the Parkinson’s Disease Questionnaire(PDQ-39)were analyzed and compared between the two groups.All patients with early-or mid-stage PD had TCM syndrome differentiation,the distribution pattern of TCM syndromes were analyzed,and the sleep condition in patients with different TCM syndromes were compared.Linear regression analysis or Logistic regression analysis was used to test for linear trends between the total PDSS score and each variable,and to explore the influencing factors of sleep disorders in early-or mid-stage PD patients.Results①No statistically significant baseline difference was found between the two groups(P>0.05).The scores of SCOPA-AUT,HAMA,HAMD,PDQ-39 and subscales of UPDRS(I mentation,behavior and mood,Ⅱactivities of daily living,Ⅲmotor exam)were higher in the PD with sleep disorder group than those in the PD without sleep disorder group(P<0.05).②Among the 87 patients with early-or mid-stage PD collected in this study,there were 22 cases with qi and blood deficiency syndrome,21 cases with qi stagnation and blood stasis syndrome,15 cases with stirring wind due to phlegm-heat syndrome,and 29 cases with liver and kidney deficiency syndrome.There was a statistically significant difference in the distribution of TCM syndromes between the PD with sleep disorder group and the PD w

关 键 词：帕金森病 睡眠障碍 中医证型 肝肾不足证 焦虑 抑郁 

分 类 号：R277.7[医药卫生—中医学]