帕金森病和多系统萎缩P型患者下尿路症状特点和影响因素的比较研究  

Comparative study of lower urinary tract dysfunction and its influence factors in patients with Parkinson's disease and multiple system atrophy-parkinsonian type

作　　者：杨梦婷 张志鹏[2] 武冬冬[1] 苏闻[1] 陈海波[1] YANG Mengting;ZHANG Zhipeng;WU Dongdong;SU Wen;CHEN Haibo(不详;Department of Neurology,Beijing Hospital,National Center of Gerontology,Institute of Geriatric Medicine,China Academy of Medical Sciences,Beijing 100005,China)

机构地区：[1]北京医院神经内科、国家老年医学中心、中国医学科学院老年医学研究院,100730 [2]北京医院泌尿外科

出　　处：《中国神经免疫学和神经病学杂志》2023年第3期169-173,共5页Chinese Journal of Neuroimmunology and Neurology

基　　金：国家重大疾病多学科合作诊疗能力建设项目(FTJ-19-03)。

摘　　要：目的探讨帕金森病(PD)和多系统萎缩P型(MSA-P型)患者的下尿路症状特点及其影响因素。方法回顾性收集北京医院PD与锥体外系疾病诊疗中心2018年6月至2022年4月就诊的34例PD患者和19例MSA-P型患者,收集两组患者一般临床资料、帕金森统一评定量表-Ⅲ(UPDRS-Ⅲ)评分、简易精神状态量表(MMSE)评分、汉密尔顿抑郁量表(HAMD)评分、汉密尔顿焦虑量表(HAMA)评分、日常生活活动能力(ADL)Barthel评分以及下尿路症状等临床资料。比较PD和MSA-P型患者间以及有无泌尿症状组间临床特征的差异。结果MSA-P型患者泌尿症状的发生率高于PD患者(χ^(2)=6.313,P=0.012),其中MSA-P型患者尿频(χ^(2)=6.313,P=0.012)、急迫性尿失禁(χ^(2)=6.259,P=0.012)以及排尿困难(χ^(2)=4.943,P=0.026)的发生率均显著高于PD组。与不伴泌尿症状PD患者相比,伴泌尿症状的PD患者女性比例(P=0.030)、UPDRS-Ⅲ评分(t=-2.087,P=0.046)、HAMA评分(Z=2.989,P=0.002)、HAMD评分(Z=-2.228,P=0.025)更高,而MMSE评分更低(Z=-2.865,P=0.004)。病程早期及中晚期PD和MSA患者间急迫性尿失禁的发生率均无统计学差异(均P>0.05)。结论PD和MSA-P型患者均存在下尿路症状,MSA-P型患者的泌尿症状更突出;PD患者的下尿路症状与运动症状、认知障碍、情绪障碍有相关性。MSA-P型患者下尿路症状和运动症状、认知障碍及情绪障碍的关系尚不清楚。Objective To investigate lower urinary tract dysfunction and its influence factors in patients with Parkinson's disease(PD)and multiple system atrophy-parkinsonian type(MSA-P).Methods We retrospectively collected 34 PD patients and 19 MSA-P patients treated in PD and extrapyramidal Disease Center of Beijing Hospital between June 2018 and April 2022.We collected clinical characteristics,unified Parkinson's disease rating scale part three(UPDRS-Ⅲ),mini-mental state examination(MMSE),Hamilton anxiety scale(HAMA),Hamilton depression scale(HAMD),activities of daily living Barthel index(ADL Barthel)and data on lower urinary tract dysfunction.We compared lower urinary tract dysfunction in the two groups and investigated the differences of clinical features between the groups with or without urinary symptoms.Results Prevalence of lower urinary tract symptoms in MSA-P patients was higher than that in PD patients(χ^(2)=6.313,P=0.012).Prevalence of urinary frequency(χ^(2)=6.313,P=0.012),urinary incontinence(χ^(2)=6.259,P=0.012),and dysuria(χ^(2)=4.943,P=0.026)in MSA-P patients were significantly higher than those in PD patients.Compared with PD patients without lower urinary tract dysfunction,PD patients with lower urinary tract dysfunction had significantly higher proportion of female(P=0.030),higher UPDRS-Ⅲscore(t=-2.087,P=0.046),higher HAMA score(Z=2.989,P=0.002),higher HAMD score(Z=-2.228,P=0.025)and lower MMSE score(Z=-2.865,P=0.004).There was no significant difference in the proportion of urinary incontinence between early and advanced PD and MSA patients(P>0.05).Conclusions Both PD and MSA-P patients had lower urinary tract dysfunction.The urinary tract dysfunction in MSA-P is more severe than that in PD.Lower urinary tract dysfunction in PD was correlated with motor symptoms,cognitive impairment and emotional disturbance.The relationship between lower urinary tract symptoms and motor symptoms,cognitive impairment or emotional disturbance of MSA-P remains unclear.

关 键 词：帕金森病 多系统萎缩 泌尿系表现 排尿障碍 排尿困难 尿失禁 急迫性 影响因素 

分 类 号：R742.5[医药卫生—神经病学与精神病学]