基于潜变量增长曲线中介模型的帕金森病患者日常生活能力的研究  

Study on activities of daily living of patients with Parkinson’s disease based on latent variable growth curve mediation model

作　　者：栗卓倩 黄颖 杨慧 韩红娟 陈杜荣 余红梅 LI Zhuo-qian;HUANG Ying;YANG Hui;HAN Hong-juan;CHEN Du-rong;YU Hong-mei(Department of Health Statistics,School of Public Health,Shanxi Medical University,Taiyuan,Shanxi 030001,China;不详)

机构地区：[1]山西医科大学公共卫生学院卫生统计学教研室,山西太原030001 [2]山西医科大学基础医学院数学教研室 [3]重大疾病风险评估山西省重点实验室,山西太原030001 [4]煤炭环境致病与防治教育部重点实验室,山西太原030001

出　　处：《现代预防医学》2023年第23期4398-4403,共6页Modern Preventive Medicine

基　　金：国家自然科学基金资助项目(81973154);山西省研究生教育创新项目(2023KY406)。

摘　　要：目的分析帕金森病(PD)患者自主神经功能障碍在快速眼动睡眠行为障碍(RBD)和日常生活能力之间的纵向中介作用及其随时间的变化趋势。方法本研究纳入帕金森进展标志物计划(PPMI)数据库410例PD患者资料,分别采用快速眼动睡眠行为障碍筛查量表(RBDSQ)、自主神经症状量表(SCOPA-AUT)和帕金森病统一评价量表第二部分(UPDRS II)评估RBD、自主神经功能障碍和日常生活能力。以RBD为自变量,自主神经功能障碍为中介变量,日常生活能力为因变量构建潜变量增长曲线中介模型。采用全息极大似然估计进行参数估计,偏差校正的非参数百分位Bootstrap法进行中介效应检验,Chi-Square(df)、非规范拟合指数(Tucker Lewis index,TLI)、比较拟合指数(comparative fit index,CFI)指标来评价模型的拟合度。结果相关分析显示,RBD、自主神经功能障碍、日常生活能力六次随访两两之间均呈正相关(P<0.01)。潜变量增长曲线中介模型结果显示,快速眼动睡眠障碍的截距→日常生活能力的截距的总效应显著(β=0.427,95%CI:0.310~0.534),快速眼动睡眠障碍的截距→自主神经功能障碍的截距→日常生活能力的截距的间接效应显著(β=0.231,95%CI:0.158~0.324),快速眼动睡眠障碍的截距→日常生活能力得分的截距的直接效应显著(β=0.196,95%CI:0.045~0.331)。快速眼动睡眠障碍的斜率→自主神经功能障碍的斜率→日常生活能力的斜率的间接效应显著(β=0.272,95%CI:0.112~0.509),但快速眼动睡眠障碍的斜率→日常生活能力的斜率的总效应不显著(β=0.030,95%CI:-0.189~0.270),快速眼动睡眠障碍的斜率→日常生活能力的斜率的直接效应不显著(β=-0.242,95%CI:-0.515~0.016)。结论PD患者自主神经功能障碍在RBD和日常生活能力之间的纵向中介效应显著,RBD的症状通过自主神经功能障碍症状的加重从而影响患者的日常生活能力。因此,在PD早期可对自主神经�Objective To analyze the longitudinal mediating effect of autonomic nervous dysfunction between rapid eye movement sleep behavior disorder(RBD)and activities of daily living(ADL)in patients with Parkinson’s disease(PD)and its changing trend with time.Methods The data of 410 patients with PD were included in Parkinson’s Progressive Marker Program(PPMI)database.RBD,autonomic nervous dysfunction,and ADL were assessed by rapid eye movement sleep behavior disorder screening questionnaire(RBDSQ),the scales for outcomes in Parkinson’s disease-autonomic(SCOPA-AUT),and unified Parkinson’s disease rating scale II(UPDRS II).The latent variable growth curve mediation model was constructed with RBD as independent variable,autonomic nervous dysfunction as mediating variable and ADL as dependent variable.The parameters were estimated by holographic maximum likelihood estimation,the mediating effect was tested by nonparametric percentile Bootstrap method for deviation correction,and the fitting degree of the model was evaluated by Chi-Square,the Tucker Lewis Index(TLI),and Comparative Fit Index(CFI).Results Correlation analysis showed that there was a positive correlation among RBD,autonomic nervous dysfunction,and ADL at six follow-up visits(P<0.01).The results of latent variable growth curve mediation model showed that the total effect of the intercept of rapid eye movement sleep disorder→the intercept of ADL was significant(β=0.427,95%CI:0.310-0.534),the indirect effect of the intercept of rapid eye movement sleep disorder→the intercept of autonomic nervous dysfunction→the intercept of ADL was significant(β=0.231,95%CI:0.158-0.324),and the direct effect of the intercept of rapid eye movement sleep disorder→the intercept of ADL score was significant(β=0.196,95%CI:0.045-0.331).The indirect effect of slope of rapid eye movement sleep disorder→slope of autonomic dysfunction→slope of ADL was significant(β=0.272,95%CI:0.112-0.509),while the total effect of slope of rapid eye movement sleep disorder→slope o

关 键 词：帕金森病 自主神经功能障碍 日常生活能力 快速眼动睡眠行为障碍 潜变量增长曲线中介模型 

分 类 号：R742.5[医药卫生—神经病学与精神病学]