多系统萎缩患者临床异质性分型的聚类分析研究  

Clinical heterogeneity and cluster analysis of multiple system atrophy

作　　者：王雪梅[1] 刘疏影[2] 韩超 许二赫[2] 毛薇[2] 陈彪[2,3,4,5] Wang Xuemei;Liu Shuying;Han Chao;Xu Erhe;Mao Wei;Chen Biao(Department of Neurology,Beijing Luhe Hospital of Capital Medical University,Beijing 101149,China;Department of Neurology,Xuanwu Hospital of Capital Medical University,Beijing 100053,China;National Clinical Research Center for Geriatric Disorders,Beijing 100053,China;Department of Geriatrics,Xuanwu Hospital,Capital Medical University,Beijing 100053,China;Advanced Innovation Center for Human Brain Protection,Capital Medical University,Beijing 100069,China)

机构地区：[1]首都医科大学附属北京潞河医院神经内科,北京101149 [2]首都医科大学宣武医院神经内科,北京100053 [3]国家老年疾病临床医学研究中心,北京100053 [4]首都医科大学宣武医院老年科,北京100053 [5]首都医科大学人脑保护高精尖创新中心,北京100069

出　　处：《中华老年医学杂志》2024年第3期304-310,共7页Chinese Journal of Geriatrics

基　　金：国家重点研发计划资助项目(2018YFC1312001、2017YFC0840105、2017ZX09304018)。

摘　　要：目的以聚类分析技术探讨能够反映患者预后的多系统萎缩(MSA)患者临床亚型,并比较各亚型患者日常生活活动能力是否存在不同。方法回顾性分析94例首都医科大学宣武医院临床确诊MSA患者的人口学资料、临床症状体征、量表评分及辅助检查结果,进行层次聚类并分析聚类所获各亚型临床特征;分析传统运动分型各亚型患者间日常生活活动能力差异,分析新分类各亚型患者间日常生活活动能力差异。结果本研究最终入组MSA患者94例,平均年龄61岁,女性占51.1%(48例)。利用收集的连续型资料进行全联动层次聚类分析,提示MSA患者可分为4种临床亚型:步态障碍型(17例,18.1%),恶性强直少动伴早发型(25例,26.6%),中间型(43例,45.7%),自主神经良性型(9例,9.6%)。各型在临床多项运动及非运动症状如帕金森病综合评价量表(UPDRS-Ⅲ)(χ^(2)=27.90,P<0.001)、步态障碍情况(χ^(2)=33.23,P<0.001)、蒙特利尔认知评估(MoCA)(χ^(2)=10.98,P=0.012)、汉密尔顿焦虑量表(HAMA)(χ^(2)=12.14,P=0.007)、汉密尔顿抑郁量表(HAMD)(χ^(2)=13.62,P=0.003)、嗅觉评分(χ^(2)=10.16,P=0.017)、体位性低血压(χ^(2)=14.59,P=0.028)中均差异有统计学意义,且日常生活能力评分差异有统计学意义(χ^(2)=25.35,P<0.001)。而传统运动分型的小脑型和帕金森型间未见非运动症状及日常生活能力差异有统计学意义(P>0.05)。结论经层次聚类分析获得的MSA临床表型,较传统的运动表型更能反映患者临床特征及对患者生活质量的影响,可能预示疾病潜在病理受损差异和进展速度,为MSA患者精准诊疗干预提供依据。Objective To examine the clinical subtypes of patients with multisystem atrophy(MSA)that may indicate the prognosis of patients.Additionally,we aim to compare the ability to perform daily activities among patients of each subtype using cluster analysis.Methods The retrospective analysis included demographic data,clinical symptoms and signs,scale scores,and ancillary examinations of 94 patients diagnosed with multisystem atrophy at Xuanwu Hospital of Capital Medical University.The study aimed to analyze the clinical characteristics of each subtype obtained through clustering.Additionally,a comparison was made between patients with traditional motor subtypes and those with new subtypes in terms of activities of daily living.The study consisted of 94 MSA patients,with an average age of 61 years and a female representation of 51.1%.Using the data collected on the continuum,a full linkage hierarchical cluster analysis was performed to classify MSA patients into four clinical subtypes:gait disorder(17 cases,18.1%),malignant tonic hyperkinetic with premature haircut(25 cases,26.6%),intermediate(43 cases,45.7%),and autonomic benign type(9 cases,9.6%).Each subtype exhibited various clinical motor and non-motor symptoms,including UPDRS-Ⅲ(χ^(2)=27.90,P<0.001),gait disturbance(χ^(2)=33.23,P<0.001),MoCA(χ^(2)=10.98,P=0.012),HAMA(χ^(2)=12.14,P=0.007),HAMD(χ^(2)=13.62,P=0.003),smell score(χ^(2)=10.16,P=0.017),postural hypotension(χ^(2)=14.59,P=0.028),and a statistically significant difference in the ability to perform daily living score(χ^(2)=25.35,P<0.001).No statistically significant differences in non-motor symptoms and activities of daily living abilities were observed between the cerebellar and Parkinsonian types of traditional motor typing(P>0.05).Conclusions The hierarchical clustering analysis conducted in this study reveals that the clinical phenotype of MSA provides a more accurate reflection of patients'clinical characteristics and their impact on quality of life compared to the traditional motor phenotype.

关 键 词：多系统萎缩 运动症状 非运动症状 临床分型 日常生活能力 

分 类 号：R741[医药卫生—神经病学与精神病学]