特发性正常颅压脑积水患者与帕金森病患者步态障碍对比研究  

A comparative study of gait disturbance in patients with idiopathic normal pressure hydrocephalus versus patients with Parkinson's disease

作　　者：朱志中[1] 侯玮佳[1] 虞舒然 程元元 梁思泉[2] 于洋[1] 巫嘉陵[3] Zhu Zhizhong;Hou Weijia;Yu Shuran;Cheng Yuanyuan;Liang Siquan;Yu Yang;Wu Jialing(Department of Rehabilitation Medicine,Tianjin Huanhu Hospital,Tianjin 300350;Department of Neurosurgery,Tianjin Huanhu Hospital,Tianjin 300350;Department of Neurorehabilitation Medicine,Tianjin Huanhu Hospital,Tianjin 300350)

机构地区：[1]天津市环湖医院康复医学科,天津300350 [2]天津市环湖医院神经外科,天津300350 [3]天津市环湖医院神经康复科,天津300350

出　　处：《中华老年医学杂志》2024年第7期846-850,共5页Chinese Journal of Geriatrics

基　　金：天津市医学重点学科(专科)建设项目资助(TJYXZDXK-052B);天津市卫生健康科研项目资助(TJWJ2022MS033)。

摘　　要：目的对比特发性正常压力脑积水(iNPH)患者与帕金森病(PD)患者步态障碍的特征。方法纳入2020年1月至2020年12月于天津市环湖医院就诊的iNPH患者16例、PD患者20例,健康成年人23例,对一般临床资料和步态评估结果进行回顾性分析。采用美国Mobility LabTM APDM Opal型可穿戴式步态测试系统进行步态分析。结果iNPH组患者年龄(68.81±8.73)岁,PD组患者年龄(65.05±10.15)岁,正常对照组年龄(59.96±6.20)岁。iNPH组与PD组年龄差异无统计学意义(P>0.05),但较健康对照组年龄更大(t=3.71,P<0.05)。iNPH组病程为(22.94±23.19)个月,较PD组(92.60±53.70)个月更短(t=5.23,P<0.05)。iNPH组简易精神状态评价量表(MMSE)得分(17.13±7.08)分、蒙特利尔认知评估量表(MoCA)得分(11.75±5.43)分,评分低于PD组[(24.17±4.73)分,t=3.45,P<0.05、(21.29±5.82)分,t=4.86,P<0.05]和对照组[(26.70±1.61)分,t=5.31,P<0.05、(22.78±3.30)分,t=7.89,P<0.05]。iNPH组足廓清[右(1.65±0.76)cm]和双侧足离地角[左(20.59±6.11)°、右(20.78±6.88)°]较PD组足廓清[右(2.56±1.30)cm],双侧足离地角[左(28.43±6.36)°、右(28.12±7.49)°]减小(t=3.74、3.02,均P<0.05)。与对照组比较,iNPH患者的所有步态参数均差异有统计学意义(均P<0.05)。结论iNPH患者的步态障碍明显,与PD患者比较,呈现出更明显的步态障碍。可穿戴式步态分析系统可以准确评估iNPH患者的步态障碍,可以应用于该疾病的步态评估及康复方案制定。Objective To compare the characteristics of gait disorders between patients with idiopathic normal pressure hydrocephalus(iNPH)and Parkinson's disease(PD)patients.Methods General clinical data and gait assessment results of 16 iNPH patients,20 PD patients,and 23 healthy adults seeking treatment at Tianjin Huanhu Hospital between January 2020 and December 2020 were retrospectively analyzed.Gait analysis was conducted using the Mobility Lab^(TM)system with APDM Opal sensors from the US.Results The 16 patients in the iNPH group had a mean age of(68.81±8.73),the 20 patients in the PD group had a mean age of(65.05±10.15),and the 23 adults in the control group had a mean age of(59.96±6.20).There was no significant difference in age between the iNPH group and the PD group(P>0.05).However,the iNPH group was older than the healthy control group(t=3.71,P<0.05).The disease duration of the iNPH group was(22.94±23.19)months,which was shorter than(92.60±53.70)months in the PD group(t=5.23,P<0.05).The mini-mental state examination(MMSE)score(17.13±7.08)and the Montreal Cognitive Assessment(MoCA)score(11.75±5.43)of the iNPH group were significantly lower than those in the PD group[(24.17±4.73),t=3.45,P<0.05、(21.29±5.82),t=4.86,P<0.05]and the control group[(26.70±1.61),t=5.31,P<0.05、(22.78±3.30),t=7.89,P<0.05].Compared with the PD group,the iNPH group had a significantly lower foot clearance[right:(1.65±0.76)cm vs.(2.56±1.30)cm]and smaller bilateral toe-off angles[left:(20.59±6.11)°vs.(28.43±6.36)°;right:(20.78±6.88)°vs.(28.12±7.49)°,t=3.74、3.02,respectively,all P<0.05].There were statistically significant differences in all gait parameters in iNPH patients compared with the control group(P<0.05).Conclusions iNPH patients exhibit clear gait disturbance,which is more prominent than in PD patients.The wearable gait analysis system can accurately assess gait disorders in iNPH patients,and can be applied to gait assessment and the development of rehabilitation plans.

关 键 词：脑积水 正常压力 帕金森病 步态分析 

分 类 号：R742.5[医药卫生—神经病学与精神病学]