脑型HLD冲动控制障碍临床特点及影响因素研究  

A Study of the Clinical Characteristics and Influencing Factors of Impulse Control Disorders in Cerebral Hepatolenticular Degeneration

作　　者：孙正涛 方向[2] 金珊[2] 龚成亮 SUN Zhengtao;FANG Xiang;JIN Shan(Anhui University of Traditional Chinese Medicine,Anhui 230000,China)

机构地区：[1]安徽中医药大学,合肥230000 [2]安徽中医药大学第一附属医院脑病中心,合肥230000

出　　处：《医学研究杂志》2024年第10期105-109,共5页Journal of Medical Research

基　　金：安徽省自然科学基金资助项目(面上项目)(2008085MH264,2208085MH271);安徽中医药大学科研基金资助项目(2021yfylc10)。

摘　　要：目的 探讨脑型肝豆状核变性hepatolenticular degeneration, HLD)患者冲动控制障碍(impulse control disorders, ICD)临床特点及相关影响因素。方法 随机收集2023年4~10月于安徽中医药大学第一附属医院脑病中心住院治疗的89例脑型HLD患者,根据明尼苏达冲动障碍访谈量表将其分为ICD组与对照组,评估患者神经功能(unified Wilson′s disease rating scale, UWDRS-Ⅰ)、肝脏功能(UWDRS-Ⅱ)、认知(minimum mental state examination, MMSE)、睡眠(Pittsburgh sleep quality index, PSQI)、焦虑(hamilton anxiety scale, HAMA)、抑郁(Hamilton depression scale, HAMD)、服用药物依从性(eight-item moriskymedication adherence scale, MMAS-8);单因素和多因素前进法Logistic回归分析筛查患者ICD相关影响因素。结果 44例患者存在ICD,其中表现为刻板行为、强迫性购物比例较高。ICD组UWDRS-Ⅰ、UWDRS-Ⅱ、PSQI、HAMD、HAMA评分均高于对照组(P<0.05)。ICD组MMSE评分低于对照组(P<0.05)。ICD组较对照组发病年龄小、病程长(P<0.05),两组在受教育程度、吸烟史方面比较,差异有统计学意义(P<0.05)。Logistic回归分析显示,受教育程度高是脑型HLD患者发生ICD的保护因素(P<0.05),UWDRS-Ⅰ评分高是脑型HLD患者发生ICD的独立危险因素(P<0.05)。结论 脑型HLD患者ICD表现为刻板行为、强迫性购物占比较高,ICD患者中存在焦虑、抑郁、认知障碍和睡眠障碍的比例明显偏高,受教育程度低、神经症状严重的脑型HLD患者更容易发生ICD。Objective To explore the clinical characteristics of impulse control disorders(ICD)and related influencing factors in patients with cerebral hepatolenticular degeneration(HLD).Methods Eighty-nine patients with cerebral HLD who were hospitalized in the Brain Disease Center of the First Affiliated Hospital of Anhui University of Traditional Chinese Medicine(AUTCM)from April 2023 to October 2023 were randomly collected and divided into the ICD group and the control group based on the Minnesota Impulsivity Disorder Interview(MIDI)scale,which assessed the patients′neurological function(UWDRS-Ⅰ),hepatic function(UWDRS-Ⅱ),cognition(MMSE),sleep(PSQI),anxiety(HAMA-14),depression(HAMD-17),and adherence to medications taken(MMAS-8);and univariate and multivariate forward stepwise Logistic regression models were used to screen the influencing factors related to ICD in patients with cerebral HLD.Results ICD were present in 44 patients,of which a higher proportion showed stereotyped behaviors and compulsive shopping.UWDRS-Ⅰ,UWDRS-Ⅱ,PSQI,HAMD and HAMA scores were higher in the ICD group than in the control group(P<0.05).MMSE scores were lower in the ICD group than in the control group(P<0.05).The ICD group had a younger age of onset and a longer disease duration than the control group(P<0.05).The two groups were significantly different in terms of education level and smoking history(P<0.05).Logistic regression analysis showed that a high level of education was a protective factor for the occurrence of ICD in patients with cerebral HLD(P<0.05),and a high UWDRS-Ⅰscore was an independent risk factor for the occurrence of ICD(P<0.05).Conclusion ICD in patients with cerebral HLD manifested as stereotypical behaviors and a higher percentage of compulsive shopping,the proportion of anxiety,depression,cognitive disorders,and sleep disorders was significantly higher among patients with ICD.Patients with cerebral HLD with a low level of education and severe neurological symptoms were more likely to develop ICD.

关 键 词：肝豆状核变性 冲动控制障碍 发生机制 危险因素 LOGISTIC模型 

分 类 号：R742[医药卫生—神经病学与精神病学]