肌强直对帕金森病患者运动迟缓评分的影响  

Effect of Myotonia on Bradykinesia Scores of Patients with Parkinson′s Disease

作　　者：吴璠 于洋[1] 梁思泉[2] 朱志中[1] 侯玮佳[1] 巫嘉陵[3] WU Fan;YU Yang;LIANG Siquan;ZHU Zhizhong;HOU Weijia;WU Jialing(Department of Rehabilitation Medicine,Tianjin Huanhu Hospital,Tianjin 300350,China;Department of Functional Neurosurgery,Tianjin Huanhu Hospital,Tianjin 300350,China;Department of Neurological Rehabilitation,Tianjin Huanhu Hospital,Tianjin 300350,China)

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

出　　处：《医学综述》2024年第23期2941-2944,F0003,共5页Medical Recapitulate

摘　　要：目的探讨肌强直对帕金森病患者运动迟缓评分的影响。方法选取2021年5月至2023年6月就诊于天津市环湖医院帕金森及功能障碍评估门诊的帕金森病患者100例,根据世界运动障碍学会统一帕金森病综合评定量表第三部分(MDS UPDRS-Ⅲ)3.3单项评分将患者分为伴肌强直组(MDS UPDRS-Ⅲ3.3≥2分,64例)和不伴肌强直组(MDS UPDRS-Ⅲ3.3<2分,36例)。采用改良运动迟缓评分量表对两组运动迟缓中手指拍打、前臂回旋运动和脚趾拍地运动的幅度、速度、节律进行评分,比较两组患者左旋多巴负荷试验前后运动迟缓评分的变化情况。结果帕金森病患者肌强直评分与运动迟缓评分呈正相关(服药前:r=0.441,P<0.001;服药后:r=0.554,P<0.001;药物改善率:r=0.638,P<0.001)。伴强直组患者在手指拍打、前臂回旋运动和脚趾拍地运动中幅度改善率低于不伴强直组[33.3(0,50.0)%比50.0(50.0,50.0)%、0(0,50.0)%比50.0(50.0,1.0)%、25.0(0,50.0)%比50.0(50.0,66.7)%](P<0.01),速度改善率高于不伴强直组[50.0(50.0,1.0)%比0(0,50.0)%、66.7(50.0,1.0)%比0(0,1.0)%、50.0(33.3,1.0)%比0(0,0)%](P<0.01),伴强直组患者在前臂回旋运动中节律改善率低于不伴强直组[0(0,0)%比0(0,1.0)%](P<0.05),但两组患者在手指拍打、前臂回旋运动和脚趾拍地运动中总改善率比较差异无统计学意义(P>0.05)。结论伴肌强直的帕金森病患者服用左旋多巴类药物后运动迟缓的速度改善更明显,不伴肌强直组运动幅度和节律改善更明显。明确肌强直与运动迟缓的关系,有利于精准评估帕金森病患者的运动迟缓,制订更有针对性的治疗方案。Objective To explore the effect of myotonia on bradykinesia scores of patients with Parkinson′s disease.Methods A total of 100 patients with Parkinson′s disease who were admitted to the Parkinson and Dysfunction Assessment Clinic of Tianjin Huanhu Hospital from May 2021 to Jun.2023 were included.According to Movement Disorder Society unified Parkinson′s disease rating scale,partⅢ(MDS UPDRS-Ⅲ)3.3 single item score,the patients were divided into a myotonia group(MDS UPDRS-Ⅲ3.3≥2,n=64)and a without myotonia group(MDS UPDRS-Ⅲ3.3<2,n=36).The modified bradykinesia rating scale(MBRS)was used to score the amplitude,speed and rhythm of finger tapping,forearm rotation and toe tapping of the two groups.The changes of bradykinesia scores before and after levodopa stress test were compared between the two groups.Results Myotonic scores were positively correlated with bradykinesia scores in Parkinson′s disease(before treatment:r=0.441,P<0.001;after treatment:r=0.554,P<0.001;drug improvement rate:r=0.638,P<0.001).The improvement rate of amplitude in finger tapping,forearm rotation,and toe tapping movements in patients with myotonia were lower than those in the group without myotonia[33.3(0,50.0)%vs 50.0(50.0,50.0)%,0(0,50.0)%vs 50.0(50.0,1.0)%,25.0(0,50.0)%vs 50.0(50.0,66.7)%](P<0.01),and the improvement rate of velocity were higher than those in the group without myotonia[50.0(50.0,1.0)%vs 0(0,50.0)%,66.7(50.0,1.0)%vs 0(0,1.0)%,50.0(33.3,1.0)%vs 0(0,0)%](P<0.01).The rate of rhythm improvement in the forearm rotation movement was lower in the group with myotonia than in the group without myotonia[0(0,0)%vs 0(0,1.0)%](P<0.05),but there was no statistically significant difference in the overall improvement rate between the two groups in finger tapping,forearm rotation movement,and toe tapping movement(P>0.05).Conclusion Parkinson′s disease patients with myotonia have a more significant improvement in bradykinesia speed after taking levodopa,and those without myotonia have a more significant improvement in moto

关 键 词：帕金森病 运动迟缓 肌强直 

分 类 号：R74[医药卫生—神经病学与精神病学]