不同运动亚型帕金森病自主神经功能障碍及其与生活质量的关系临床研究  

A clinical study of autonomic dysfunction in different motor subtypes of Parkinson disease and its association with quality of life

作　　者：柳竹[1,2,3] 王雪梅 王展[1,2,3] 杨雅琴 朴英善[1,2,3] 冯涛 LIU Zhu;WANG Xuemei;WANG Zhan(Center for Neurodegenerative Disease,Department of Neurology,China National Clinical Research Center for Neurological Diseases,Beijing Institute of Brain Disorders,Beijing Tiantan Hospital,Capital Medical University,Beijing 100070,China)

机构地区：[1]首都医科大学附属北京天坛医院神经病学中心运动障碍性疾病科,北京100070 [2]国家神经系统疾病临床医学研究中心,北京100070 [3]北京脑重大疾病研究院帕金森病研究所,北京100070

出　　处：《中风与神经疾病杂志》2024年第11期963-968,F0002,共7页Journal of Apoplexy and Nervous Diseases

基　　金：国家自然科学基金青年科学基金项目(81901833);北京市科学技术委员会首都临床特色应用研究青年项目(Z181100001718059)。

摘　　要：目的本研究旨在探索帕金森病(PD)不同运动亚型的患者在自主神经功能症状的特征,以及不同运动亚型帕金森病患者自主神经功能损害对生活质量的影响。方法对所有入组患者记录基本信息,运动症状和非运动症状评分。根据运动功能评分中的震颤(TD)和姿势步态异常(PIGD)评分进行亚型分类。比较TD型和PIGD型患者的运动症状、非运动症状,尤其是自主神经症状,并分析不同运动分型自主神经功能症状与生活质量之间的关系,相关性分析采用Pearson或Spearman相关分析法。结果共入组TD组105例(57.7%),PIGD组63例(34.6%),一般情况和运动症状无明显差异。分别比较TD组与PIGD组间焦虑、抑郁、淡漠、认知、便秘、服药前后立卧位收缩压血压差值和直立性低血压发生率两组间无明显差异。自主神经功能总分PIGD组(中位数24)明显高于TD组(中位数19)。生活质量评分PIGD组中位数66分,TD组中位数46分,PIGD组明显较TD组生活质量差。PIGD组与TD组帕金森病患者生活质量与自主神经功能症状呈正相关(PIGD组R^(2)=0.209,P≤0.001;TD组R^(2)=0.166,P≤0.001)。TD组生活质量与便秘相关(r=0.313,P=0.002)且与美多芭服药前立卧位血压收缩压最大差值相关(r=0.252,P=0.009)。结论PIGD型较TD型PD患者自主神经功能症状严重、生活质量差。两种运动亚型的PD患者均存在自主神经功能损伤越严重,生活质量越差。TD型患者生活质量还与便秘和美多芭服药前立卧位血压收缩压最大差值相关。Objective To investigate the features of autonomic nervous function symptoms in patients with different motor subtypes of Parkinson disease(PD)and the impact of autonomic dysfunction on quality of life in patients with different motor subtypes of PD.Methods Basic information was recorded for all patients enrolled in this study,including the scores of both motor and non-motor symptoms.The patients were divided into different subtypes based on tremordominant(TD)and postural instability and gait difficulty(PIGD)scores.Motor and non-motor symptoms,especially autonomic symptoms,were compared between the patients with TD subtype and those with PIGD subtype,and the association between autonomic dysfunction and quality of life was analyzed for patients with different motor subtypes.Results There were 105 patients(57.7%)in the TD group and 63(34.6%)in the PIGD group.There were no significant differences between the TD group and the PIGD group in age,sex,lifestyle,course of disease,levodopa equivalent dose,and disease severity,and there were also no significant differences between the two groups in the scores of anxiety,depression,apathy,cognition,and constipation,the reduction in systolic blood pressure(SBP)in standing and supine positions,and the incidence rate of orthostatic hypotension before and after medication.The PIGD group had a significantly higher total score of autonomic nervous function than the TD group,with a median of 24 and 19,respectively.The median of quality of life score was 66 points in the PIGD group and 46 points in the TD group,suggesting that the PIGD group had a poorer quality of life than the TD group.Quality of life was positively correlated with autonomic nervous function symptoms in the PD patients in both the PIGD group(R2=0.209,P=0.000)and the TD group(R2=0.166,P=0.000).In the TD group,quality of life was correlated with constipation(r=0.313,P=0.002)and the maximum difference in SBP in standing and supine positions before Madopar administration(r=0.252,P=0.009).Conclusion PD patients with P

关 键 词：帕金森病 运动亚型 非运动症状 自主神经功能障碍 生活质量 

分 类 号：R742.5[医药卫生—神经病学与精神病学]