伴RBD帕金森病患者认知障碍高危因素及预测模型  

Risk factors and prediction model of cognitive impairment in Parkinson's disease patients with RBD

作　　者：朱梦琪 王宁[1] Zhu Mengqi;Wang Ning(Department of Neurology,the Third People's Hospital of Fuyang City,Anhui 236000,China)

机构地区：[1]阜阳市第三人民医院神经内科,安徽236000

出　　处：《脑与神经疾病杂志》2025年第1期24-28,共5页Journal of Brain and Nervous Diseases

基　　金：2022年度安徽省科技创新指导项目(2022Y-B0102)。

摘　　要：目的探究伴快速眼动期睡眠行为障碍(RBD)的帕金森病(PD)患者认知障碍高危因素,并据此构建预测模型。方法选取2020年6月至2023年11月阜阳市第三人民医院神经内科收治的236例伴RBD的PD患者为研究对象,依据是否并发认知功能障碍将其分为认知障碍组与非认知障碍组。采用一般资料调查问卷、蒙特利尔认知评估量表(MoCA)、汉密尔顿焦虑量表(HAMA)、汉密尔顿抑郁量表17项(HAMD-17)、国际PD和运动障碍协会统一PD评定量表第2部分、第3部分(MDS-UPDRS Ⅱ、MDS-UPDRS Ⅲ)、Hoehn Yahr(H-Y)分级及实验室检查指标进行评定。采用单因素及Logistic多因素回归分析影响伴RBD的PD患者认知障碍的因素,并构建预测模型评价其预测效能。结果236例伴RBD的PD患者MoCA评分为(20.49±4.06)分,其中<26分者175例(74.15%),≥26分者61例(25.85%);单因素分析显示,年龄、受教育程度、农药接触史、病程、H-Y分级、MDS-UPDRS Ⅱ评分、MDS-UPDRSⅢ评分、HAMD-17评分、游离甲状腺素(FT4)、超敏C反应蛋白(hs-CRP)均可能为伴RBD的PD患者认知障碍的影响因素(^(均)P<0.05);Logistic回归分析显示,农药接触史、MDS-UPDRS Ⅱ评分、MDSUPDRS Ⅲ评分、HAMD-17评分、FT4、hs-CRP均是其风险因素(P<0.05);受试者特征曲线(ROC)曲线分析可知,Logistic回归模型预测伴RBD的PD患者认知障碍的曲线下面积(AUC)为0.966,95%CI为0.945~0.987,P<0.001,敏感度90.86%,特异度为93.44%。结论农药接触史、MDS-UPDRSⅡ评分、MDS-UPDRSⅢ评分、HAMD-17评分、FT4、hs-CRP均是影响伴RBD的PD患者认知障碍的影响因素,且据此构建的预测模型具有良好预测价值,可为临床制定防治方案提供依据。Objective To explore the risk factors of cognitive impairment in Parkinson's disease(PD)patients with rapid eye movement sleep behavior disorder(RBD),and to construct a predictive model.Methods A total of 236 patients with RBD PD admitted to the Department of Neurology,the Third People's Hospital of Fuyang City from June 2020 to November 2023 were selected as the research objects.According to whether they were complicated with cognitive dysfunction,they were divided into cognitive impairment group and non-cognitive impairment group.The general information questionnaire,Montreal Cognitive Assessment(MoCA),Hamilton Anxiety Scale(HAMA),Hamilton Depression Scale 17(HAMD-17),Movement disorder society's unified PD rating scale Ⅱ,Ⅲ(MDS-UPDRS Ⅱ,MDS-UPDRS Ⅲ),Hoehn Yahr(H-Y)classification and laboratory examination indicators were used for evaluation.Univariate and Logistic multivariate regression analysis were used to analyze the factors affecting cognitive impairment in patients with PD with RBD,and a prediction model was constructed to evaluate its predictive efficacy.Results The MoCA score of 236 patients with PD with RBD was(20.49±4.06)points,including 175 cases(74.15%)with<26 points and 61 cases(25.85%)with≥26 points.Univariate analysis showed that age,education level,agricultural work,course of disease,H-Y grade,MDS-UPDRS Ⅱscore,MDS-UPDRS Ⅲ score,HAMD-17 score,free thyroxine(FT4),high-sensitive c-reactive protein(hs-CRP)may be the influencing factors of cognitive impairment in patients with PD with RBD(^(all)P<0.05).Logistic regression analysis showed that agricultural work,MDS-UPDRS Ⅱ score,MDSUPDRS Ⅲ score,HAMD-17 score,FT4 and hs-CRP were the risk factors(P<0.05).ROC curve analysis showed that the area under the curve(AUC)of Logistic regression model for predicting cognitive impairment in patients with PD with RBD was 0.966,95%CI was 0.945-0.987,P<0.001,sensitivity was 90.86%,specificity was 93.44%.Conclusion Engaged in agricultural work,MDS-UPDRS Ⅱ score,MDS-UPDRS Ⅲ score,HAMD-17 score,FT4

关 键 词：快速眼动期睡眠行为障碍 帕金森 认知障碍 高危因素 预测模型 

分 类 号：R742.5[医药卫生—神经病学与精神病学]