多系统萎缩冻结步态的临床特点及相关影响因素  

Clinical characteristics and related-influencing factors for freezing of gait in multiple system atrophy

作　　者：张含 王垚 李楠楠[2] 张新宁 贾承儒 陈志刚[2] ZHANG Han;WANG Yao;LI Nannan;ZHANG Xinning;JIA Chengru;CHEN Zhigang(Beijing University of Chinese Medicine,Beijing 100029,China;Dongfang Hospital of Beijing University of Chinese Medicine,Beijing 100078,China;Department of Engineering Physics,Tsinghua University,Beijing 100084,China;Xi’an Hospital of Traditional Chinese Medicine,Xi’an 710021,China)

机构地区：[1]北京中医药大学,北京100029 [2]北京中医药大学东方医院,北京100078 [3]清华大学工程物理系,北京100084 [4]西安市中医医院,陕西西安710021

出　　处：《中国实用神经疾病杂志》2025年第2期146-151,共6页Chinese Journal of Practical Nervous Diseases

基　　金：国家自然科学基金项目(编号:82174328);国家重点研发计划项目(编号:2018YFC1312000)。

摘　　要：目的探讨多系统萎缩(MSA)患者中冻结步态(FOG)的临床特点及影响因素。方法随机收集2019-07—2021-03在北京中医药大学东方医院脑病科就诊的56例MSA患者的临床资料。依据是否合并FOG将患者分为MSA+FOG组(20例)和MSA对照组(36例),采用单因素分析和多因素Logistic回归分析评价MSA伴FOG患者的临床特征。结果56例患者中,20例(35.71%)患有FOG。与不伴FOG的患者相比,伴有FOG患者的年龄(t=2.197,P=0.032)更大、H-Y分级(Z=-3.668,P<0.001)、UMSARS(t=3.769,P<0.001)评分较高,MoCA评分较低(t=-3.226,P=0.002)。在MoCA子项中,伴FOG患者的视空间执行力(Z=-3.140,P=0.002)较不伴FOG患者低。FOG患者MSA-P型的UMSARS评分高于MSA-C型(t=2.361,P=0.030)、MoCA评分低于MSA-C型(t=-3.551,P=0.002)。Logistic回归分析结果显示,较高的H-Y分级(OR=8.351,P=0.018)是MSA患者发生FOG独立影响因素。结论伴FOG的MSA患者在年龄、病情严重程度、认知功能方面较不伴FOG患者程度重,认知受损在视空间和执行力方面较为突出,MSA-P型比MSA-C型更容易出现FOG,且运动及认知受损更重。高H-Y分级是MSA患者伴发FOG的独立影响因素。Objective To investigate the clinical features and influencing factors for multiple system atrophy(MSA)with freezing of gait(FOG).Methods Clinical data of 56 MSA patients in the Neurology Department of Dongfang Hospital of Beijing University of Chinese Medicine from July 2019 to March 2021 were randomly collected.The patients were divided into MSA with FOG group(MSA+FOG group,20 cases)and MSA without FOG group(MSA control group,36 cases).Univariate analysis and multivariate Logistic regression analysis were used to analyze the clinical characteristics of MSA patients with FOG.Results A total of 20 of 56 patients(35.71%)had FOG.Compared to the patients without FOG,patients with FOG were older(t=2.197,P=0.032),and had higher H-Y grade(Z=-3.668,P<0.001),higher UMSARS scores(t=3.769,P<0.001),lower MoCA scores(t=-3.226,P=0.002).In the subitems of MoCA scale,compared to the patients without FOG,patients with FOG had lower scores of visual space and execution ability(Z=-3.140,P=0.002).In patients with FOG,the UMSARS scores of MSA-P type was higher than that of MSA-C type(t=2.361,P=0.030)and MoCA scores(t=-3.551,P=0.002)was lower than that of MSA-C type.Logistic regression analysis showed that higher H-Y grade was independent influencing factor for the occurrence of FOG in MSA patients(OR=8.351,P=0.018).Conclusion MSA patients with FOG exhibit more pronounced age-related symptoms,disease severity,and cognitive impairment compared to those without FOG,with cognitive deficits particularly pronounced in visuospatial and executive functions.MSA-P subtype is more prone to FOG and experiences more severe motor and cognitive impairments compared to MSA-C subtype.High H-Y grade is an independent influencing factor for FOG in MSA patients.

关 键 词：多系统萎缩 冻结步态 霍亚分级 临床特征 相关性分析 危险因素 

分 类 号：R744.8[医药卫生—神经病学与精神病学]