帕金森病不同表型冻结步态的运动功能与心理因素的差异性研究  

Differences in motor function and psychological factors across phenotypic patterns of freezing of gait in Parkinson’s disease

作　　者：常淞 崔啸 黄河清 CHANG Song;CUI Xiao;HUANG Heqing(Department of Medical Psychology,First Affiliated Hospital,Army Medical University(Third Military Medical University),Chongqing,China)

机构地区：[1]陆军军医大学(第三军医大学)第一附属医院医学心理科,重庆

出　　处：《陆军军医大学学报》2025年第9期1018-1028,共11页Journal of Army Medical University

基　　金：国家自然科学基金重点项目(62036003)。

摘　　要：目的 探究帕金森病(Parkinson’s disease,PD)伴冻结步态(freezing of gait,FOG)患者的运动功能与心理因素的特征性改变,并探索这些特征的表型异质性趋势。方法 本研究为横断面研究,纳入2023年3月至2024年3月在陆军军医大学第一附属医院神经内科就诊的患者,其中PD不伴FOG(Parkinson’s disease without freezing of gait,PD-NFOG)患者17例,PD伴FOG(Parkinson’s disease with freezing of gait,PD-FOG)患者25例,PD-FOG患者根据步态特征分为原地震颤型(trembling in place,TP)13例和小步伐拖足行进型(shuffling with small steps,SS)12例,同时通过社区招募纳入年龄、性别和受教育程度等人口学信息相匹配的正常对照(healthy control,HC)组28例。采用定量步态参数测定系统和量表,对受试者的运动功能进行评估,包括帕金森病统一得分量表中的运动评分量表(unified Parkinson’s disease rating scalemⅢ,UPDRSⅢ)、H&Y分级等;采用心理量表对受试者的情绪状态、认知功能及生活质量进行评估,包括医院焦虑量表(Hospital Anxiety and Depression ScaleAnxiety,HADS-A)、医院抑郁量表(Hospital Anxiety and Depression Scale-Depression,HADS-D)、广泛性焦虑障碍量表(Generalized Anxiety Disorder-7,GAD-7)、抑郁症筛查量表(Patient Health Questionnaire-9,PHQ-9)、快感缺失量表(Snaith-Hamilton Pleasure Scale,SHAPS)、眼神读心测验量表(Reading the Mind in the Eyes Test,RMET)、蒙特利尔认知评估量表(Montreal Cognitive Assessment,MoCA)、数字符号替换测试量表(Digital Symbol Substitution Test,DSST)等。结果 (1)PD-FOG和PD-NFOG组在运动功能参数(步宽、步幅、步高、步频等)和认知功能评分(MoCA得分)上存在显著差异(P<0.05);组间在RMET[η^(2)=0.716(95%CI:0.611~0.761),P<0.05]、DSST[η^(2)=0.667(95%CI:0.553~0.744),P<0.05]、MoCA[η^(2)=0.597(95%CI:0.425~0.750),P<0.05]3项认知功能评分上显示了最大的效应量,均为中等效应量;(2)PD-FOG组运动与心理的关联特征:H&Y分�Objective To investigate the characteristic changes in motor function and psychological factors among Parkinson's disease(PD) patients with different phenotypic patterns of freezing of gait(FOG),and to explore the trends in phenotypic heterogeneity of these features. Methods A cross-sectional study was conducted on 17 PD patients without FOG(PD-NFOG) and 25 PD patients with FOG(PD-FOG) [including 13 cases of trembling-in-place(TP) and 12 cases of shuffling-with-small-steps(SS)]. Another 28demographically matched(age, gender, education level and others) healthy individuals were recruited from community and served as healthy controls(HC). Motor function was assessed using quantitative gait analysis and clinical scales, including the unified Parkinson's disease rating scale part Ⅲ(UPDRS-Ⅲ) and H&Y staging. Psychological evaluations were carried out with Hospital Anxiety and Depression Scale(HADS-A/HADS-D), Generalized Anxiety Disorder-7(GAD-7), Patient Health Questionnaire-9(PHQ-9), SnaithHamilton Pleasure Scale(SHAPS), Reading the Mind in the Eyes Test(RMET), Montreal Cognitive Assessment(MoCA), and digital symbol substitution test(DSST). Results(1) There were significant differences between the PD-FOG and PD-NFOG groups in terms of motor parameters(stride width, length, height and cadence) and cognitive function(MoCA) score(P<0. 05). The largest effect sizes were found for cognitive function scores of RMET [η^(2)=0. 716(95%CI: 0. 611~0. 761), P<0. 05], DSST [η^(2)=0. 667(95%CI: 0. 553~0. 744), P<0. 05], and MoCA [η^(2)=0. 597(95%CI: 0. 425~0. 750), P<0. 05], all of which were classified as medium effect sizes.(2) Associative characteristics of motor and psychological factors in the PD-FOG group: H&Y stage was positively correlated with HADS-A [r=0. 470(95%CI: 0. 080~0. 735), P=0. 018] and HADS-D [r=0. 560(95%CI: 0. 199~0. 787), P=0. 004], while the total score of UPDRS-Ⅲ was negatively correlated with DSST [r=-0. 574(95%CI:-0. 794~-0. 219), P=0. 003].(3)Subgroup analysis revealed significant differences(P

关 键 词：冻结步态 帕金森病 心理因素 认知功能 运动功能 

分 类 号：R395.2[哲学宗教—心理学] R443.1[医药卫生—医学心理学] R742.5[医药卫生—基础医学]