帕金森病伴发焦虑与运动症状及非运动症状关系的研究

Investigation on the relationship between anxiety and the motor symptoms or non-motor symptoms in patients with Parkinson's disease

目的探讨帕金森病(PD)患者伴发焦虑与运动症状及非运动症状(NMS)的关系。方法对124例PD患者应用汉密尔顿焦虑量表(HAMA)进行评测,分为焦虑组和非焦虑组,并完成相关运动症状及NMS量表评测。结果 (1)124例PD患者焦虑发生率为33.87%,焦虑和抑郁共病率为31.45%;(2)两组患者运动症状及运动并发症相关量表评测结果分别为:Hoehn-Yahr分期:2.48±0.80vs.2.04±0.78;UPDRS-Ⅲ(运动):30.68±9.91vs.24.70±12.25;"开-关"现象发生率:35.71%vs.17.07%,两组间具有统计学差异(P<0.05);两组患者异动症发生率及剂末现象的发生率分别为:14.29%vs.7.32%、45.24%vs.30.49%,两组间无统计学差异(P>0.05);(3)焦虑组患者出现NMS个数为(14.57±3.83)个,非焦虑组患者为(10.03±5.25)个,两组间均有统计学差异(P<0.05);(4)焦虑组抑郁、性生活障碍、不宁腿综合征、淡漠、白天思睡、入睡困难、眩晕、疼痛、噩梦以及体位性头晕等NMS发生率高于非焦虑组,两组均有统计学差异(P<0.05);(5)焦虑组和非焦虑组患者NMS相关量表评测结果分别为:UPDRS-Ⅰ(精神、行为和情绪):4.74±1.93vs.2.93±1.84;HAMD:19.41±6.97vs.9.82±5.83;PSQI:19.48±6.36vs.12.37±6.47;ESS:6.69±5.62vs.3.56±3.34;SCOPA-AUT:43.48±7.75vs.36.76±7.33;RLSRS:21.77±6.51vs.17.29±7.27,两组间具有统计学差异(P<0.05),两组患者的MMSE、MoCA及FS-14评分分别为:26.12±4.37vs.27.16±3.28、21.05±6.38vs.22.71±4.67及10.71±2.69vs.9.42±3.26,均无统计学差异(P>0.05);(6)焦虑组和非焦虑组患者UPDRS-Ⅱ(日常生活活动)以及PDQL评分结果分别为:15.29±5.85vs.12.22±5.39、128.62±20.51vs.149.30±20.13,具有统计学差异(P<0.05)。结论焦虑是PD常见的NMS之一,与运动障碍的程度以及运动并发症相关;PD伴发焦虑患者NMS的发生率高,个数多,精神、行为、情绪、睡眠、自主神经障碍突出,严重影响患者的日常生活活动能力,使生活质量明显下降。

Objective To explore the relationships between anxiety and the motor symptoms or non-motor symptoms（NMS）in patients with Parkinson＇s disease（PD）.Methods 124 PD patients were collected and divided into anxiety group and non-anxiety group according to the scores of Hamilton Anxiety Scale（HAMA）and a comparison study was conducted by using related motor symptoms and NMS scales.Results（1）33.87% of PD patients were accompanied by anxiety,31.45% of PD patients suffered from anxiety and depression synchronously.（2）Results of motor symptoms and movement complications in the two groups were as followed：Hoehn-Yahr Staging：2.48±0.80 vs.2.04±0.78,UPDRS-Ⅲ（motor）：30.68±9.91 vs.24.70±12.25,incidence of＂on-off＂phenomenon：35.71% vs.17.07%,and there were significant differences between the two groups（P0.05）;the incidences of dyskinesia and wearing-off were 14.29% vs.7.32% and 45.24% vs.30.49%,respectively,which were not statistically significant（P0.05）.（3）The number of NMS in anxiety group was 14.57±3.83,non-anxiety group was 10.03±5.25,and there was a significant difference between the two groups（P0.05）.（4）The incidences of depression,sexual dysfunction,restless legs syndrome,apathy,daytime somnolence,insomnia,dizziness,pain,nightmare and positional vertigo in anxiety group were higer than that in non-anxiety group,and there were significant differences between the two groups（P0.05）.（5）Results of NMS in anxiety group and non-anxiety group were as followed：UPDRS-Ⅰ（psychiatrics,cognition and emotion）：4.74±1.93 vs.2.93±1.84;HAMD：19.41±6.97 vs.9.82±5.83;PSQI：19.48±6.36 vs.12.37±6.47;ESS：6.69±5.62 vs.3.56±3.34;SCOPA-AUT：43.48±7.75 vs.36.76±7.33;RLSRS：21.77±6.51 vs.17.29±7.27,and there were significant differences between the two groups（P0.05）.The scores of MMSE,MoCA and FS-14 in two groups were：26.12±4.37 vs.27.16±3.28,21.05±6.38 vs.22.71±4.67 and 10.71±2.69 vs.9.42±3.26,respectively,and there were no significant differences（P0.05）.（6）The scores of UPDRS-Ⅱ（Activities of Daily Living）and PDQL in two groups were：15.29±5.85 vs.12.22±5.39,128.62±20.51 vs.149.30±20.13,respectively,and there were significant differences between the two groups（P0.05）.Conclusions Anxiety is one of the common NMS in PD associated with the severity of dyskinesia and movement complications.PD patients with anxiety have more NMS and show the high incidences of some NMS.Behavior,emotion,sleep and automatic function,which dramatically compromise the activities of daily living and quality of life of PD patients.