帕金森病初诊患者的非运动症状特点及其性别差异

The characteristics and gender differences of non-motor symptoms in early diagnosed Parkinson’s disease.

目的探讨初诊帕金森病(PD)患者非运动症状(NMS)的特点及其性别差异。方法选取首次就诊的PD患者203例(男性102例,女性101例)及正常对照者255例(男性110例,女性145例),收集入组对象的临床资料并采用简易智能评估量表(MMSE)、蒙特利尔认知评估量表(MoCA)、汉密尔顿抑郁量表(HAMD)、汉密尔顿焦虑量表(HAMA)、帕金森病睡眠量表(PDSS)、统一PD评分量表(UPDRS)第Ⅲ部分及Hoehn-Yahr(H-Y)分期对PD患者进行评估。应用NMS问卷筛查量表(NMSQ)评定其非运动症状,比较不同性别的NMS的特点。采用多因素线性回归分析PD患者NMDQ总分的影响因素。结果98.5%的PD患者均存在至少一项NMS,其中以记忆力下降(67.5%)、情绪低落(49.8%)最为常见。PD组NMS的总分及9个分域得分均显著高于对照组(均P<0.05)。PD组女性兴趣减退、情绪低落、焦虑及出汗增多的比率显著高于同组男性,而吞咽困难的比率显著降低(均P<0.05)。正常对照组(HC组)女性出汗增多的比率显著高于同组男性,记忆力下降的比率显著降低(均P<0.05)。PD男性及女性患者的NMS总分均受HAMD和PDSS影响(均P<0.05),而男性更易受病程影响(β=0.181,P=0.032)。结论PD初诊患者的非运动症状发生率明显高于正常人且具有性别差异。

Objective To explore the characteristics and gender differences of non-motor symptoms(NMS) in De Novo Parkinson’s diseases(PD). Methods 203 newly diagnosed PD patients(102 males, 101 females) and 255 healthy controls(110 males, 145 females) were selected. The clinical data were collected and evaluated by mini-mental State Examination(MMSE),Montreal Cognitive Assessment(MoCA),Hamilton Depression Scale(HAMD),Hamilton Anxiety Scale(HAMA),Parkinson’s disease Sleep Scale(PDSS),Unified PD Rating Scale Part Ⅲ(UPDRS-Ⅲ) and Hoehn Yahr(H-Y) stage. Non-motor questionnaire screening scale(NMSQ) was used to assess their non-motor symptoms, and compared the characteristics of NMS in different genders. Multivariate linear regression was used to analyze the influencing factors of NMDQ score in PD patients. Results 98.5% of PD patients had at least one NMS,among which forgetfulness(67.5%),depression(49.8%) were the most common. The total score and nine domains of NMS in PD group were significantly higher than those in healthy controls(all P<0.05). The rates of interest decline, depression, anxiety and excessive sweating in female in PD group were significantly higher than those in male, while the rate of dysphagia was significantly lower(all P<0.05). The rates of hallucination and sweating increase in female in healthy controls were significantly higher than those inmale, the rate of memory decline was significantly lower(all P<0.05). The total scores of NMS in male and female patients with PD were affected by HAMD and PDSS(all P<0.05),while male patients were more likely to be affected by the disease duration(β= 0.181,P=0.032). Conclusion The incidence of non motor symptoms in newly diagnosed PD patients is significantly higher than that in healthy controls and different in gender.