帕金森病抑郁的临床特征、影响因素及治疗

Clinical feature,influence factor and treatment of Parkinson disease with depression

目的探讨帕金森病(PD)合并抑郁患者的临床特征、影响因素及治疗,为临床治疗PD提供进一步依据。方法统计81例PD患者帕金森病抑郁(PDD)发病率,比较PDD组与PD非抑郁(PDND)组年龄、病程、统一PD评定量表(UPDRS)评分、性别、Hoehn-Yahr分期、临床分型的差异及汉密尔顿抑郁量表(HAMD)因子分差异。比较采用抗PD药物合并抗抑郁药与单纯使用抗PD药物治疗PDD 30天后UPDRS及HAMD评分的变化。结果81例PD患者中52例并发抑郁,其中轻度抑郁31例(59.6%),中重度抑郁21例(40.4%)。震颤为主型抑郁发生率44.4%,强直为主型抑郁发生率为69.8%。UPDRS分值越高、Hoehn-Yahr分期越高、女性、强直为主型更容易合并抑郁。PDD主要表现在焦虑/躯体化、认识障碍、阻滞、睡眠障碍及绝望感方面。抗PD药物合并抗抑郁药治疗能显著降低患者的UPDRS及HAMD评分。结论PD合并抑郁比较常见,以轻度抑郁为主,UPDRS分值越高、Hoehn-Yahr分期越高、女性、强直为主型更容易合并抑郁。治疗上使用抗PD药物联用抗抑郁药优于单纯抗PD药物。

Objective To investigate the clinical characteristics and influencing factors of Parkinson disease（PD） with depression（PDD） ,and to provide a better treatment for the disease. Methods Depressive states of 81 PD patients were evaluated with Zung Self-rating depressive scale（SDS） and Hamilton depression scale（HAMD）. Meanwhile the seven factors scores of HAMD were recorded. Unified PD rating scale （UPDRS） and Hoehn-Yahr stages were used to evaluate the symptom severity of PD and the clinical type were decided：tremor type and rigidity type. According to SDS and HAMD,all patients were divided into two groups：PDD group and nondepressed PD（PDND） group. The differences of gender, age, course, UPDRS scores, Hoehn-Yahr stages and clinical type were compared between two groups. UPDRS and HAMD scores of PDD were recorded after 30 days in the patients who were administrated anti-Pakinson drugs accompanied with antidepressants or anti-Pakinson drugs alone. Results Fifty-two （64.2%） patients of 81 patients were PDD patients. Among these 52 patients, 31 （59.6%） patients were light depression, 21 （40.4%） patients were moderate and severe depression. The rate of depression in tremor type was 44.4 % and that of rigidity type was 69.8 %. UPDRS scores of PDD group were higher than those of PDND group. Anxiety/somatization, cognitive disturbance, blockage,sleep disorder and feeling of desire were the main characters of PDD. The patients who had higher UPDRS scores,higher Hoehn-Yahr stages were female,rigidity type had higher risk of attaek of depression,and the difference was significant. UPDRS score and HAMD score of PDD patients who were given anti-Pakinson drugs accompanied with antidepressants decreased greatly than the patients who were given anti-Pakinson drugs only. Conclusion Depression is a very common psychological obstacle in PD patients, and majority is light depression. Female, rigidity type, severe PD patients have a higher risk of attack of depression. Anti-Parkinson drugs accompanied with antidepressants used to treat PDD decrease UPDRS and HAMD scores significantly and improve the clinieal symptom compared to anti-Parkinson drugs only.