早期帕金森病患者非运动性症状与健康相关生活质量的研究:随机对照临床试验

Study on non-motor symptoms impacting on health related quality of life in early Parkinson disease:randomized controlled clinical trial

目的探讨早期帕金森病患者非运动性症状与健康相关生活质量的关系，以及健康相关生活质量的影响因素。方法391例原发性帕金森病患者，采用美国国立卫生研究院流行病学研究中心抑郁量表（CES—D）、匹兹堡睡眠质量指数（PSQI）、疲劳量表（FSS）、阿尔茨海默病评价量表一认知分量表（ADAS—Cog）和便秘量表（CSS）评价其抑郁、睡眠障碍、疲劳、认知障碍和便秘程度，简化36医疗结局研究量表（SF-36）评价其健康相关生活质量。结果391例患者中，抑郁、睡眠障碍、疲劳、记忆障碍和便秘者分别占37.34％（146／391）、54．73％（214／391）、40．15％（157／391）、34．78％（136／391）和46．55％（182／391）。抑郁症状者与无抑郁症状者（t=18．469，P=0．000）、睡眠障碍者与无睡眠障碍者（t=7．411，P=0．000）、疲劳者与无疲劳者（t=3．992，P=0．000）比较，SF-36总评分差异具有统计学意义；而记忆障碍者与无记忆障碍者（t=1．234，P=0．221）、便秘者与无便秘者（t=2．032，P=0．051）比较，SF-36总评分差异无统计学意义。将CES—D评分、PSQI评分和FSS评分引入回归方程，雕值由0．277增至0．649，提示SF-36总评分可被预测的部分由27．70％增至64．90％；CES．D评分不仅对SF-36总评分有预测价值，而且对8个维度评分均有预测价值（P〈0．05）。结论早期帕金森病患者普遍存在非运动性症状，其中抑郁、睡眠障碍、疲劳是导致健康相关生活质量恶化的主要原因。抑郁全面影响患者健康相关生活质量，是早期帕金森病患者健康相关生活质量恶化的最强预测因素。

Objective To investigate the impact of non-motor symptoms （NMS） on health related quality of life （HRQOL） in patients with early Parkinson disease （PD）. Methods Three hundred and ninetyone patients with PD, non-motor symptoms were evaluated by rating scales, including National Institute of Health （NIH） Center for Epidemiologic Studies Depression Scale （CES-D）, Pittsburgh Sleep Quality Index （PSQI）, Fatigue Severity Scale （FSS）, Alzheimer Disease Assessment Scale-Cognitive Subscale （ADAS-Cog） and Constipation Severity Scale （CSS）. HRQOL was evaluated by Medical Outcomes Study 36-Item ShortForm Health Survey （SF-36）. Multiple regression analysis was used to examine the relationship of these nonmotor symptoms and HRQOL, as measured by the SF-36. The total score of SF-36 was compared between the patients with and without these non-motor symptoms as well. Results A total of 146 patients （37.34%） were screened positively for depression, 214 （54.73%） for sleep disorder, 157 （40.15%）for fatigue, 136 （34.78%） for memory disorder and 182 （46.55%） for constipation. Patients with depression （t = 18.469, P= 0.000）, sleep disorder （t = 7.411, P= 0.000）, and fatigue（t = 3.992, P= 0.000） had significantly lower SF-36 total score than those without these features. No significant differences of total SF-36 score were seen among patients with and without memory disorder （t = 1.234, P= 0.221） and those with and without constipation （t = 2.032, P= 0.051）. Multiple regression analysis revealed that depression （measured by CES-D）, sleep disorder （measured by PSQI） and fatigue （measured by FSS） increased the ability to explain the variance of SF-36 total score from 27.70% to 64.90%. Additionally, the application of CES-D could predict not only the decreasing of SF-36 total score but also each sub-dimension score of SF-36. Conclusion Non-motor symptoms are common in early PD patients. Depression, sleep disorder and fatigue correlate strongly with the worsen of HRQOL. Depression has a substantial impact on HRQOL, which is the strongest predictive factor for the worsen of HRQOL. Our results highlight the broad importance of recognizing and treating these non-motor symptoms in PD patients in the early stage.