帕金森病患者运动并发症的临床调查

Motor Complications in Parkinson's Disease:A Clinical Investigation

目的:探讨帕金森病(PD)患者运动并发症的临床特点及其影响因素。方法:详细记录作者单位6家医院107例帕金森病患者的病史资料,应用帕金森病评分量表(UPDRS)和Hoehn-Yahr(H-Y)进行评估,并进行统计分析、结果:①在107例PD患者中异动症的发生率为13.08%,症状波动为18.69%,两者在接受左旋多巴治疗5年以上患者中的发生率分别为30.0%、40.0%;②伴发运动并发症的患者与不伴运动并发症的患者相比较,其病程长,发病年龄小,服用左旋多巴每日剂量更大、时间更长,高血压发病率更低(P<0.05);③症状波动的独立影响因素有服用左旋多巴的疗程(OR=1.014,P<0.05)和多巴胺受体激动剂每日剂量(OR=1.018,P<0.05);异动症的独立影响因素有左旋多巴每日剂量(OR=1.013,P<0.05)。结论:帕金森病患者普遍伴运动并发症,其中服用大剂量左旋多巴、年轻起病、不伴高血压的患者更容易发生运动并发症;早期、持续、低剂量的多巴胺能刺激可以延缓运动并发症的发生。

Objective：To investigate the clinical features and related factors of motor complications in Parkinson＇s disease （PD）. Methods： Data in medical charts of 107 PD patients registered to 6 hospitals were retrieved. The disease severity in these patients was evaluated using Unified Parkinson＇s disease rating scale （UPDRS） and Hoehn- Yahr staging （H-Y） and submitted for statistical analysis. Results：（1） Of the 107 patients,13 （13.08%） experienced dyskinesias and 20 （ 18.69% ） motor fluctuations, accounting for 30.0% and 40.0% of patients who had been on levodopa for 5 years or over, respectively. （2） Compared with those free of motor complications, these patients presented with longer duration of illness, younger age at onset, higher dose and longer course of daily levodopa use, lower incidence of hypertension （ P 〈 O. 05）. （3） Binary logistic regression revealed that the duration of levodopa therapy（ OR = 1. 014, P 〈 0.05 ） and daily dose of dopamine receptor agonists （ OR = 1. 018, P 〈 0. 05 ） as the independent factors of motor fluctuations, and daily dose of levodopa （ OR = 1.013, P 〈 0.05 ） as the independent factor of dyskinesias. Conclusion ： There was a high incidence of motor complications in PD patients, especially in those with young age at onset, higher dose of daily levodopa use and without hypertension. Early and persistent low-dose dopaminergic stimulation may delay the occurrence of motor complications in PD patients.