帕金森病患者非运动症状的临床研究

Non-motor Symptoms in Patients with Parkinson′s Disease

目的研究170例帕金森病(PD)患者非运动症状(NMS)的发生率及其与临床特征的相关性,为PD早期诊断、病情进展预测及预后评估提供依据。方法对170例PD患者进行NMS问卷调查,统计各种NMS的发生率及其在运动症状出现之前的发生率,用Spearman等级相关分析研究NMS发生个数与临床特征的相关性,用χ2检验研究NMS发生率最高的不宁腿综合征(RLS)的影响因素、严重影响患者生活质量的记忆障碍和情绪障碍与病程及病情严重程度的关系。结果 (1)99.41%的PD患者出现了NMS,发生率最高者为RLS(57.1%),其他依次为身体不适(52.9%)、近记忆障碍(52.4%)、抑郁(51.8%)、疲劳(50.0%);(2)在运动症状出现之前的PD-NMS中,发生率最高者为失眠(55.3%),其他依次为抑郁(48.9%)、无兴趣(48.2%)、嗅觉减退(46.2%)、焦虑(45.9%);(3)PD患者NMS发生数为0～26个,平均为(10±5)个,NMS发生个数与性别、文化程度、年龄、发病年龄、临床分型无相关性(r值分别为0.056、-0.006、0.016、-0.44和0.002,P>0.05),与病情严重程度、病程明显相关(r值分别为0.170和0.194,P<0.05);(4)轻、中、重度PD患者RLS、近记忆障碍及情绪障碍的发生率间差异均有统计学意义(χ2值分别为6.288、9.365和29.710,P<0.05)。结论 (1)几乎所有PD患者出现了NMS,发生率最高的NMS为RLS;(2)PD患者在运动症状出现之前可出现多种NMS,失眠发生率最高,对PD的发生及进展具有预警作用;(3)随着病程延长及病情进展,PD患者出现NMS的个数明显增多;(4)随着病情的加重,RLS、近记忆障碍和情绪障碍的发生率明显增加。

Objective To explore the incidence of non-motor symptoms（NMS） in Parkinson′s disease （PD） patients and its correlation with clinical features,to provide a basis for early diagnosis,prediction of disease progression and prognosis.Methods An NMS questionnaire survey was performed in 170 PD patients.The incidence of varying NMSs and that before NMS occurring were calculated,correlation between number of NMS and clinical features studied by Spearman rank correlation analysis,the influencing factors of restless leg syndrome （RLS）,the relationship of dysmnesia and emotion disorders influencing quality of life （QOL） to disease courses and severity by χ2 test.Results （1） 99.41% PD patients presented with NMS,the highest incidence was RLS （57.1%）,and then came malaise （52.9%）,recent memory impairment （52.4%）,depression （51.8%）,fatigue （50.0%）.（2） The incidence of insomnia was the highest （55.3%） in pre-MS PD-NMS,the others were depression （48.9%）,disinterest （48.2%）,hyposmia （46.2%）,anxiety （45.9%）.（3） The number of NMS was 0～26 in PD patients,averaging（10±5）.NMS number was not correlated with gender,education level,age,age of onset,clinical typing（r= 0.056,-0.006,0.016,-0.44,0.002,respectively,P0.05）,but significantly with severity and duration of disease（r=0.170,0.194,respectively,P0.05）.（4） There was significant difference in incidence of RLS,recent memory impairment and emotion disorder between patients with mild,moderate,severe PD （χ2=6.288,9.365,29.710,respectively,P0.05）.Conclusion （1） Almost all PD patients present with NMS,the highest incidence was RLS.（2） PD patients may have many kinds of NMS before MS occurring,the incidence of insomnia is the highest,which pre-warns the genesis and progression of PD.（3） With the extension and progression of disease,the number of NMS increases remarkably.（4） With the aggravation of disease,the incidence of RLS,recent memory impairment,emotion disorders increase significantly.