帕金森病伴抑郁和焦虑共病的研究

Study of Parkinson disease with comorbidity of depression and anxiety

目的探讨帕金森病（PD）患者伴抑郁和焦虑共病的发生率及其相关因素。方法采用汉密尔顿抑郁量表（HAMD）、汉密尔顿焦虑量表（HAMA）对480名PD患者和105名正常对照者进行评分,采用统一PD评定量表第Ⅲ部分（UPDRSⅢ）、Hoehn-Yahr（H-Y）分期评定PD患者的运动症状,采用PD非运动症状（NMS）筛查问卷（NMSQ）、PD睡眠量表（PDSS）和蒙特利尔认知测验（MOCA）评定PD患者的NMS。结果 PD组中抑郁的发生率（19.4%）明显高于正常对照组（5.7%）,焦虑的发生率（30.4%）明显高于正常对照组（14.3%）,抑郁和焦虑共病的发生率（15.8%）也明显高于正常对照组（5.7%）（均P〈0.01）。多元Logistc回归分析显示,抑郁的发生与NMSQ评分呈正相关（OR=1.21,95%CI：1.07~1.37）;焦虑的发生与女性（OR=1.91,95%CI：1.04~3.50）、H-Y分期（OR=2.87,95%CI：1.23~6.70）、UPDRSⅢ评分（OR=1.03,95%CI：1.00~1.06）及NMSQ评分（OR=1.18,95%CI：1.10~1.26）呈正相关,而与PDSS评分（OR=0.98,95%CI：0.96~0.99）呈负相关;抑郁和焦虑共病的发生与UPDRSⅢ评分（OR=1.07,95%CI：1.03~1.11）和NMSQ评分（OR=1.35,95%CI：1.23~1.47）呈正相关,而与PDSS评分（OR=0.96,95%CI：0.94~0.97）呈负相关。结论 PD患者伴抑郁和焦虑共病的发生率较高,并与PD患者的病情严重程度、睡眠质量及NMS密切相关。

Objective To investigate the incidence and its related factors of the comorbidity of depression and anxiety in patients with Parkinson disease（PD）.Methods Four hundred and eighty PD patients and 105 normal controls were evaluated by Hamilton Depression Rating Scale（HAMD） and Hamilton Anxiety Rating Scale（HAMA）.The Unified PD Rating Scale Ⅲ（UPDRSⅢ） and Hoehn-Yahr（H-Y） staging were used to assess the motor symptoms of PD patients.The PD non-motor symptoms（NMS） questionnaire scale（NMSQ）,PD sleep scale（PDSS） and Montreal cognitive assessment（MOCA） were used to assess the NMS of PD patients.Results The incidence of depression in PD group（19.4%） was significantly higher than that in normal control group（5.7%）;the incidence of anxiety in PD group（30.4%） was significantly higher than that in normal control group（14.3%）;and the incidence of the comorbility of depression and anxiety in PD group（15.8%） was significantly higher than that in normal control group（5.7%）（all P0.01）.The multiple Logistic analysis showed that the incidence of depression was positively correlated with the score of NMSQ（OR=1.21,95%CI： 1.07-1.37）;the incidence of anxiety was positively correlated with female（OR=1.91,95%CI： 1.04-3.50）,H-Y staging（OR=2.87,95%CI： 1.23-6.70）,the score of UPDRSⅢ（OR=1.03,95%CI： 1.00-1.06） and the score of NMSQ（OR=1.18,95%CI： 1.10-1.26）,while negatively correlated with the score of PDSS（OR=0.96,95%CI： 0.94-0.97）;the incidence of the comorbility of depression and anxiety was positively correlated with the score of UPDRSⅢ（OR=1.07,95%CI： 1.03-1.11） and the score of NMSQ（OR=1.35,95%CI： 1.23-1.47）,while negatively correlated with the score of PDSS（OR=0.96,95%CI： 0.94-0.97）.Conclusion The incidence of the comorbility of depression and anxiety in PD patients is higher,which is associated with the state of illness,sleep quality and the NMS.