帕金森病患者运动症状进展及运动并发症危险因素纵向分析

A longitudinal study of the progression of motor symptoms and risk factors of motor complications in Parkinson＇ s disease

目的观察帕金森病（Parkinson’s disease，PD）患者运动症状的进展及运动并发症的发生情况，探讨运动症状的进展速度及运动并发症发生的危险因素。方法随访2007年在新华医院神经内科确诊的PD患者130例，随访时间为3年。采用统一PD评分量表（UPDRS）和H—Y分级评估及随访130例患者运动症状进展及运动并发症发生情况，统计并分析运动症状的进展速度及运动并发症发生的危险因素。结果（1）PD患者H-Y分级平均年增长2．5％，UPDRSH1分数平均年增长3．1％；随访末患者吞咽困难发生率较基线增加23．0％；跌倒发生率增加16．7％；（2）异动症的独立危险因素为：随访末左旋多巴的剂量（OR=1．004，95％CI1．001—1．006，P=0．008）；症状波动的独立危险因素为：病程（OR=1．637，95％C11．083～2．473，P=0．019），左旋多巴用药时间（OR=0．698，95％C10．494—0．987，P=0．042），入组时（OR=1．005，95％CI1．001-1．010，P=0．016）及随访末左旋多巴剂量（OR=1．014，95％CI1．001～1．027，P=0．032）。结论随病程进展，PD患者的运动症状逐渐加重，吞咽困难和跌倒的发生率上升，运动并发症的发生率增加。左旋多巴的暴露总量是PD患者出现运动并发症的预测因素。

Objective To observe progression of motor symptoms and occurrence of motor complications in parkinsonian patients and investigate the rate of progression of motor symptoms and risk factors of motor complications. Methods One hundred and thirty patients diagnosed with PD in 2007 in Department of Neurology, Xinhua Hospital were followed up for 3 years. The Unified Parkinson＇ s Disease Rating Scale （UPDRS） and H-Y staging were used to assess and follow up motor symptoms and occurrence of motor complications, and analyze the rate of progression of motor symptoms and risk factors of motor complications with statistics. Results （ 1 ） Mean annual growth in H-Y staging was 2.5%, and UPDRS motor scores was 3.1%; the incidence of dysphagia at endpoint in patients was increased by 23.0% compared with baseline; incidence of falls was increased by 16. 7%;（2）Daily levodopa dose at endpoint （ OR = 1. 004,95% CI 1. 001--1. 006, P = 0. 008 ） was independent risk factors with dyskinesia; While duration （ OR = 1. 637,95% CI 1. 083--2. 473, P = 0. 019 ）, levodopa treatment duration （ OR = 0. 698, 95% CI O. 494---0. 987, P = 0. 042）, daily levodopa dose at baseline （ OR = 1. 005,95% C1 1. 001- 1. 010 ,P =0. 016） and at endpoint （ OR = 1. 014,95% CI 1. 001-1. 027 ,P =0. 032） were risk factors with motor fluctuations. Conclusions As the disease progresses, motor function in parkinsonian patients gradually worsens, the incidence of swallowing difficuhy and of falls is increased, and the incidence of motor complications is increased. The total exposure to levodopa in parkinsonian patients is predictor for motor complications.