帕金森病伴疼痛患者临床特征及认知功能研究

The clinical characteristics and cognitive function of Parkinson＇s disease patients associated with pain

目的 探讨伴慢性疼痛的帕金森病（PD）患者疼痛类型及危险因素,并分析疼痛与认知功能的相关性.方法 116例原发性PD患者分为伴疼痛组与不伴疼痛组,统一使用PD评分量表（UPDRS）、Hoehn-Yahr（H-Y）分期,汉密顿抑郁量表（HRSD,24项）、视觉模拟评分法（VAS）、蒙特利尔认知评估量表（MoCA）等进行评估.结果 伴慢性疼痛组UPDRS各项得分、H-Y分期及HRSD得分均高于不伴疼痛组,差异均有统计学意义（P值均＜0.05）.logistic回归分析显示只有HRSD得分有统计学意义（OR=1.093,P=0.007）.伴慢性疼痛PD患者的“延迟记忆”得分低于不伴疼痛患者（1.9±1.3比2.5±1.3）,差异有统计学意义（P=0.020）;疼痛出现在运动症状之前患者的延迟记忆得分明显低于疼痛出现于运动症状以后的患者（1.2±1.2比2.2±1.3）,差异有统计学意义（P=0.015）.结论 骨骼肌疼痛是PD患者最为常见的疼痛类型,抑郁可能是导致PD合并疼痛的独立危险因素,伴慢性疼痛PD患者的认知功能损害主要表现为延迟记忆障碍.

Objective To explore the type and etiology of chronic pain in patients with Parkinson＇s disease （PD）,and to assess the association between pain and cognitive function.Methods A total of 116 PD patients were enrolled in the study and assessed with the following rating scales：Unified Parkinson＇s Disease Rating Scale （UPDRS）,Hoehn-Yahr Scale （H-Y）,Hamilton Depression Rating Scale for Depression（HRSD）,Visual Analogue Scale （VAS） and Montreal Cognitive Assessment （MoCA）.Results Compared with PD patients without pain,PD patients with pain had higher scores of UPDRS,H-Y and HRSD rating scales.Depression（scores of HRSD） was the only factor associated with pain showed by the Logistic regression model （P =0.007）.PD patients with pain had lower scores of delayed recall （P =0.020）.PD patients with pain happened before their motor symptoms had a lower score of delayed recall （P =0.015）.Conclusions Musculoskeletal pain is the most common type in PD patients with pain.Depression is probably an independent risk factor for pain in PD patients.Delayed recall is the dominant impaired cognitive function.