帕金森病患者非运动症状波动的临床特点

Clinical features of fluctuations of non-motor symptoms in patients with Parkinson's disease

目的探讨帕金森病(PD)患者非运动症状波动的临床特点。方法采用剂末现象问卷(WOQ-19)评价121例原发性PD患者的运动症状波动和非运动症状波动,并采用视觉模拟评分法(VAS)对WOQ-19的每一项症状进行量化。采集患者的一般信息及服药情况,同时采用统一PD评定量表Ⅲ(UPDRSⅢ)和Hoehn-Yahr量表(H-Y分级)评价患者运动功能及对进行病程分级。结果 121例PD患者中,114例(94.2%)有非运动症状,其中44例(38.6%)有非运动症状波动。非运动症状中,焦虑、情绪低落/思维迟钝、情绪变化的发生率较高。在非运动症状波动中,焦虑、情绪变化、多汗、情绪低落/思维迟钝的症状波动发生率较高。神经精神性症状波动发生率(42.3%)显著高于自主神经性症状(27.9%)与感觉性症状(23.4%)(均P<0.05)。患者焦虑、情绪变化、情绪低落/思维迟钝、多汗、疼痛、酸痛、麻木、腹部不适感的VAS评分在服药后明显降低(均P<0.05)。非运动症状波动患者病程、服药年限、H-Y分级、UPDRSⅢ开期及关期评分、复方左旋多巴剂量及左旋多巴等效剂量均显著高于无波动患者(均P<0.05)。兼有运动症状、非运动症状波动患者UPDRSⅢ关期评分及左旋多巴等效剂量均明显高于单纯运动症状波动患者(均P<0.05)。结论 PD患者非运动症状波动发生率约40%,神经精神性非运动症状波动更频繁。非运动症状波动与病程及服药年限长,H-Y分级、UPDRSⅢ评分及左旋多巴等效剂量高,同时兼有运动症状波动等因素有关。

Objective To explore clinical features of fluctuations of non-motor symptoms in patients with Parkinson＆#39;s disease （PD）.Methods Motor and non-motor fluctuations of 121 PD primary patients were assessed with Wearing-Off Questionnaire 19（WOQ-19）;the symptoms of each item were further quantified by Visual analogue score （ VAS ） .The demographic and anti-parkinson medication data were collected , and the unified Parkinson ＇s disease rating scaleⅢ（ UPDRSⅢ） and Hoehn-Yahr stage （ H-Y stage ） were used to evaluate motor functions and disease stages respectively.Results Of the 121 patients,114（94.2%）individuals showed non-motor symptoms and 44 （38.6%） patients presented non-motor fluctuation.Among the non-motor symptoms surveyed, anxiety, cloudy mind/dullness of thinking and mood changes had higher incidence rates ;some non-motor symptoms such as anxiety , mood changes , sweating and cloudy mind/dullness of thinking showed significantly higher incidence of fluctuations . Patients with neuropsychiatric symptoms （42.3%） had significantly higher fluctuation rate than patients with sensory symptoms （23.4%） and autonomic symptoms （27.9%）（all P＆lt;0.05）.The VAS scores of anxiety,mood changes, cloudy mind/dullness of thinking, sweating, pain, aching, numbness and abdominal discomfort were significantly reduced after taking medcine（all P〈0.05）.Non-motor fluctuation patients had significantly longer disease duration and drug therapy duration,significantly higher H-Y stages,UPDRSⅢscores of on period and off period ,daily dose of compound levodapa and levodopa-equivalent daily dose than patients without non-motor fluctuation （ all P〈0.05 ） . Patients with both motor and non-motor fluctuation had higher UPDRS Ⅲ scores （ off period ） and higher levodopa-equivalent daily dose than patients with only motor fluctuation （all P〈0.05）.Conclusions The prevalence of PD non-motor fluctuation is about 40%.Neuropsychiatric symptoms fluctuate more frequently .The occurrence of non-motor fluctuation are associated with including longer disease duration and therapy duration , higher H-Y stages and UPDRSⅢscores ,higher levodopa-equivalent daily dose and concomitant motor fluctuation .