帕金森病患者异动症及症状波动发生情况及其影响因素研究

Incidence of Dyskinesia and Motor Fluctuations in Patients With Parkinson's Disease and the Influencing Factors

目的分析帕金森病(PD)患者异动症、症状波动发生情况,并探讨其影响因素。方法选取2014年10月—2015年9月惠州市第一人民医院神经内科收治的PD患者130例,回顾性分析其临床资料,包括发病年龄、性别、首发症状、病程、左旋多巴类制剂治疗时间、左旋多巴等效剂量、H-Y分级、统一帕金森病评分量表(UPDRS)评分等。统计PD患者异动症、症状波动发生情况,其影响因素的分析采用多因素logistic回归分析。结果 130例PD患者中20例(15.38%)患者发生异动症,43例(33.08%)患者发生症状波动。发生异动症与无异动症的患者性别、首发症状比较,差异无统计学意义(P>0.05);发生异动症的患者发病年龄小于无异动症的患者,病程、左旋多巴类制剂治疗时间长于无异动症的患者,左旋多巴等效剂量大于无异动症的患者,H-Y分级、UPDRS评分高于无异动症的患者(P<0.05)。发生症状波动与无症状波动的患者性别、首发症状比较,差异无统计学意义(P>0.05);发生症状波动的患者发病年龄小于无症状波动的患者,病程、左旋多巴类制剂治疗时间长于无症状波动的患者,左旋多巴等效剂量大于无症状波动的患者,H-Y分级、UPDRS评分高于无症状波动的患者(P<0.05)。多因素logistic回归分析结果显示,左旋多巴类制剂治疗时间〔OR=1.154,95%CI(1.027,1.964)〕、左旋多巴等效剂量〔OR=1.024,95%CI(1.003,1.502)〕、H-Y分级〔OR=1.362,95%CI(1.175,2.671)〕是PD患者发生异动症的危险因素(P<0.05);左旋多巴类制剂治疗时间〔OR=1.146,95%CI(1.057,1.705)〕、左旋多巴等效剂量〔OR=1.204,95%CI(1.085,2.035)〕、H-Y分级〔OR=2.265,95%CI(1.552,4.428)〕、UPDRS评分〔OR=1.219,95%CI(1.086,1.927)〕是PD患者发生症状波动的危险因素(P<0.05)。结论 PD患者异动症及症状波动发生率较高;左旋多巴类制剂治疗时间、左旋多巴等效剂量、H-Y分级是PD患者发生异动症、症状波动的危险因素,UPDRS评分也是PD患者发生症状波动的危险因素。

Objective To analyze the incidence of dyskinesia and motor fluctuations in patients with Parkinson’ s disease,to explore the influencing factors. Methods From October 2014 to September 2015, a total of 130 patients with Parkinson’s disease were selected in the Department of Neurology,the First People’s Hospital of Huizhou,the clinical data was retrospectively analyzed, including onset age, gender, initial symptom, disease course, levodopa agents treatment time,levodopa equivalents,H-Y grade and UPDRS score. Incidence of dyskinesia and motor fluctuations in patients with Parkinson’ s disease were recorded,and the influencing factors was analyzed by multivariate logistic regression analysis. Results Of the 130 patients with Parkinson’s disease,20 cases（ accounting for 15. 38%） occurred dyskinesia,43 cases（ accounting for 33. 08%）occurred motor fluctuations. No statistically significant differences of gender or initial symptom was found in Parkinson’ s disease patients complicated with dyskinesia and did not complicated with dyskinesia（ P 〉 0. 05）; compared with Parkinson’ s disease patients did not complicated with dyskinesia, the onset age of Parkinson’ s disease patients complicated with dyskinesia was statistically significantly lower,disease course and levodopa agents treatment time were statistically significantly longer,levodopa equivalents was statistically significantly more,H-Y grade and UPDRS score were statistically significantly higher（ P 〈 0. 05）.No statistically significant differences of gender or initial symptom was found in Parkinson’s disease patients complicated with motor fluctuations and did not complicated with motor fluctuations（ P 〉 0. 05）; compared with Parkinson’ s disease patients did not complicated with motor fluctuations, the onset age of Parkinson’ s disease patients complicated with motor fluctuations was statistically significantly lower, disease course and levodopa agents treatment time of were statistically significantly longer,levodopa equivalents was statistically significantly more,H-Y grade and UPDRS score were statistically significantly higher（ P 〈0. 05）. Multivariate logistic regression analysis showed that,levodopa agents treatment time 〔OR = 1. 154,95% CI（ 1. 027,1. 964） 〕,levodopa equivalents 〔OR = 1. 024,95% CI（ 1. 003,1. 502） 〕 and H-Y grade 〔OR = 1. 362,95% CI（ 1. 175,2. 671） 〕 were risk factors of dyskinesia in patients with Parkinson’s disease（ P 〈 0. 05）; levodopa agents treatment time 〔OR= 1. 146,95% CI（ 1. 057,1. 705） 〕,levodopa equivalents 〔OR = 1. 204,95% CI（ 1. 085,2. 035） 〕,H-Y grade 〔OR =2. 265,95% CI（ 1. 552,4. 428） 〕 and UPDRS score 〔OR = 1. 219,95% CI（ 1. 086,1. 927） 〕 were risk factors of motor fluctuations in patients with Parkinson’s disease（ P 〈 0. 05）. Conclusion The incidence of dyskinesia and motor fluctuations is relatively high in patients with Parkinson’s disease,levodopa agents treatment time,levodopa equivalents and H-Y grade are risk factors of dyskinesia and motor fluctuations,and UPDRS score is one of the risk factors of motor fluctuations,too.