帕金森病伴发认知障碍患者的营养状况及其影响因素分析

Analysis of nutritional status and its influence factors in patients with Parkinson disease complicated with cognitive impairment

目的了解不同认知障碍程度的帕金森病患者的营养状况。方法回顾性分析在北京天坛医院住院的108例帕金森病患者,按照认知障碍程度将患者分为帕金森病不伴认知障碍(PD-NCI)组、帕金森病伴发轻度认知障碍(PD-MCI)组及帕金森病伴发痴呆(PDD)组。收集患者的人口学资料,包括性别、年龄、病程、HoehnYahr(H-Y)分期等;收集临床资料,包括是否有味觉或嗅觉减退或消失、吞咽困难或饮水呛咳、食欲下降或挑食、便秘或便失禁;计算体质量指数(BMI);检测患者血红蛋白、淋巴细胞总数、总蛋白、白蛋白、胆固醇、三酰甘油、低密度脂蛋白胆固醇、钙、磷及尿酸等生化指标,比较3组的水平差异。结果 (1)PDD组血总蛋白水平明显低于PD-NCI组,血白蛋白及钙水平明显低于PD-NCI组及PD-MCI组,低密度脂蛋白胆固醇水平明显高于PD-NCI组(P<0.05)。(2)PD-MCI组及PDD组的年龄明显大于PD-NCI组(P<0.05);PDD组病程长于PD-MCI组及PD-NCI组(P<0.05);PDD组H-Y分期明显高于PD-MCI组及PD-NCI组(P<0.05)。(3)与PD-NCI组比较,PDD组存在明显的食欲下降或挑食(P<0.05)。结论与PD-MCI组和PD-NCI组比较,PDD组总蛋白、白蛋白及钙水平明显降低,低密度脂蛋白胆固醇水平明显升高,提示PDD患者存在明显的营养障碍。

Objective To investigate the nutritional status of patients with Parkinson disease（ PD） complicated with cognitive impairment. Methods Totally 108 patients with PD in Beijing Tiantan Hospital were retrospectively investigated and divided into PD with no cognitive impairment（ PD-NCI） group,PD with mild cognitive impairment（ PD-MCI） group and PD with dementia（ PDD） group according to the severity of cognitive impairment. The general demographic information and clinical data of patients were collected,including gender,age,disease duration,H-Y stage,decrease or loss of taste or smell,difficulty in swallowing or cough due to drinking water,loss of appetite orpicky eating and status of constipation or incontinence. The biochemical indicators, such as hemoglobin, lymphocyte count,total protein,albumin,cholesterol,triglyceride,low density lipoprotein,calcium,phosphorus,and uric acid were detected and compared. Results The total protein level in PDD group was lower than that in PD-NCI group（ P〈0. 05）.The levels of albumin and calcium in PDD group were lower than those in PD-NCI group and PD-MCI group（ P〈0. 05）.The level of low density lipoprotein in serum in PDD group was higher than that in PD-NCI group（ P〈0. 05）. The mean age of PD-MCI group and PDD group was significantly higher than that in PD-NCI group（ P〈0. 05）. Disease duration in PDD group was longer than that in PD-MCI group and PDNCI group（ P〈0. 05）. The H-Y stage of PDD group was significantly higher than that in PD-MCI group and PD-NCI group（ P〈0. 05）. PDD group had significantly poor appetiteor picky eating compared with PD-NCI group（ P〈0. 05）. Conclusions There are lower levels of total protein,hypocalcemia,higher level of low density lipoprotein in PDD group comparing with PD-MCI and PD-NCI group,which indicates the presence of heterotrophia in the patients with PDD.