门诊帕金森病患者快速眼球运动睡眠期行为障碍在不同运动亚型间的比较

A comparative study on clinical rapid eye movement sleep behavior disorder and motor subtypes in outpatients with Parkinson＆#39;s disease

目的 探讨帕金森病患者中快速眼球运动睡眠期行为障碍（RBD）的发生率和严重程度,以及两者与其运动亚型之间的关系.方法 连续收集2012年1月至2015年1月于北京医院神经内科帕金森病门诊就诊的187例帕金森病患者[Hohen-Yahr （H-Y）分期为Ⅰ～Ⅲ期].收集患者一般资料并进行统一帕金森病评估量表（UPDRS）评分.根据起始症状是否以震颤为主将患者分为震颤型（119例）和非震颤型（68例）两个亚组.同时入组年龄和性别与帕金森病组相匹配的健康对照100名.根据国际睡眠障碍分型修订版关于RBD的最低诊断标准,对帕金森病组和健康对照组中符合临床诊断RBD的对象进行斯塔万格睡眠量表（SSQ）评分,比较两组中临床RBD的发生率.同时比较震颤型组和非震颤型组中临床RBD的发生率和严重程度（SSQ评分）、病程及UPDRS评分结果等,并分析临床RBD严重程度与帕金森病病情严重程度之间的相关性.结果 187例帕金森病患者中患有RBD者共87例（46.5％）,与健康对照组（5/100,5.0％）比较差异有统计学意义（x2=1.537,P =0.000）.非震颤型与震颤型2个亚组在RBD的发生率和严重程度方面差异无统计学意义.非震颤型患者的SSQ评分与UPDRS总分（r=0.266,P=0.028）和H-Y分期（r=0.263,P =0.030）均呈正相关.结论 帕金森病患者的RBD发生率与运动亚型无关;帕金森病临床严重程度与RBD严重程度在非震颤型中存在正相关,在震颤型中没有发现相关性.

Objective To investigate the incidence and severity of clinical rapid eye movement sleep behavior disorder （RBD） in Parkinson＇s disease （PD）,and the association with motor subtypes.Methods We recruited 187 patients with PD （Hoehn-Yahr stage Ⅰ-Ⅲ） from outpatient department in Beijing Hospital.The general information of the patients was collected and the Unified Parkinson＇s Disease Rating Scale （UPDRS） scores were caculated.The patients were divided into two subgroups as tremor dominant （TD） and non-tremor dominant （NTD）.One hundred matched healthy controls （HC） were enrolled.We used the minimal diagnostic criteria of parasomnias described in the International Classification of Sleep Disorders-Revised to diagnose clinical RBD.The Stavanger Sleepiness Questionnaire （SSQ） was used to rate the severity of clinical RBD.The PD group and HC group were compared with incidence of clinical RBD.The TD subgroup and NTD subgroup were compared with each other for severity and incidence of clinical RBD,the UPDRS scores and disease duration.The correlation between severity of clinical RBD and clinical severity of PD was analyzed in the patient groups.Results The incidence of clinical RBD in PD and HC groups was 46.5% （87/187） and 5.0% （5/100）.The difference between two groups was significant （x2 =1.537,P =0.000）.Of the patients,36.4% （68/187） had the NTD subtype of PD.There were no significant differences in the incidence and severity of clinical RBD between NTD subtype and TD subtype.For the NTD patients,there was positive correlation between severity of clinical RBD （SSQ scores） and clinical severity （UPDRS scores and the Hoehn-Yahr stage） of PD （r =0.266,P =0.028;r =0.263,P =0.030）.Conclusion In our study,incidence of clinical RBD is unrelated to motor subtypes of PD.There is a positive correlation between clinical severity of PD and severity of clinical RBD in the NTD subtype but not in the TD subtype.