帕金森病并发剂峰异动症的危险因素及其对生活质量的影响

Peak-dose Dyskinesia in Parkinson's Disease: a Comparative Study on Risk Factors and Quality of Life

目的：调查帕金森病（PD）并发剂峰异动症的相关危险因素及其对生活质量的影响。方法：对使用左旋多巴至少1月的PD患者问卷调查一般情况、运动症状、非运动症状和治疗情况,分析其并发剂峰异动症的相关影响因素及对日常生活能力的影响。结果：共纳入PD患者97例,出现剂峰异动症13例（13.4%,异动症组）,与未并发剂峰异动症的PD患者（无异动症组）比较,异动症组女性更多、发病年龄轻、病程长、体重低、UPDRSⅡ评分高、＂开＂期H-Y评分高、＂关＂期H-Y评分高、症状波动多见、焦虑和抑郁程度更重、单位左旋多巴剂量高、左旋多巴等效剂量高、PDQ-39总分数高和更可能使用金刚烷胺（P〈0.05）。多因素Logistic回归分析发现女性[6.28（1.19～33.16）,P=0.030]、长病程[1.41（1.18～1.69）,P〈0.001]和焦虑[11.25（1.49～84.82）,P=0.019]是PD患者并发剂峰异动症的独立危险因素。结论：女性、长病程和焦虑状态可能是PD并发剂峰异动症的独立危险因素,剂峰异动症可显著降低PD患者的生活质量。

Objective： To investigate the risk factors of peak-dose dyskinesia in Parkinson＇s disease（PD） and the impact of peak- dose dyskinesia on quality of life in PD patients. Methods： The PD patients who had received levodopa for at least 1 month, were recruited.The clinical data were analyzed including the demographic characteristics, motor symptoms, non-motor symptoms and treatments for PD by physical examination and questionnaire survey. The clinical characteristics and quality of life between the groups with and without peak- dose dyskinesia in PD patients were compared. Results： The study population consisted of 97 patients. There were 13（13.4%） patients with peak-dose dyskinesia（dyskinesia group）. Compared with non-dyskinesia group, the dyskinesia group were more likely to be female gender, younger age at onset, longer disease duration, lower body weight, more severe motor symptoms, more severe anxiety and depression, higher weight-adjusted daily levodopa dose, higher levodopa dose equivalency, higher PDQ- 39 total score and more likely to use amantadine（P〈0.05）. On multiple logistic regression analysis, after adjusting by sex, age on the onset and PD duration, the PD patients with female gender[6.28（1.19～33.16）, P=0.030], long PD duration[1.41（1.18～1.69）, P〈0.001] and anxiety[11.25（1.49～84.82）, P=0.019] were associated with peak-dose dyskinesia. Conclusion： Female gender, long PD duration and anxiety were the independent risk factors of the PD patient with peak-dose dyskinesia and peakdose dyskinesia can markedly deteriorate the quality of life in PD patients.