帕金森病患者伴便秘的临床特征研究

Clinical features of Parkinson disease with constipation

目的探讨帕金森病（PD）患者伴发便秘的临床特征。方法连续收集2013年10月至2015年8月就诊于北京天坛医院老年病科及神经内科的204例PD患者，采用罗马Ⅲ功能性便秘的诊断标准评价便秘，完成相关运动症状（Ms）、非运动症状（NMs）、日常生活能力和生活质量的评价。结果（1）204例PD患者中131例伴发便秘，占64．2％，为PD-C组；73例不伴发便秘，占35．8％，为PD-NC组。在PD-C组中，便秘发生在运动症状之前者为38例，占29．0％（38／131）。（2）PD-C组年龄及起病年龄均明显大于PD-NC组[（64．13±9．67）岁比（58．35±11．37）岁；（60．07±10．46）岁比（55．10±12．97）岁]（F=2．287、4．948；t=-3．827、-2．788；均P〈0．01），病程长于PD-NC组r2．25（1．00～5．00）年比2．00（1．00～3．13）年]（Z=-2．254；P〈0．05）；两组在性别、受教育水平、起病侧别及临床类型方面差异均无统计学意义（P〉0．05）。（3）PD-C组统一帕金森病量表（UPDRS）III及Hoehn—yahr（H～Y）分期均高于PD-NC组[26.00（18．00-37．50）分比19．00（12．50～31．00）分；2．00（1．50～2．50）期比1．50（1．00～2．50）期]（Z=-2．349、-2．334；均P〈0．05），UPDRSIV评分及剂末现象个数差异无统计学意义（P〉0．05）。（4）PD-C组NMS个数、MS出现前后NMS个数均多于PD-NC组[11．00（6．00～15．00）个比6．00（3．00～11．00）个；2．00（0．00～4．00）个比1．00（0．00～2．00）个；8．00（3．00～14．00）个比5．00（2.00～9．50）个J（Z=-3．715、-2．612、-2．630；均P〈0．05）；PI〉C组汉密尔顿抑郁量表（HAMD）、汉密尔顿焦虑量表（HAMA）、匹兹堡睡眠质量指数量表（PSQI）、自主神经症状量表（SCOPA—AUT）、疲劳严重度量表（FSS）及情感淡漠量表（As）的评分均高于PD-NC组（均P〈0．05）；PD-C组蒙特利尔认知评估（MoCA）量表的评分低于PD-NC组（Z=-2．132；P〈0．05）。（5）PD-C组UPDRSII及日常生活能力量表（ADL）的评分高于PD-NC组（均P〈0．05）；PD-C组39项PD生活质量问卷（PDQL-39）评分低于PD-NC组（均P〈0．05）。（6）非条件Logistic回归分析显示，年龄、自主神经功能症状、HAMA和HAMD是PD-C的危险因素（OR=1．091、1．107、1．103和1．080，均P〈0．05）。结论PD-C的发生率高，部分发生在运动症状之前。PD-C组年龄更大、起病年龄更大、病程更长及运动症状更重；PD-C组非运动症状个数更多，认知、情绪及睡眠更差，疲劳及淡漠更重；年龄、自主神经功能紊乱、焦虑及抑郁是PD-C的危险因素；PD-C严重影响患者的日常生活能力与生活质量。

Objective To investigate the clinical features of Parkinson disease （PD）with constipation. Methods From October 2013 to August 2015, a total of 204 PD patients were consecutively recruited from the Departments of Geriatrics and Neurology,Beijing Tiantan Hospital, Capital Medical University, and were evaluated by Rome III diagnostic criteria for functionalconstipation and other related scales of motor symptoms（MS）and non-motor symptoms （NMS）, the activity of daily living（ADL）and quality of life. Results Overall, 131 of 204（64.2%0）PD patients with constipation were assigned to the PD-C group and 73 of 204 （35.8%）PD patients without constipation were assigned to the PD-NC group. In the PD-C group, 38 of 131 （29 %）PD patients had constipation before motor symptoms occurred. The mean age and age of onset in the PD-C group were significantly older than those in the PD-NC group （64.13 ± 9.67 vs. 58.35 ± 11.37; 60.07 ± 10.46 vs. 55. 10±12.97;F=2. 287,4. 948;t= -3. 827, -2. 788;P〈0.01 for both）. Meanwhile, compared with the PD-NC group, the PD-C group was associated with dramatically longer disease duration （2.25, range： 1.00-5.00 vs. 2.00, range： 1.00-3.13 ; Z = -- 2. 254; P 〈 0.05 ）, increased scores of the Unified Parkinson Disease Rating Scale （UPDRS） III （26.00 scores, range： 18.00-37.50 vs. 19.00, range： 12.50-31.00;Z= - 2. 349, P〈0.05）, more advanced stages on the Hoehn-Yahr （H-Y） scale （2.00 stage, range： 1.50-2.50 vs. 1.50, range： 1.00-2.50; Z = - 2. 334, P 〈 0.05）, higher total numbers of NMS （ 11.00, range： 6.00-15.00 vs. 6.00, range： 3.00-11.00 ; Z = - 3.715, P〈 0.05 ）, and higher numbers of NMS occurring before and after MS（before,2.00, range：0.00 4.00 vs. 1.00, range： 0.00-2.00;after, 8.00, range： 3.00-14.00 vs. 5.00, range： 2.00-9.50; Z = 2. 612, - 2. 630, respectively;P〈0.05 for both）. Additionally, there were significant differences between the groups in the scores of the Hamilton depression scale （HAMD）, the Hamilton anxiety scale （HAMA）, the Pittsburgh sleep quality index （PSQI）, the scales for outcomes in Parkinson disease-autonomic （SCOPA-AUT）, the Fatigue severity scale （FSS）, the Apathy scale, the Montreal Cognitive Assessment（MoCA）scale, the UPDRS II and ADL Scale, and the PDQL-39 （all P〈0.05）. Binary Logistic regression analysis showed that age,SCOPA-AUT, HAMA and HAMD were risk factors for PD-C（OR= 1. 091,1. 107,1.10 and 1. 080;P〈0.05 for all）. Conclusions PD patients have a high incidence of constipation, and more than a quarter of patients have constipation before MS occurs. Meanwhile, PD patients with constipation are usually associated with old age and late age of onset,long disease duration, severe MS, frequent and severe NMS, bad cognition, emotional state and sleep, severe fatigue, and apathy. Moreover, advanced age, autonomic dysfunction, anxiety and depression increase the risk of PD with constipation. Constipation has a serious negative impact on the activity of daily living and quality of life in PD patients.