多系统萎缩患者精神症状分布及影响因素研究

Distribution of psychiatric disturbances and relevant factors in patients with multiple system atrophy

目的 了解多系统萎缩（MSA）患者精神症状分布临床特点,并分析神经精神症状的影响因素.方法 采用中文版神经精神问卷（CNPI）调查47例很可能MSA患者12项精神症状的发生率和分布情况,并分析神经精神症状与临床特征包括性别、年龄、受教育时间、病程、认知水平、统一多系统萎缩评定量表第三部分（UMSARS-Ⅲ）评分、统一帕金森病评定量表第三部分（UPDRS-Ⅲ）评分、汉密尔顿抑郁量表（HAMD）评分、汉密尔顿焦虑量表（HAMA）评分、MSA分型、多巴丝肼使用剂量等的相关性.结果 74.5%（35/47）的MSA患者存在1项或以上的精神症状.最常见的症状是抑郁（66.0%,31/47）和睡眠障碍（63.8%,30/47）,未发现有欣快症状者.抑郁症状的评分均值最高[（5.23＆#177;1.67）分].MSA患者CNPI总分与受教育时间、简易精神状态检查（MMSE）评分呈负相关（r值分别为-0.238和-0.334,均P〈0.01）,与病程、HAMD评分呈正相关（r值分别为0.308和0.307,均P〈0.01）,与性别、年龄、UMSARS-Ⅲ评分、UPDRS-Ⅲ评分、MSA分型、多巴丝肼使用剂量无相关性（均P〉0.05）.逐步多元线性回归分析结果显示HAMA和MMSE评分对CNPI总分影响最大（r2分别为0.196和0.270,均P=0.000）.结论 MSA患者神经精神症状发生率高且具多样性,MSA患者认知水平越低、病程越长精神症状越严重.

Objective To study the clinical distribution characteristics of psychiatric symptoms in patients with multiple system atrophy （ MSA ） and analyze the influence factors of neuropsychiatric symptoms.Methods Twelve psychiatric symptoms were evaluated in 47 patients with MSA by the Neuropsychiatric Inventory of the Chinese version （ CNPI ） .The occurrence rate and distribution were evaluated.The correlation between the neuropsychiatric symptoms and the clinical features including gender , age, education duration, disease course, cognitive level, Unified Multiple System Atrophy Rating Scale part 3 （ UMSARS-Ⅲ） score, Unified Parkinson＆#39;s Disease Rating Scale part 3 （ UPDRS-Ⅲ） score, Hamilton Depression Rating Scale （ HAMD） score, Hamilton Anxiety Scale （ HAMA） score, MSA subtype and levodopa and benserazide usage dose was also analyzed .Results A total of 74.5%（ 35/47 ） of the MSA patients presented at least one kind of psychiatric symptoms .The most common neuropsychiatric symptoms were depression （66.0%, 31/47） and sleep disorder （63.8%, 30/47）, while the symptom of euphoria was not found.The highest mean score was found for depression （ mean score：5.23 ＆#177;1.67 ） .The CNPI scores of MSA patients were negatively correlated to the education duration and Simple Mental State Examination （MMSE） score （r=-0.238, -0.334 respectively, both P〈0.01）.The CNPI scores of MSA patients were positively correlated to the disease course and HAMD score （ r=0.308, 0.307 respectively, both P〈0.01） .The CNPI scores of MSA patients had no relevance to the gender , age, UMSARS-Ⅲscore, UPDRS-Ⅲscore, MSA subtype and levodopa and benserazide dosage （ all P〉0.05）. Multiple liner regression analysis showed that HAMA and MMSE scores had the greatest impact on CNPI （r2 =0.196, 0.270, respectively, both P=0.000） .Conclusions The incidence of neuropsychiatric symptoms is high and varied in patients with MSA .The neuropsychiatric symptoms were more severe in MSA patients with lower cognitive levels and longer disease courses .