帕金森病异质性与自主神经症状关联分析

Analysis of the relationship between Parkinson's disease heterogeneity and autonomic symptoms

目的通过临床资料的收集,分析帕金森病患者(Parkinson’s disease,PD)自主神经症状(autonomic symptom,AS)出现的特点、临床异质性分类与AS的关联。方法记录121例PD患者的一般资料,使用帕金森病自主神经症状量表(the scale outcomes in PD for autonomic symptoms,SCOPA-AUT)评估患者的AS;Hoehn-Yahr(H-Y)分级进行病情严重度评级。根据PD异质性分组方法将患者分为:以H-Y分级为标准的早期、中期、晚期组,以病程为标准划分为≤2a、2~5a及>5a3组;以发病年龄为标准的早发组(≤50岁)、晚发组(>50岁);以性别为标准的男性组、女性组;以运动障碍表现为依据的混合组、震颤组和强直组;比较各亚组间SCOPA-AUT量表评分的差异。结果全组PD患者出现至少一项AS症状的占98.30%,消化系统症状及泌尿系统障碍是出现概率最高,程度最重的AS病变。以H-Y分级为标准的PD亚型及以病程为标准的亚型组内SCOPA-AUT评分比较,各组间差异有统计学意义(P=0.00);以发病年龄、性别及以运动障碍表现为依据分型的PD亚型组内比较,SCOPA-AUT评分组差异无统计学意义(P>0.05);女性较男性在AS症状方面症状较轻。结论 PD患者普遍存在自主神经功能障碍(automomic dysfuction,AD),病情越重,病程越长,AD越重;女性可能是AS的一项保护性因素。

Objective We analyzed the characteristics of autonomic symptoms in PD patients and the correlation between the clinical heterogeneity of PD and autonomic symptoms. Methods We recruited 121 Parkinson＇s disease patients in our study. Patients＇s autonomic symptoms were assessed by using the scale outcomes in PD for autonomic symptoms （SCOPA-AUT）. Hoe- hn-Yahr （H-Y） was used to describe the progress of PD symptoms. Based on the H-Y classification, patients were allocated into the early, middle and late stage groups. Based on the course of disease, patients were allocated into three groups, 〈~2 years, 2-5 years and more than 5 years. Based on the age of symptom onset,patients were allocated into early onset group （450 years old） and late onset group （〉50 years old）. Based on gender, patients were allocated into male and female groups. Finally, according to the performance of motor disorders, patients were divided into mixed group, tremor group and rigid group. Results 98.3 ~ of the PD patients recruited suffered at least one of autonomic symptoms. SCOPA-AUT score showed that the digestive system symp- toms and urinary system dysfunction were the most frequent and the most severe lesion. Compared of three subtypes of PD based on the H-Y classification and another three based on the course of disease, there were significant statistical difference in H-Y clas sification, the course of disease and SCOPA-AUT score. There was no significant difference in SCOPA-AUT score between those groups, which were divided based on the age of onset, gender, and the performance of motor disorders. The symptoms of autonomic symptoms were milder in female than in male. Conclusion Autonomic dysfunction is common in PD patients. Autonomic dysfunc- tion become more serious with the course of disease. Female maybe a protective factor of the autonomic system in PD patients.