异质性帕金森病患者非运动症状分布特点

Distribution features and related factors analysis of non motor symptoms in the phenotype of Parkinson's disease

目的分析临床异质性的帕金森病(Parkinson’disease,PD)患者非运动症状(non motor symptom,NMS)发生及分布的特点,及NMS发生的相关因素。方法 PD患者使用统一帕金森病非运动症状评价量表(Unified Parkinson's Disease Rating Scale,NMSS)、H-Y分期、统一PD评定量表(Unified Parkinson’s Disease Rating Scale,UPDRS)Ⅲ部分评分进行评定。171例分组:以发病年龄为标准分为早发组(≤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分为混合组、震颤组和强直组;以H-Y分级严重度为标准分为早期、中期、晚期组,比较各组NMS发生的程度、频率及常见症状表现的差异,分析NMS相关影响因素。结果全组PD患者出现至少一项NMS症状者占94.15%,情感障碍、睡眠、便秘及嗅觉/味减退程度最重,发生频率最高的为NMS。异质性分组分析提示,NMS在不同的临床类型的PD患者中发生的程度和频率有轻微差异,其中在≤50岁组PD患者性欲改变最突出,值得关注;男性入睡困难和白天嗜睡的睡眠障碍多见,女性则自我感觉悲哀,情绪低落等抑郁症状稍突出;震颤型较易出现出汗增多,混合及强直型情绪低落悲哀多见;早期及中期的PD患者的嗅觉减退、便秘、睡眠问题突出,但疾病进入晚期情感问题明显加重。Spearman相关分析显示,PD患者NMS的发生与年龄、病程、H-Y分期、UPDRSⅢ评分呈正相关(P=0.00)。结论针对临床异质性的PD患者应关注不同类型的NMS,寻求相应的干预策略和治疗措施,提高个体化治疗的精准性,改善患者的生活质量。

Objective To detect the characteristics of occurrence and distribution of non-motor symptoms（NMS）in patients with the phenotype of Parkinson＇s disease and related factors of NMS.Methods We recruited 171 Parkinson＇s disease patients in our study.NMS were assessed using non-motor symptoms Scale（NMSS）.Hoehn-Yahr（H-Y）and Unified Parkinson＇s Disease Rating Scale（UPDRS）Ⅲ was used to describe how the progress of Parkinson＇s disease.Based on the time of symptom onset,patients were allocated into early onset group（≤50 years old）and late onset group（50 years old）.Based on gender,patients were allocated into male and female groups,and based on the performance of motor disorders,the patients were divided into mixed group,tremor group and rigid group.Finally,according to the H-Y severity classification,patients were allocated into the early,middle and late stage groups.We compared the differences of the degree,frequency and the common symptoms of NMS among different groups.Results 94.15% of the PD patients suffered at least one of the NMS symptoms.Emotional problems,sleeping disorder,constipation and hyposmia were the most severe and frequent symptoms among all the NMS.Clinical heterogeneity group analysis demonstrated different incidence and severity of NMS among different subtypes of PD.It was worth noting that patients who were younger than 50 were more likely to suffer loss of sexual desire.More male PD patients had difficulty in falling asleep and had daytime sleepiness,while more female PD patients suffered depression.Compared with the mixed type and rigid type group,patients in the tremor type group were more vulnerable to hyperhidrosis.Hyposmia,constipation,sleep problems were the most common NMS in PD patients in the early and middle stage.However,in the late stage,emotional problems became the most frequently detected NMS in PD patients.Conclusion The NMS varied among different type of PD patients.Strategies for interventions and individual treatment should be devised based on different target PD patients to improve their life quality.