帕金森病患者快速眼动睡眠行为障碍的临床特征

Clinical characteristics of rapid eye movement sleep behavior disorder in patients with Parkinson's disease

目的探讨帕金森病(PD)患者快速眼动睡眠行为障碍(RBD)的临床特征。方法连续收集2013年2月~2016年8月就诊于河北医科大学第一医院神经内科的61例PD患者,记录一般资料。对患者进行多导睡眠监测(PSG)和RBD筛查量表(RBDSQ)评估,根据结果将患者分为临床RBD组、亚临床RBD组和无RBD组。应用统一PD评定量表第三部分(UPDRSⅢ)、Hoehn-Yahr(H-Y)分级、汉密尔顿焦虑抑郁量表(HAMA14、HAMD24)、匹兹堡睡眠指数量表(PSQI)、MMSE、蒙特利尔认知评估量表(Mo CA)评估患者的运动及非运动症状,应用TCD检测患者黑质回声强度,对患者服用抗PD药物进行左旋多巴等效剂量(LDE)换算。结果最终入组56例患者,根据PSG和RBDSQ结果分为临床RBD组25例,亚临床RBD组22例,无RBD组9例。临床RBD组及亚临床RBD组病程明显短于无RBD组,两组患者所需的左旋多巴等效剂量(LDE)均多于无RBD组(均P<0.05)。临床RBD组的H-Y分级和PSQI评分均显著高于亚临床RBD组及无RBD组,亚临床RBD组的H-Y分级和PSQI评分显著高于无RBD组(均P<0.05)。临床RBD组TCD阳性检出率高于无RBD组(P<0.05)。RBDSQ评分与病程呈负相关,与H-Y分级、LDE、PSQI评分呈正相关(均P<0.05)。结论 PD患者RBD发生率高,伴RBD的患者病程短,RBD的严重程度与患者H-Y分级、LDE和总体睡眠质量显著相关。伴有临床RBD的PD患者黑质强回声的发生率高。

Objective To investigate the clinical characteristics of rapid eye movement sleep behavior disorder （RBD） in patients with Parkinson＇s disease （PD）. Methods The general informations of 61 patients with Parkinson＇s disease in neurology department of the first hospital of hebei medical university from February 2013 to August 2016 were collected. All patients were assessed by polysomnogram （PSG） and RBD screening scale （RBDSQ）. The patients were divided into clinical RBD group, subclinical RBD group and non RBD group. The motor and non-motor symptoms were detected by unified PD rating scale （UPDRS HI ）, Hoehn-Yahr （H-Y） stage, Hamihon anxiety and depression scale （ HAMA14, HAMD24 ） , Pittsburgh sleep index scale （ PSQI）, MMSE and Montreal cognitive assessment scale （MOCA）. Echo intensity of substantia nigra were detected by TCD. The anti PD drug was converted into levodopa equivalent dose （LDE）. Results Finally, there were 56 cases in this group. According to the results of PSG and RBDSQ, patients were divided into clinical RBD group （25 cases）, subclinical RBD group （22 cases） and non RBD group （9 cases）. The course of clinical RBD group and subclinical RBD group was obviously shorter than that in non RBD group, and the LDE of the two groups was significantly higher than that in non RBD group （ all P 〈 0.05 ）. The H-Y stage and PSQI score of clinical RBD group were significantly higher than those in subclinical RBD group and non RBD group, and the H-Y stage and PSQI score of subclinical RBD group were significantly higher than those in non RBD （ all P 〈 0. 05 ）. The positive rate of TCD in the clinical RBD group was significantly higher than that in non RBD group （P 〈 0. 05 ）. The RBDSQ score was negatively correlated with course of disease, while positively correlated with H-Y stage, LDE and PSQI score of disease （ all P 〈 0. 05 ）. Conclusions The incidence of RBD in patients with PD is high, and the course of patients with RBD is short. The severity of RBD is significantly correlated with H-Y stage, LDE and overall sleep quality of PD patients. The incidence of high substantia nigra hyperechoic in PD patients with clinical RBD is high.