帕金森病患者冲动强迫行为的临床特点及相关因素分析

Analysis of the clinical characteristics and related factors of impulse compulsive behaviors in patients with Parkinson＇s disease

目的了解帕金森病患者冲动强迫行为（ICBs）的临床特点及影响因素。方法收集2012年11月至2015年11月北京医院及北京平谷中医院神经内科门诊就诊的帕金森病患者，采用冲动控制障碍问卷（QUIP）评定ICBs，同时收集患者的一般资料及服药情况，完成相关量表评定。以是否具有ICBs进行分组，并行组间分析；以ICBs为因变量，以帕金森病发病年龄、是否饮茶、39项帕金森病生活质量问卷评分、金刚烷胺剂量、多巴胺受体激动剂的左旋多巴每日等效剂量（DA-LEDD）为自变量，进行Logistic回归分析。结果231例帕金森病患者中24例QUIP筛查阳性，其中13例（5.63%）确诊ICBs，包括强迫性购物2例（0.87%），病理性赌博1例（0.43%），性欲亢进4例（1.73%），刻板行为8例（3.46%），多巴胺失调综合征2例（0.87%）；具有两项及以上ICBs的患者有3例。ICBs组DA-LEDD[137.5（37.5，175.0） mg/d]高于非ICBs组[50.0（0，125.0） mg/d，Z＝－2.175，P＝0.030]，饮茶比例大于非ICBs组[2/13和3/218（1.4%），χ^2＝11.369，P＝0.027]，差异均有统计学意义。两组患者发病年龄、病程、统一帕金森病评定量表（UPDRS）总分及UPDRS-Ⅲ评分、修订的Hoehn-Yahr分期量表评分、认知功能、焦虑抑郁评分、DA-LEDD、左旋多巴每日等效总剂量、使用多巴胺受体激动剂、使用金刚烷胺、吸烟、饮酒、喝咖啡等差异均无统计学意义。Logistic回归分析结果显示DA-LEDD（≥100 mg/d）与ICBs的发生呈正相关（OR＝4.404, 95% CI 1.191～16.284，P＝0.026）。结论ICBs在帕金森病患者中并非罕见，主要临床类型为刻板行为，ICBs的发生很有可能与较高剂量（DA-LEDD≥100 mg/d）多巴胺受体激动剂的使用相关。

ObjectiveTo analyze the clinical characteristics and related factors associated with impulse compulsive behaviors （ICBs） in Parkinson′s disease （PD）.MethodsTwo hundred and thirty-one PD outpatients were recruited from Beijing Hospital and Chinese Medicine Hospital of Pinggu District of Beijing from November 2012 to November 2015. Questionnaire for Impulse Compulsive Disorders in Parkinson＇s Disease （QUIP） was used to assess all subjects if they have ICBs or not. The general materials, medication utilized were recorded, and the related scales were used to evaluate PD patients. Intergroup analysis was made according to with or without ICBs. The Logistic regression analysis was adopted to analyze the relevance between incidence of ICBs and on-set age of PD, drinking tea or not, the 39-item Parkinson＇s Disease Questionnaire score, dosage of amantadine and dopamine agonist levodopa equivalent daily doses （DA-LEDD）.ResultsTwenty-four cases of 231 outpatients were QUIP screening positive, and only 13 cases （5.63%） were diagnosed with ICBs as follows： hypersexuality in four （1.73%）, compulsive shopping in two （0.87%）, pathological gambling in one （0.43%）, punding in eight（3.46%）, dopamine dysregulation syndrome in two （0.87%） and with two or more ICBs in three （1.30%）. Compared with non-ICBs group, ICBs group took more dopamine agonists （137.5（37.5, 175.0） mg/d vs 50.0（0, 125.0） mg/d, Z=-2.175, P=0.030）, and had higher percentage of drinking tea （2/13 vs 3/218（1.4%）, χ^2=11.369, P=0.027）. Logistic regression showed that higher dosage of dopamine agonist （DA-LEDD≥100 mg/d, OR=4.404, 95% CI 1.191-16.284, P=0.026） was a risk factor for ICBs.ConclusionsICBs are not rare in Parkinson′s disease, and punding is more common among the clinical phenotypes of ICBs. More dopamine agonists in PD （more than 100 mg/d） may be associated with about 4-fold increased odds of having ICBs.