帕金森病疲劳症状特点及其与其他症状的相关分析

Characteristics of fatigue and correlation with other symptoms of Parkinson's disease

目的探讨帕金森病患者疲劳症状特点及其与其他症状的相关性。方法共100例原发性帕金森病患者,根据疲劳严重程度评分(FSS)分为疲劳组(FSS评分>4分,58例)和非疲劳组(FSS评分≤4分,42例),采用统一帕金森病评价量表第三部分(UPDRSⅢ)、修订的Hoehn-Yahr分期和改良Webster症状评分评价运动症状;非运动症状量表(NMSS)、简易智能状态检查量表(MMSE)、汉密尔顿抑郁量表(HAMD)、汉密尔顿焦虑量表(HAMA)、Epworth嗜睡量表(ESS)和匹兹堡睡眠质量指数(PSQI)评价非运动症状;统一帕金森病评价量表第二部分(UPDRSⅡ)评价日常生活活动能力和39项帕金森病调查表(PDQ-39)评价生活质量。结果 100例帕金森病患者中58例存在疲劳症状,发生率58%。帕金森病疲劳组白天打盹(χ~2=16.256,P=0.000)、疲劳(χ~2=84.639,P=0.000)、缺乏兴趣(χ~2=10.705,P=0.001)、主动性下降(χ~2=9.350,P=0.002)、情绪低落(χ~2=9.350,P=0.002)、焦虑和(或)惊恐情绪(χ~2=4.625,P=0.032)、情感平淡(χ~2=22.032,P=0.000)、快感缺失(χ~2=18.247,P=0.000)、记忆力减退(χ~2=4.366,P=0.037)、尿急(χ~2=5.774,P=0.016)、尿频(χ~2=5.774,P=0.016)、性生活困难(χ~2=3.877,P=0.049)、嗅觉或味觉减退(χ~2=5.360,P=0.021)发生率,以及UPDRSⅢ评分(t=6.374,P=0.000)、修订的Hoehn-Yahr分期(Z=-3.345,P=0.001)和改良Webster症状评分(t=6.819,P=0.000),NMSS(t=2.923,P=0.011)、HAMD(Z=-2.451,P=0.014)、HAMA(t=5.417,P=0.000)和ESS(Z=-2.116,P=0.034)评分,UPDRSⅡ(Z=-3.115,P=0.002)和PDQ-39(Z=-2.696,P=0.007)评分均高于非疲劳组且差异有统计学意义。Spearman秩相关分析显示,FSS评分与改良Webster症状评分(rs=0.622,P=0.000)、NMSS评分(rs=0.611,P=0.000)呈高度正相关,与病程(rs=0.582,P=0.000)、UPDRSⅢ评分(rs=0.573,P=0.000)、修订的Hoehn-Yahr分期(rs=0.542,P=0.000)、HAMD评分(rs=0.505,P=0.000)、HAMA评分(rs=0.477,P=0.000)、ESS评分(rs=0.474,P=0.000)、PSQI评分(rs=0.410,P=0.000)、UPDRSⅡ评分(rs=0.559,P=0.000)和PDQ-39评分(rs=0.578,P=0.000)呈中度正相关,而与MMSE评分呈低度负相关(rs=-0.258,P=0.000)。结论帕金森病患者疲劳症状发生率较高,且与其他症状之间存在相关性,严重影响生活质量。

Objective To study the characteristics of fatigue and the correlation between fatigue and other symptoms of Parkinson＇s disease （PD）. Methods According to Fatigue Severity Scale （FSS）, 100 PD patients enrolled in this study were divided into fatigue group （FSS 〉 4 score, N = 58） and non-fatigue group （FSS ≤ 4 score, N = 42）. Unified Parkinson＇s Disease Rating Scale m （UPDRS III）, revised Hoehn-Yahr stage and modified Webster score were used to investigate the severity of motor symptom. Non- Motor Symptoms Scale （NMSS）, Mini-Mental State Examination （MMSE）, Hamilton Depression Rating Scale （HAMD）, Hamilton Anxiety Rating Scale （HAMA）, Epworth Sleepiness Scale （ESS） and Pittsburgh Sleep Quality Index （PSQI） were adopted to measure the severity of non-motor symptom. In addition, UPDRS II was used to evaluate the activities of daily living and 39-Item Parkinson＇s Disease Questionnaire （PDQ-39） was used to measure life quality of PD patients, respectively. Results There were 58 out of 100 PD patients having fatigue symptom, namely the occurrence rate of fatigue was 58%. The occurrence rate of daytime nap （χ^2= 16.256, P = 0.000）, fatigue （χ^2 = 84.639, P = 0.000）, lack of interest （χ^2 = 10.705, P = 0.001）, lack of passion （χ^2 = 9.350, P = 0.002）, depression （χ^2 = 9.350, P = 0.002）, anxiety/panic （χ^2 = 4.625, P = 0.032）, emotional apathy （χ^2 = 22.032, P = 0.000）, anhedonia （χ^2 = 18.247, P = 0.000）, poor memory （χ^2 = 4.366, P = 0.037）, urgency of urination （χ^2 = 5.774, P = 0.016）, frequency of micturition （χ^2 = 5.774, P = 0.016）, hard in sex life （χ^2 = 3.877, P = 0.049）, and decreased sense of smell or taste （X2 = 5.360, P = 0.021） were significantly higher in PD patients of fatigue group than those in non-fatigue group. UPDRS 1]I scores （t = 6.374, P = 0.000）, revised Hoehn-Yahr stage （Z = - 3.345, P = 0.001）, modified Webster score （t = 6.819, P = 0.000）, NMSS （t = 2.923, P = 0.011）, HAMD （Z = - 2.451, P = 0.014）, HAMA （t = 5.417, P = 0.000）, ESS （Z = - 2.116, P = 0.034）, UPDRS 11 （Z = - 3.115, P = 0.002） and PDQ-39 （Z = - 2.696, P = 0.007） were significantly higher in PD patients of fatigue group than those in non- fatigue group. Spearman rank correlation analysis indicated that FSS scores had high positive correlation with modified Webster score （rs = 0.622, P= 0.000） and NMSS （r, = 0.611, P = 0.000）, moderate positive correlation with duration （rs = 0.582, P = 0.000）, UPDRS 111 （rs = 0.573, P = 0.000）, revised Hoehn-Yahr stage （rs = 0.542, P = 0.000）, HAMD （r, = 0.505, P = 0.000）, HAMA （rs = 0.477, P = 0.000）, ESS （rs= 0.474, P = 0.000）, PSQI （rs = 0.410, P = 0.000）, UPDRS lI （rs = 0.559, P = 0.000） and PDQ-39 （rs = 0.578, P = 0.000）, and low negative correlation with MMSE （rs = - 0.258, P = 0.000）. Conclusions The occurrence of fatigue in PD is high, which has interaction effect with other symptoms of PD, consequently affecting the life quality of PD patients.