早期帕金森病患者姿势稳定性的变化及相关因素分析

Postural stability changes and analysis of the related factors in early-stage Parkinson’s disease patients

目的 研究早期帕金森病(Parkinson disease,PD)患者姿势稳定性的变化并分析相关影响因素。方法 收集2019年2月至2019年6月作者医院收治的早期未治疗PD患者30例及同期招募的健康对照者20名。完成基于惯性加速度器的姿势摆动度的测定,选取急动度(Jerk)和均方根加速度(root mean square acceleration,RMS)为度量指标,分别在前后方向(antero-posterior,AP)、中侧(medio-1ateral,ML)方向及总矢量方向上进行测定。比较不同视觉状态下PD与健康对照姿势摆动指标的差异,比较不同视觉状态下PD治疗前后姿势摆动指标的差异。结果 (1)在睁眼和闭眼状态下,除RMS(ML)外,PD组Jerk(AP)、Jerk、Jerk(ML)、RMS(AP)、RMS均较对照组高(均 P <0.05);(2)除RMS(ML)外,闭眼状态下PD组及对照组的Jerk(AP)、Jerk、RMS(AP)、RMS较睁眼状态下高( P <0.05或 P <0.01);PD组和对照组由睁眼状态至闭眼状态各摆动指标恶化率比较无统计学差异( P >0.05)。(3)在睁眼状态下,PD患者初始左旋多巴治疗前后摆动指标比较差异均无统计学意义( P >0.05),而在闭眼状态下,除PD患者治疗后RMS(ML)较治疗前高( P =0.047)外,余指标比较均无统计学差异(均 P >0.05)。结论 早期PD患者亦存在姿势不稳,且闭眼状态下明显;初始常规剂量左旋多巴治疗则未明显影响姿势稳定性。

Objective To investigate the changes of postural stability in early-stage Parkinson's disease(PD) patients and analyze the related factors. Methods Thirty untreated early-stage PD patients admitted to the author's hospital and twenty healthy controls were recruited from February to June in 2019. The measurement of the posture sway based on the inertial accelerometer were completed. Jerk and root mean square acceleration (RMS) were selected as parameters for the posture sway measurement,which were assessed in the antero-posterior(AP) direction,medio-1ateral(ML)/left-right direction and the total vector direction respectively. In different visual status,the difference of parameters between untreated PD group and healthy controls were compared.In different visual status,the difference of postural sway parameters between levodopa treatment and untreated conditions were compared in PD patients. Results (1) Both in the eyes open(EO) and eyes closed conditions(EC),Jerk (AP),Jerk,Jerk (ML),RMS (AP),and RMS of PD group were higher than those in the control group except RMS (ML)( P <0.05);(2) In the EC condition,Jerk (AP),Jerk,RMS (AP),and RMS of PD group and control group were higher than those in the EO condition except RMS (ML)( P <0.05 or P <0.01). There was no significant difference in the increase rate /deterioration rate in the sway parameters between the PD group and the control group from the EO condition to the EC condition( P >0.05).(3) There was no significant difference in the sway parameters between untreated and treated patients in the EO condition ( P >0.05). It was same as in the EC condition except for the increase of RMS (ML) after treatment( P =0.047). Conclusions Early-stage PD patients also have unstable posture and it will get worse when eyes are closed. Initial regular doses treatment of levodopa has no significant effect on posture stability.