帕金森病患者运动症状进展的临床相关危险因素研究

Study on clinical risk factors related to movement symptom progression in patients with Parkinson’s disease

目的探讨帕金森病(PD)患者运动症状进展的临床相关因素。方法前瞻性纳入南京脑科医院就诊的PD患者[Hoehn-Yahr(H-Y)分期<3期]140例,收集基本资料并采用统一PD评定量表(UPDRS)、 H-Y分期进行评估,随访3年。根据PD患者H-Y分期变化情况,分析影响运动症状展加重的相关临床因素。结果随着病程进展,基线及随访强直、运动迟缓、轴性症状、UPDRSⅢ、H-Y分期、左旋多巴等效剂量(LED)值差异均有统计学意义(均P<0.001)。随访3年发现,起病年龄大(P=0.016),基线轴性症状重(P=0.006),患者运动症状进展快。基线时震颤症状明显,运动症状进展反而慢(P=0.019)。结论发病年龄晚、轴性症状重,是PD运动症状进展的危险因素。震颤是PD患者良性症状,病情进展慢。临床上应给与充分重视,并采取积极的个体化治疗。

Objective To investigate the clinical factors related to movement symptom progression in patients with Parkinson’s disease(PD). Methods One hundred and fourty cases of PD patients [Hoehn-Yahr(H-Y) stage< 3 stage] admitted to Nanjing brain hospital were prospectively included. Basic data were collected and assessed by unified PD rating scale(UPDRS) and H-Y stage, followed up for 3 years. According to the changes of H-Y stage in PD patients, the relevant clinical factors affecting the aggravation of motor symptoms were analyzed. Results The difference between baseline and follow-up with progression, rigidity, bradykinesia, axial symptoms, UPDRS Ⅲ, H-Y stage, levodopa dose equivalent value LED score changes were statistically significant(all P<0.001). The patients were followed up for 3 years and found that the onset age was older(P=0.016), the basal axis symptom was heavier(P=0.006), and the movement symptom progressed rapidly. At baseline, tremor symptoms were obvious, but motor symptoms progressed slowly(P=0.019). Conclusions Late onset age and severe axial symptoms are risk factors for the progression of PD motor symptoms. Tremor is a benign symptom of PD patients with slow disease progression. Clinical should give sufficient attention, and take active individual treatment.