早期帕金森病患者步态特征定量分析的初步探索

An exploratory study of quantitative analysis of gait characteristics in patients with early Parkinson′s disease

目的研究早期帕金森病患者行走时步态的时空和运动学特征。方法收集2017年5月至2018年8月在上海交通大学医学院附属新华医院神经内科门诊就诊的帕金森病患者8例(Hoehn-Yahr分级≤2.5级),以及患者配偶或同期来源于社区的健康志愿者共7名作为对照组。利用三维光学运动分析系统来进行步态测试,计算相应运动学时空参数,比较两组受试者在自由行走、转身以及不同认知负荷下(单任务行走和双重任务行走)的步态特征。采用线性混合模型进行各步态参数的比较及交互作用分析。结果帕金森病组行走时的摆臂幅度较对照组减小[单任务下分别为(0.63±0.15)m与(0.89±0.27)m,双任务下分别为(0.64±0.16)m与(0.99±0.22)m,β=-0.353,95%CI-0.558^-0.148,P=0.002]。帕金森病组的双臂摆动幅度不对称性比对照组更大(单任务下分别为12.48%±5.48%与6.96%±4.39%,双任务下分别为17.13%±4.05%与7.67%±5.23%,β=8.992,95%CI 4.148~13.836,P=0.001)。双重任务行走时帕金森病组双臂摆幅不对称性较对照组增加的幅度比在单任务行走时增加的幅度更大(β=3.916,95%CI 1.367~6.466,P=0.003)。对于下肢步态特征,在任务状态一定时,帕金森病组跨步长和步长均较对照组减小[跨步长分别为(1.10±0.17)m与(1.31±0.10)m,β=-0.169,95%CI-0.300^-0.038,P=0.015;步长分别为(0.55±0.09)m与(0.65±0.04)m,β=-0.081,95%CI-0.150^-0.013,P=0.023],步宽以及两种行走任务状态下的跨步长、步长在两组间的差异无统计学意义(均P>0.05)。帕金森病组完成转身过程的耗时比对照组长[(1.66±0.30)s与(1.37±0.23)s,β=0.302,95%CI 0.049~0.555,P=0.023],在转身起始模式上,转身起始时间与分析的身体部位有关,为头部先于骨盆开始转向(β=-0.060,95%CI-0.107^-0.014,P=0.011),而与组别无关(P>0.05)。结论通过量化的步态参数能更准确地反映早期帕金森病的步态特征。早期帕金森病患者的摆臂幅度减小,摆臂不对称性增大,步长缩短,转身速率减慢;摆臂不对称性在双重任务行走时进一步加大。

Objective To identify and quantify spatiotemporal and kinematic gait parameters in a group of early-stage Parkinson′s disease(PD)patients compared with healthy subjects.Methods Eight patients with PD(PD group,Hoehn-Yahr stage≤2.5)and seven age-matched healthy subjects(control group)were enrolled from the Department of Neurology,Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine between May 2017 and August 2018 for the study.The spatiotemporal and kinematic gait parameters were obtained by Vicon 3D optical motion analysis system under three conditions:single-task walking,dual-task walking and turning.The linear mixed model was used to compare the gait parameters between the two groups and analyze the interactive effects.Results Arm swing amplitude in the PD group was lower than that in the control group((0.63±0.15)m vs(0.89±0.27)m in single-task walking,(0.64±0.16)m vs(0.99±0.22)m in dual-task walking,β=-0.353,95%CI-0.558--0.148,P=0.002).The PD group showed significantly higher arm swing asymmetry than the control group(12.48%±5.48%vs 6.96%±4.39%in single-task walking,17.13%±4.05%vs 7.67%±5.23%in dual-task walking,β=8.992,95%CI 4.148-13.836,P=0.001).A notable interactive effect of groups and task factors in arm swing asymmetry was found.The arm swing asymmetry of the PD group increased more than the control group in dual-task walking than in single-task walking(β=3.916,95%CI 1.367-6.466,P=0.003).As for the gait characteristics of the lower limbs,stride length and step length of the PD group were lower than those of the control group((1.10±0.17)m vs(1.31±0.10)m in stride length,β=-0.169,95%CI-0.300--0.038,P=0.015;(0.55±0.09)m vs(0.65±0.04)m in step length,β=-0.081,95%CI-0.150--0.013,P=0.023).For both groups,statistically significant differences were not observed in step width,stride length and step length between single-task and dual-task walking(P>0.05).The PD group completed the turning process faster than the control group((1.66±0.30)s vs(1.37±0.23)s,β=0.302,95%CI 0.049-0.555,P=0.023).As for the rotation-onset pattern,no statistically significant differences were found between the PD and the control group for the onset of the head,trunk and pelvic rotation(P>0.05).Participants started to rotate their heads before the pelvis in all groups(β=-0.060,95%CI-0.107--0.014,P=0.011).Conclusions The quantified gait parameters can more accurately reflect the gait characteristics of early PD.Patients with PD exhibited smaller arm swing magnitude,greater arm swing asymmetry,shorter stride length,and slower turning speed compared to the controls.Arm swing asymmetry further differs between subjects with early PD and controls under dual-task walking.