帕金森病伴发抑郁的临床特征及性别差异

The Gender and Clinical Symptoms Difference in Depression of Parkinson’s Disease

目的通过对帕金森伴发抑郁(dPD)进行量表评估,进一步研究其发病机制,指导特异性治疗。方法应用PD相关量表对200例PD患者的运动及非运动症状进行评分。利用HAMD量表,将评分≥20分的56例患者纳入dPD组,评分<20分的144例患者纳入ndPD组。所得评分进行统计分析。结果①PD患者女性抑郁的患病率高于男性,差异具有统计学意义。②dPD患者男性强直及运动迟缓得分均较女性高,震颤得分较女性低,差异具有统计学意义。③PD女性在情绪/情感淡漠NMS症状群、感觉问题/幻觉得分高于男性,差异具有统计学意义。④dPD患者的HAMA得分、HAMD得分、NMSQ总分均较ndPD患者得分高;dPD患者的PDSS得分较ndPD患者低;dPD患者的震颤得分、强直得分、姿势不稳得分、运动迟缓得分、UPDRS-III得分均较ndPD患者得分高,以上差异有统计学意义。⑤dPD患者的抑郁得分与左旋多巴等效剂量呈负相关,与H-Y分期、PD睡眠量表、强直评分呈正相关。结论①dPD患者运动症状具有性别差异。②dPD患者的运动症状及非运动症状均较ndPD患者严重。③dPD患者的抑郁得分与药物使用量、运动症状和非运动症状均有相关性。④针对存在的性别差异,研发性别特异性的治疗剂需引起特别的关注,以用来有效治疗PD及dPD患者。

Objective We aimed to analyze the gender differences by evaluating the motor and non-motor symptoms among the patients with parkinson’s disease and the patients with depression of parkinson’s disease,and to explore the possible pathogenesis further and make sex-specific therapeutic strategies. Methods Two hundred patients with parkinson’s disease from both the outpatients department and the ward were included in this analysis. There were 56 patients whose HAMD scores exceeded 19,which were divided into the depession of parkinson’s disease( dPD) group.There are 144 patients whose HAMD scores under 20,which were divided into the non-depession of parkinson’s disease( ndPD) group. The scores from all the scales were analyzed using statistical software. Results ①The depression incidence of females was significantly higher than that of males in PD patients( P < 0. 05) . ②Rigidity score and Bradykinesia score in males were significantly higher than that in females in dPD patients( P < 0. 05). Tremor score in males was significantly lower than that in females in dPD patients( P < 0. 05) . ③A significantly higher score in mood/apathy and feel problem/hallucination domains were observed in female PD patients( P < 0. 05) . ④The HAMA score,HAMD score,NMSQ total score of dPD patients were all significantly higher than that of ndPD patients( P < 0. 05). The PDSS score of dPD patients was significantly lower than that of ndPD patients( P < 0. 05). The tremor score,rigidity score,postural instability score,bradykinesia score,UPDRS-III score of dPD patients were all significantly higher than that of ndPD patients( P < 0. 05) . ⑤The HAMD scores correlated with levodopa equivalent doses( Led)( r =-0. 31,P = 0. 01),H-Y stage( r = 0. 23,P = 0. 03),PDSS( r = 0.36,P = 0. 01) and rigidity( r = 0. 27,P = 0. 04) scores. Conclusion ①There are gender differences bewteen males and females in motor disorders in depression of parkinson’s disease. ②The motor disorders and non-motor disorders were more severe in depression of parkinson’s disease than in non-depression of parkinson’s disease. ③The HAMD score in depression of parkinson’s disease correlated with levodopa equivalent doses,the motor disorders and the non-motor disorders. ④The spectrum of motor and non-motor symptoms showed different gender distribution in PD and dPD patients. Gender-specific therapeutic agents hold particula attention for developing treatments with optimal efficaty in men and women in the future.