帕金森病患者伴发便秘的临床特征及其对生活质量的影响

Clinical characteristics of Parkinson's disease patients with constipation and its effect on quality of life

目的探讨帕金森病(PD)伴发便秘患者的临床特征、影响因素及其对生活质量的影响。方法采用自行设计的调查表连续收集2018年3~9月就诊于西安交通大学第一附属医院神经内科的122例PD患者的临床资料。按罗马Ⅲ功能性便秘诊断标准确定有无便秘、Wexner量表评价便秘严重程度、采用非运动评价量表(NMSS)评价非运动症状、统一的帕金森病评定量表(UPDR)Ⅲ部分评价运动症状的严重程度、改良的Hoehn-Yahr分级评价疾病严重程度、帕金森病患者生活质量问卷-39(PDQ-39)评定生活质量。根据资料的性质采用相应的统计学方法分析PD患者伴或不伴有便秘的影响因素。结果122例PD患者中伴发便秘者71例(58.20%),29例(40.85%)便秘发生于运动症状之前,平均5(2.0,11.5)年;随着Hoehn-Yahr分级增加,便秘发生率随之增加,但差异无统计学意义(P>0.05),便秘严重程度也随之增加,差异有显著统计学意义(P<0.01);便秘组患者的年龄、起病年龄、改良的Hoehn-Yahr分级、异动症发生、左旋多巴和多巴胺受体激动剂使用率、UPDRSⅢ评分、NMSS评分和PDQ-39评分明显大于非便秘组,差异均有统计学意义(P<0.05);相关性分析显示:便秘发生与病程、Hoehn-Yahr分级、NMSS评分、UPDRSⅢ评分、PDQ-39评分呈正相关(r=0.48、0.24、0.26、0.25、0.29,P<0.05);Logistic回归分析显示:NMSS评分为便秘发生的唯一独立危险因素(P<0.01);PDQ-39分值和年龄、Hoehn-Yahr分级、UPDRSⅢ评分、NMSS评分及Wexner评分呈正相关(r=0.52、0.62、0.70、0.82、0.51,P<0.01);线性回归分析显示:性别、Hoehn-yahr分级、UPDRSⅢ和Wexner评分是影响PDQ-39评分的危险因素(P<0.05)。结论便秘是PD患者非常常见的非运动症状,伴发便秘的患者生活质量更差。

Objective To discuss the clinical characteristics and influencing factors of Parkinson's disease(PD)patients with constipation,and their effects on quality of life.Methods A total of 122 patients with Parkinson's disease were recruited by a self-designed questionnaire.RomeⅢdiagnostic criteria of functional constipation was used to evaluate constipation.Wexner was used to measure the severity of constipation.Non-motor symptoms scale(NMSS)was used to evaluate non-motor symptoms.Unified Parkinson's disease rating scaleⅢ(UPDRSⅢ)was used to evaluate the severity of motor symptoms.Severity of illness was evaluated by the modified Hoehn-Yahr stages.Parkinson’s disease questionnaire-39 items(PDQ-39)were used to evaluate the quality of life.The corresponding statistical methods were used to analyze the difference of PD patients with or without constipation.Results Among the 122 patients,71(58.20%)was associated with constipation,of which 29(40.85%)experienced constipation before motor symptoms,for an average of 5(2.0,11.5)years.The incidence of constipation increased(P>0.05)and the severity of constipation increased(P<0.01)with the progression of the modified Hoehn-Yahr stages.Compared to patients without constipation,PD patients with constipation had older age,earlier onset age,higher modified Hoehn-Yahr grade,higher occurrence of dyskinesia higher use rate of levodopa and dopamine receptor agonists,and higher scores of UPDRSⅢ,PDQ-39,and NMSS(P<0.05).Correlation analysis showed that constipation was positively correlated with disease duration,the modified Hoehn-Yahr stages,NMSS scores,UPDRSⅢscores,and PDQ-39 scores(r=0.48,0.24,0.26,0.25,0.29,P<0.05).Logistic regression analysis showed that NMSS score was an independent risk factor for constipation.PDQ-39 score was positively correlated with age,modified Hoehn-Yahr stages,NMSS scores,UPDRSⅢscores,NMSS scores,and Wexner scores(r=0.52,0.62,0.70,0.82,0.51,P<0.01).The linear regression analysis showed that gender,Hoehn-yahr grade,UPDRSⅢscore,and Wexner score were independent risk factors that affected the PDQ-39 score(P<0.05).Conclusion Constipation is a common non-motor symptom in patients with PD.Complication with constipation lead to worse quality of life.