帕金森病患者骨质疏松的临床观察

Clinical observation of osteoporosis in Parkinson’s disease patients

目的探索帕金森病(Parkinson’s disease,PD)患者发生骨质疏松症的危险因素及其与PD非运动症状的关系。方法对58例PD患者和63例健康查体人群进行研究,其中PD伴骨质疏松25例,PD不伴骨质疏松33例。检测所有受试者腰椎及一侧股骨颈骨密度(BMD)和血清25-羟维生素D(25OHD)水平,收集PD患者年龄、性别、体质量指数、左旋多巴等效日剂量(LED)、血清同型半胱氨酸(Hcy)水平,并对其进行国际运动障碍协会统一帕金森病评定量表Ⅲ部分(MDS-UPDRSⅢ)、Hoehn-Yahr分期(H-Y分期)评测及情绪、认知、睡眠等非运动症状进行评分。结果PD组股骨颈BMD、腰椎总BMD、25OHD均低于对照组,骨质疏松率、25OHD缺乏率均高于对照组(均P值<0.05)。女性、左旋多巴等效日剂量、高同型半胱氨酸血症、H-Y分期晚期、低体质指数是PD发生骨质疏松的危险因素。情绪、认知、睡眠等非运动症状与PD患者骨质疏松不相关。结论PD患者是发生骨质疏松的高危人群,应针对其发生骨质疏松的相关危险因素采取干预措施,降低致残、致死率。

Objective The purpose of this study is to explore the risk factors of osteoporosis in patients with Parkinson's disease(PD)and the relationship between osteoporosis and non-motor symptoms of PD.Methods 58 PD patients and 63 healthy people were studied,including 25 cases of PD with osteoporosis and 33 cases of PD without osteoporosis.The bone mineral density(BMD)and serum 25-hydroxyvitamin D(25OHD)levels of lumbar vertebrae and femoral neck of all subjects were detected.The age,sex,body mass index,levodopa equivalent daily dose(LED)and serum homocysteine(Hcy)levels of PD patients were collected,and they were evaluated by the International Association for Motor Disorders Unified Parkinson’s Disease Rating Scale Ⅲ(MDS-UPDRS Ⅲ),Hoehn-Yahr Stage(H-Y Stage)and scored for non-motor symptoms such as emotion,cognition and sleep.Results In PD group,BMD of femoral neck,total BMD of lumbar spine and 25OHD were lower than those in control group,while osteoporosis rate and 25OHD deficiency rate were higher than those in control group(P<0.05).Female,equivalent daily dose of levodopa,hyperhomocysteinemia,late H-Y stage and low body mass index are the risk factors of osteoporosis in PD.Emotion,cognition,sleep and other non-motor symptoms are not related to osteoporosis in PD patients.Conclusion PD patients are a high-risk group with osteoporosis.Intervention measures should be taken to reduce the disability and mortality rate according to the related risk factors of osteoporosis.