路易体痴呆患者跌倒的危险因素分析

The study on risk factors for falls in patients with dementia with Lewy bodies

目的分析路易体痴呆(dementia with Lewy bodies,DLB)发生跌倒的危险因素。方法连续收集2015年7月至2021年3月在天津市环湖医院认知障碍门诊就诊并随访的DLB患者,记录人口学资料及临床资料,进行神经心理量表评估,按就诊前1年内是否有跌倒分为两组,采用多因素Logistic回归分析两组患者跌倒的危险因素。结果共纳入185例DLB患者,其中男91例(49.2%)、女94例(50.8%),平均年龄(72.04±8.12)岁。DLB患者就诊前1年内出现跌倒的比例为27.0%(50例)。多因素logistics回归分析结果显示肌强直〔比值比(odds ratio,OR)2.286,95%可信区间(confidence interval,CI)为1.027~5.090,P=0.043〕、姿势步态异常(OR=4.756,95%CI为2.213~10.217,P<0.001)以及神经精神科问卷(NPI)得分较高(OR=1.027,95%CI为1.002~1.053,P=0.034)是DLB患者发生跌倒的独立危险因素。结论DLB患者跌倒发生率较高,尤其应该重视对伴有肌强直、姿势步态异常、精神行为异常的DLB患者的跌倒风险预防,加强干预措施。

Objective To analyze the risk factors of falls in dementia with Lewy bodies(DLB).Methods A total of 185 cases of patients with DLB in the cognitive impairment outpatient department in the Tianjin Huanhu hospital from July 2015 to March 2021 were registered consecutively.Demographic and clinical data were recorded and they were assessed by neuropsychological scales.The patients were divided into two groups according to whether they had fallen within 1 year before the visit,and multivariate logistic regression was used to analyze the risk factors of falls in both groups.Results A total of 185 patients with DLB were included in the study,including 91 males(49.2%)and 94 females(50.8%),with an average age of(72.04±8.12)years.27.0%(50 cases)of the DLB patients had falls within 1 year prior to treatment.Multivariate logistic regression analysis showed that rigidity[odds ratio(OR)=2.286,95%confidence interval(CI)1.027-5.090,P=0.043],abnormal posture and gait(OR=4.756,95%CI 2.213-10.217,P<0.001),and high NPI score(OR=1.027,95%CI 1.002-1.053,P=0.034)were independent risk factors for falls in DLB patients.Conclusions The prevalence of falls in patients with DLB was high.In particular,attention should be paid to the prevention of falls in DLB patients with rigidity,postures and gait abnormalities,and mental behavior abnormalities,and intervention measures should be strengthened.