帕金森病冲动控制障碍发生率及相关影响因素分析

Study on the incidence and related risk factors for impulsive control disorders in Parkinson’s disease

目的总结帕金森病患者冲动控制障碍发生率并筛查其相关危险因素。方法纳入2016年5月至2017年9月中国医科大学附属第一医院收治的201例原发性帕金森病患者,采用冲动控制障碍问卷(QUIP)评估冲动控制障碍;统一帕金森病评价量表第一至四部分(UPDRSⅠ~Ⅳ)分别评估精神、行为和情绪,日常活动,运动功能,治疗相关并发症;Hoehn-Yahr分期评估疾病严重程度;老年抑郁量表(GDS)评估抑郁症状。单因素和多因素前进法Logistic回归分析筛查帕金森病冲动控制障碍相关危险因素。结果共201例帕金森病患者,经QUIP量表筛查出41例冲动控制障碍患者,冲动控制障碍发生率为20.40%,主要表现为强迫性服药占8.46%(17/201)、强迫性饮食占7.46%(15/201)、刻板行为占6.46%(13/201)、强迫性购物占3.98%(8/201)、病理性赌博占1.49%(3/201)、性欲亢进占0.49%(1/201)。Logistic回归分析显示,服药时间长(OR=1.237,95%CI:1.038~1.474;P=0.018)、UPDRSⅣ评分高(OR=1.389,95%CI:1.077~1.790;P=0.011)、抑郁(OR=2.417,95%CI:0.174~0.984;P=0.046)是帕金森病冲动控制障碍的危险因素。结论帕金森病冲动控制障碍发生率较高,服药时间长、治疗相关并发症严重、抑郁是其危险因素,临床可以根据QUIP量表评估冲动控制障碍风险以指导临床用药。

Objective To investigate the incidence and risk factors for impulsive control disorders(ICDs) in Parkinson’s disease(PD).Methods A total of 201 patients with PD were included from May2016 to September 2017.ICDs were assessed by Questionnaire for Impulsive-Compulsive Disorders in Parkinson’s Disease(QUIP).Mentation,behavior and mood,activities of daily living,motor function,and complications for therapy were assessed by Unified Parkinson’s Disease Rating Scale(UPDRS).Disease severity was assessed by Hoehn-Yahr staging,and depression was assessed by Geriatric Depression Scale(GDS).Univariate and multivariate forward Logistic regression analyses were used to analyze the risk factors for PD patients with ICDs.Results Among 201 PD patients,41 patients(20.40%) were diagnosed with ICDs,including 17 cases of compulsive medicine use(8.46%),15 cases of compulsive eating(7.46%),13 cases of punding(6.46%),8 cases of compulsive shopping(3.98%),3 cases of pathological gambing(1.49%) and one case of hypersexuality(0.49%).Logistic regression analysis showed that the longer treatment duration(OR=1.237,95%CI:1.038-1.474;P=0.018),severe complications for therapy(high UPDRS IV score;OR=1.389,95%CI:1.077-1.790,P=0.011),depression(OR=2.417,95%CI:0.174-0.984;P=0.046) were the risk factors for PD patients with ICDs.Conclusions The incidence of ICDs in PD is high,which is affected by many factors.The risk of ICDs can be evaluated by the QUIP scale to guide medication.