初诊帕金森病患者疼痛相关危险因素分析

Study on related risk factors of pain in de novo Parkinson’s disease patients

目的筛查初诊且未曾服药的帕金森病患者发生疼痛的危险因素。方法纳入2018年10月至2021年9月南京医科大学附属脑科医院收治的129例初诊帕金森病患者,根据统一帕金森病评价量表第二部分(UPDRSⅡ)第17项分为非疼痛组(评分为零,88例)和疼痛组(评分≥2,41例),采用简易智能状态检查量表(MMSE)和校正蒙特利尔认知评价量表(MoCA)评估患者认知功能,汉密尔顿抑郁量表24项(HAMD-24)评估患者抑郁症状,统一帕金森病评价量表第三部分(UPDRSⅢ)评估运动功能,Hoehn-Yahr分期改良版评估病情严重程度;单因素和多因素前进法Logistic回归分析筛查帕金森病患者发生疼痛的危险因素。结果129例患者中共41例(31.78%)发生疼痛。与非疼痛患者(88例)相比,疼痛患者MMSE评分(Z=-2.389,P=0.017)和校正MoCA评分(Z=-2.166,P=0.030)较低;HAMD-24评分(Z=-4.024,P=0.000)及其焦虑/躯体化(Z=-3.707,P=0.000)、精神障碍(Z=-2.519,P=0.012)、迟缓症状(Z=-2.048,P=0.041)、睡眠障碍(Z=-3.484,P=0.000)和绝望症状(Z=-3.069,P=0.002)分评分,UPDRSⅢ评分(Z=-3.639,P=0.000)和Hoehn-Yahr分级(Z=-2.232,P=0.026)较高。Logistic回归分析显示,病程长(OR=1.354,95%CI:1.013~1.809;P=0.041)、HAMD-24评分高(OR=1.095,95%CI:1.033~1.162;P=0.002)和UPDRSⅢ评分高(OR=1.040,95%CI:1.001~1.082;P=0.046)是帕金森病患者发生疼痛的危险因素。结论初诊帕金森病患者疼痛发生率较高,病程长、抑郁症状严重和运动障碍严重是帕金森病患者发生疼痛的主要危险因素。

Objective To explore the risk factors of pain in de novo Parkinson’s disease(PD)patients.Methods A total of 129 de novo PD patients collected from The Affiliated Brain Hospital of Nanjing Medical University from October 2018 to September 2021 were included.According to the Item-17 of the Unified Parkinson’s Disease Rating ScaleⅡ(UPDRSⅡ-17 th),patients were classified as PD patients without pain(UPDRSⅡ-17 th was 0,n=88)and PD patients with pain(UPDRSⅡ-17 th≥2,n=41).MiniMental State Examination(MMSE)and corrected Montreal Cognitive Assessment(corrected MoCA)were used to assess cognitive function.Meanwhile,Hamilton Depression Rating Scale-24 Items(HAMD-24)was used to assess the depression status and the UPDRSⅢ was used to assess the motor function.The modified version of Hoehn-Yahr staging was used to assess disease severity.The related risk factors of pain in PD patients were analyzed by univariate and multivariate forward Logistic regression.Results The incidence of pain in PD patients was 31.78%(41/129).Compared with PD without pain group,PD with pain group had lower scores in MMSE(Z=-2.389,P=0.017)and corrected MoCA(Z=-2.166,P=0.030),but higher scores in HAMD-24(Z=-4.024,P=0.000),UPDRSⅢ(Z=-3.639,P=0.000)and Hoehn-Yahr staging grading(Z=-2.232,P=0.026).Further analysis of the differences between 2 groups in 7 domains of HAMD-24 showed PD with pain group had higher scores of the anxiety/somatization(Z=-3.707,P=0.000),mental disorder(Z=-2.519,P=0.012),retardation symptom(Z=-2.048,P=0.041),sleep disturbances(Z=-3.484,P=0.000)and despair symptom(Z=-3.069,P=0.002)than PD without pain group.Logistic regression analysis showed long duration(OR=1.354,95%CI:1.013-1.809;P=0.041),high HAMD-24 score(OR=1.095,95%CI:1.033-1.162;P=0.002)and high UPDRSⅢ score(OR=1.040,95%CI:1.001-1.082;P=0.046)were risk factors of pain in PD patients.Conclusions Pain in PD has a high incidence in de novo PD patients.Long duration,a depressed state and severe motor symptoms are main risk factors for the development of pain in PD patients.