帕金森病前驱期轻微运动症状临床特征分析

Analysis of clinical features of mild motor symptoms in prodromal Parkinson′s disease

目的探讨帕金森病前驱期(pPD)患者轻微运动症状(MMS)的特征及其演变特点。方法基于2018年7月至2020年12月在南京市社区通过帕金森病前驱期临床评估量表进行筛查建立的pPD队列,对完成基线评估且随访时间至少在1年以上的30例pPD患者进行临床数据分析,并依据统一帕金森病评定量表中第三部分(UPDRS-Ⅲ)评分将其分为MMS组(UPDRS-Ⅲ评分>3分)和非MMS组(NMMS组,UPDRS-Ⅲ评分≤3分),比较两组患者基线和随访终点临床特征的差异和演变特点,采用多元线性回归分析pPD患者运动症状进展的危险因素。结果在30例pPD患者中,MMS组患者有23例,在随访终点有7例转化为帕金森病,NMMS组患者有7例,在随访终点有1例转化为帕金森病。pPD患者随访终点的UPDRS-Ⅲ评分[10.00(7.00,17.00)分]、蒙特利尔认知评估量表(MoCA)评分[25.50(24.75,28.00)分]及汉密尔顿焦虑量表(HAMA)评分[9.00(5.00,13.00)分]较基线时[7.00(4.00,12.00)分、24.00(22.75,25.25)分、8.00(2.00,11.00)分]均明显增加,差异具有统计学意义(Z=-3.505,P<0.001;Z=-2.956,P=0.003;Z=-2.427,P=0.015)。亚组分析发现MMS组患者在随访终点的UPDRS-Ⅲ评分[11.00(7.00,18.00)分]、MoCA评分[25.00(24.00,27.00)分]及HAMA评分[9.00(6.00,15.00)分]较基线时[8.00(6.00,12.00)分、24.00(22.00,25.00)分、9.00(3.00,11.00)分]均明显增加,差异具有统计学意义(Z=-2.768,P=0.006;Z=-2.457,P=0.014;Z=-2.250,P=0.024)。MMS组患者在随访终点的非运动症状问卷评分[(8.96±5.20)分]较基线时[(11.04±4.41)分]明显下降,差异有统计学意义(t=2.441,P=0.023)。MMS组患者在随访终点的简易精神状态检查量表(MMSE)、汉密尔顿抑郁量表(HAMD)、中国香港中文大学快速眼球运动睡眠期行为障碍量表(RBDQ-HK)及Sniffin′sticks嗅觉测试评分与基线时相比差异均无统计学意义。NMMS组中只有UPDRS-Ⅲ评分在随访终点[7.00(5.00,8.00)分]较基线时[4.00(1.00,4.00)分]增加,差异具有统计学意义(Z=-2.375,P=0.018)。NMMS组患者在随访终点的MoCA、MMSE、HAMA、HAMD、RBDQ-HK及Sniffin′sticks嗅觉测试评分较基线时比较差异均无统计学意义。结论具有轻微运动症状的pPD患者临床转化率高,应重视对该类人群的帕金森病筛查。

Objective To investigate the characteristics and evolution of mild motor symptoms(MMS)in patients with prodromal Parkinson′s disease(pPD).Methods Based on the pPD cohort screened by Parkinson′s Disease Prodromal Clinical Assessment Scale in Nanjing community from July 2018 to December 2020,the clinical data of 30 patients with pPD who completed the baseline assessment and were followed up for at least 1 year were analyzed.According to the Unified Parkinson Diease Rating ScaleⅢ(UPDRS-Ⅲ)score,the patients were divided into MMS group(UPDRS-Ⅲscore>3)and non-MMS group(NMMS group,UPDRS-Ⅲscore≤3).The differences and evolution characteristics of clinical characteristics between the 2 groups were compared.Multivariate linear regression was used to analyze the risk factors of motor symptom progression in pPD patients.Results Among the 30 patients with pPD,7 of 23 patients in the MMS group were converted to PD at the end of follow-up,1 of 7 patients in the NMMS group were converted to PD at the end of follow-up.The UPDRS-Ⅲscore[10.00(7.00,17.00)],Montreal Cognitive Assessment Scale(MoCA)score[25.50(24.75,28.00)]and the Hamilton Anxiety Scale(HAMA)score[9.00(5.00,13.00)]at the end of follow-up of pPD patients were significantly higher than those at baseline[7.00(4.00,12.00),24.00(22.75,25.25)and 8.00(2.00,11.00)],and the differences were statistically significant(Z=-3.505,P<0.001;Z=-2.956,P=0.003;Z=-2.427,P=0.015).Subgroup analysis showed that UPDRS-Ⅲscore[11.00(7.00,18.00)],MoCA score[25.00(24.00,27.00)]and HAMA score[9.00(6.00,15.00)]at the end of follow-up in the MMS group were higher than those at baseline[8.00(6.00,12.00),24.00(22.00,25.00)and 9.00(3.00,11.00)],and the difference was statistically significant(Z=-2.768,P=0.006;Z=-2.457,P=0.014;Z=-2.250,P=0.024).The Non-Motor Symptoms Questionnaire score at the end of follow-up in the MMS group(8.96±5.20)was significantly lower than that in the baseline(11.04±4.41),and the difference was statistically significant(t=2.441,P=0.023).There was no significant difference in Mini-Mental State Examination(MMSE),Hamilton Depression Scale(HAMD),Rapid Eyes Movement Sleep Behavior Disorder Questionnaire-Hong Kong(RBDQ-HK)and Sniffin′sticks olfactory test score at the end of follow-up in the MMS group.Only UPDRS-Ⅲscore in the NMMS group was increased at the end of follow-up[7.00(5.00,8.00)]compared with the baseline[4.00(1.00,4.00)],and the difference was statistically significant(Z=-2.375,P=0.018).There was no significant difference in MoCA,MMSE,HAMA,HAMD,RBDQ-HK,and Sniffin′sticks olfactory test score between the NMMS group and the baseline at the end of follow-up.Conclusion The clinical conversion rate of pPD patients with MMS is high,and screening of this population should be paid attention.