帕金森病伴发疲劳的影响因素分析

Analysis of influencing factors of fatigue in Parkinson’s disease

目的分析帕金森病(PD)患者疲劳的影响因素及其临床症状特点,为PD伴发疲劳的治疗提供参考。方法病例对照研究,选取2019年1月-2020年12月包头医学院第二附属医院神经内科收治的155例PD患者,根据疲劳严重度量表(FSS),PD无疲劳组(FSS>4分)59例,PD伴发疲劳组(FSS≤4分)96例。采用统一帕金森病评定量表第三部分(MDS-UPDRSⅢ)、Hoehn-Yahr(H-Y)分级、汉密尔顿抑郁量表(HAMA)17项、汉密尔顿焦虑量表(HAMD)14项、帕金森病睡眠量表(PDSS)中文版、简易精神状态量表等评估患者的运动症状和非运动症状。采用疲劳量表-14(FS-14)对PD患者的躯体疲劳、脑力疲劳进行评分。PD患者依据MDS-UPDRSⅡ~Ⅲ条目计算震颤类项目总分和姿势异常-步态障碍类项目总分。结果与非疲劳组比较,疲劳组患者MDS-UPDRSⅢ、H-Y评分、HAMA、HAMD、病程均增高,PDSS降低(P<0.05)。MDS-UPDRSⅢ评分(OR=1.105,P=0.011)、抑郁(OR=1.160,P=0.028)是疲劳的独立危险因素。脑力疲劳与HAMD(r_(s)=0.792)正向强相关关系;躯体疲劳与MDS-UPDRSⅢ(r_(s)=0.645)、姿势异常-步态障碍类总分(r_(s)=0.659)、HAMA(r_(s)=0.654)、H-Y评分(r_(s)=06.74)正向强相关关系,与PDSS(r_(s)=-0.674)负向强相关关系。结论运动症状、抑郁严重的PD患者易发生疲劳。姿势异常-步态障碍型、抑郁、睡眠障碍的PD患者易发生躯体疲劳,焦虑的PD患者易发生脑力疲劳。

Objective To analyze the influencing factors and clinical significance of fatigue in patients with Parkinson’s disease(PD).Methods 155 patients with PD were selected from the Department of Neurology of the Second Affiliated Hospital of Baotou Medical College from January 2019 to December 2020.According to the fatigue severity scale(FSS),59 patients in the PD non fatigue group(FSS>4 points)and 96 patients in the PD fatigue group(FSS≤4 points).Unified Parkinson’s disease rating scale Part III(MDS-UPDRSⅢ)、Hoehn-Yahr(H-Y)、Hamilton Depression Scale(HAMA)17,Hamilton Anxiety Scale(HAMD)14,Parkinson’s disease Sleep Scale(PDSS)Chinese version,simple mental state scale and so on.The physical fatigue and mental fatigue of PD patients were scored by fatigue Scale-14(fs-14).The total scores of tremor items and postural abnormalities gait disorders were calculated according to the items of MDS UPDRSⅡ~Ⅲ.Results Compared with the non fatigue group,the mds-updrsⅢ,H-Y score,HAMA,HAMD and course of disease in the fatigue group were increased,and the PDSS was decreased(P<0.05).Mds-updrsⅢscore(OR=1.105,P=0.011)and depression(OR=1.160,P=0.028)were independent risk factors for fatigue.Mental fatigue was positively and strongly correlated with HAMD(r_(s)=0.792);physical fatigue was positively and strongly correlated with mds-updrsⅢ(r_(s)=0.645),total score of postural abnormalities gait disorders(r_(s)=0.659),HAMA(r_(s)=0.654)and H-Y score(r_(s)=0.674),which was positively and strongly correlated with PDSS(r_(s)=-0.674)negative strong correlation.Conclusion The incidence rate of fatigue in PD patients is high,and is associated with motor symptoms,sleep disorders,anxiety and depression.