身体优先型和脑优先型早期帕金森病患者非运动症状的临床比较研究

A comparative clinical study of non-motor symptoms in early Parkinson′s disease patients with body-first subtype and brain-first subtype

目的探讨早期帕金森病患者各种非运动症状(NMS)的出现率以及在身体优先和脑优先两种亚型之间各种NMS出现率的差异。方法连续收集2012年1月至2015年1月于北京医院神经内科帕金森病门诊就诊的121例早期帕金森病患者(Hohen-Yahr分期为1~2期)的一般资料及疾病临床特征。采用国际睡眠障碍分型修订版中的快速眼球运动期睡眠行为障碍(RBD)的最低诊断标准诊断RBD,根据RBD与运动症状出现的先后顺序将患者分为身体优先型和脑优先型两组。采用非运动症状问卷调查(NMSQuest)评定NMS。比较身体优先型和脑优先型帕金森病患者的临床特征及各NMS的出现率之间的差异。应用统一帕金森病评定量表(UPDRS)对患者的疾病严重程度进行评分,其中第三部分(UPDRS-Ⅲ)评价患者的运动功能;应用汉密尔顿抑郁量表(HAMD)和汉密尔顿焦虑量表(HAMA)评估患者的抑郁和焦虑状况;应用帕金森病睡眠量表(PDSS)评定患者的睡眠状况;应用39项帕金森病生活质量问卷(PDQ-39)评定患者的生活质量。结果121例帕金森病患者中,身体优先型共60例(49.59%),脑优先型共61例(50.41%),两组患者的UPDRS-Ⅲ评分差异无统计学意义。所有入组帕金森病患者的NMS平均个数为(10.97±4.88)个。身体优先型患者在吞咽困难[46.7%(28/60)比23.0%(14/61),χ^(2)=7.507,P=0.006]、恶心呕吐[16.7%(10/60)比3.3%(2/61),χ^(2)=6.069,P=0.014]、便秘[85.0%(51/60)比55.7%(34/61),χ^(2)=12.393,P<0.001]、便失禁[8.3%(5/60)比0(0/61),χ^(2)=5.302,P=0.021]、近事记忆困难[58.3%(35/60)比32.8%(20/61),χ^(2)=7.962,P=0.005]、兴趣减少[43.3%(26/60)比24.6%(15/61),χ^(2)=4.743,P=0.029]、注意力不集中[45.0%(27/60)比19.7%(12/61),χ^(2)=8.884,P=0.003]、情绪低落[55.0%(33/60)比34.4%(21/61),χ^(2)=5.181,P=0.023]、生动梦境[73.3%(44/60)比39.3%(24/61),χ^(2)=14.196,P<0.001]、不宁腿[53.3%(32/60)比27.9%(17/61),χ^(2)=8.140,P=0.004]的出现率均明显高于脑优先型,差异均具有统计学意义。身体优先亚型的分型与NMSQuest(r=-0.489,P<0.001)、UPDRS(r=-0.189,P=0.038)、HAMD(r=-0.231,P=0.011)、HAMA(r=-0.298,P=0.001)以及PDQ-39评分(r=-0.276,P=0.002)呈负相关,与PDSS评分呈正相关(r=0.205,P=0.024)。NMSQuest是PDQ-39评分的主要决定因素(ΔR^(2)=0.265,P<0.001)。结论帕金森病患者伴有多种NMS,是影响患者生活质量的主要因素。在早期帕金森病患者中,身体优先型较脑优先型可能具有更多的NMS负担及更高的出现率。

Objective To investigate the incidence of various non-motor symptoms(NMS)in early stage of Parkinson′s disease(PD)patients and the differences between the body-first and brain-first subtypes.Methods A total of 121 patients with PD(Hoehn-Yahr stage 1-2)were recruited from PD Clinic,Department of Neurology,Beijing Hospital from January 2012 to January 2015.The general information and clinical features of the patients were collected.The minimal diagnostic criteria of parasomnias described in the International Classification of Sleep Disorders-Revised were used to diagnose rapid eye movement sleep behavior disorder(RBD).According to the sequence of RBD and motor symptoms,the patients were divided into 2 groups:body-first subtype and brain-first subtype.NMS was evaluated by the Non-Motor Symptom Questionnaire(NMSQuest).The clinical features and the incidence of various NMS were compared between the 2 groups.The Unified Parkinson′s Disease Rating Scale(UPDRS)was used to evaluate the severity of the disease,and its third part(UPDRS-Ⅲ)was used to evaluate the motor function of the patients.Hamilton Rating Scale for Depression(HAMD)and Hamilton Rating Scale for Anxiety(HAMA)were used to evaluate the depression and anxiety status of the patients.The sleep status of patients was assessed by Parkinson′s Disease Sleep Scale(PDSS).The quality of life of the patients was assessed by 39-item Parkinson′s Disease Questionnaire(PDQ-39).Results Of all the patients,49.59%(60/121)had the body-first subtype and 50.41%(61/121)had the brain-first subtype of PD.There was no significant difference in UPDRS-Ⅲscore between the 2 groups.The average number of NMS in all PD patients was 10.97±4.88.Body-first subtype patients had higher NMS incidence than brain-first subtype in difficulty in swallowing[46.7%(28/60)vs 23.0%(14/61),χ^(2)=7.507,P=0.006],nausea and vomiting[16.7%(10/60)vs 3.3%(2/61),χ^(2)=6.069,P=0.014],constipation[85.0%(51/60)vs 55.7%(34/61),χ^(2)=12.393,P<0.001],fecal incontinence[8.3%(5/60)vs 0(0/61),χ^(2)=5.302,P=0.021],difficulty in remembering recent events[58.3%(35/60)vs 32.8%(20/61),χ^(2)=7.962,P=0.005],loss of interest[43.3%(26/60)vs 24.6%(15/61),χ^(2)=4.743,P=0.029],inattention[45.0%(27/60)vs 19.7%(12/61),χ^(2)=8.884,P=0.003],depression[55.0%(33/60)vs 34.4%(21/61),χ^(2)=5.181,P=0.023],intense vivid dreams[73.3%(44/60)vs 39.3%(24/61),χ^(2)=14.196,P<0.001]and restless legs[53.3%(32/60)vs 27.9%(17/61),χ^(2)=8.140,P=0.004].The differences were significant.Body-first subtype and NMSQuest(r=-0.489,P<0.001),UPDRS(r=-0.189,P=0.038),HAMD(r=-0.231,P=0.011),HAMA(r=-0.298,P=0.001)and PDQ-39 scores(r=-0.276,P=0.002)were negatively correlated.Body-first subtype and PDSS score was positively correlated.NMSQuest(ΔR^(2)=0.265,P<0.001)was the main determinant of PDQ-39 score.Conclusions PD patients are accompanied by various NMS,which is a major factor affecting the quality of life.Compared with brain-first subtype,body-first subtype might have more NMS burden and higher incidence rate in most NMS in early PD patients.