初诊帕金森病患者小幻觉患病率和相关危险因素分析

Prevalence and related risk factors of minor hallucinations in newly diagnosed Parkinson's disease patients

目的调查初诊未服药的帕金森病(PD)患者中小幻觉(MH)的患病率和相关危险因素。方法纳入2018年11月至2022年12月南京医科大学附属脑科医院PD专病门诊收治的274例初诊未服药PD患者,根据统一PD评定量表第一部分(UPDRSⅠ)第2项评分筛选出MH的PD患者(MH组,评分≥2分),并在非MH的PD患者(NMH组,评分0分)中筛选年龄、性别、教育程度、病程相匹配的患者。采用合适的量表评估患者认知功能、抑郁症状、焦虑症状、睡眠质量、非运动症状、快速眼动期睡眠障碍(RBD)症状、日常生活活动、运动功能、病情严重程度,比较两组间的差异,并使用单因素和多因素前进法Logistic回归分析PD患者发生MH的相关危险因素。结果274例初诊PD患者中共11例(4.01%)出现MH。与NMH组(22例)相比,MH组的汉密尔顿抑郁量表(HAMD)评分、汉密尔顿焦虑量表(HAMA)评分、PD非运动症状问卷量表(PDNMS)评分、RBD评分显著升高(均P<0.05)。单因素Logistic回归分析显示,HAMD评分高、HAMA评分高、PDNMS评分高、RBD评分高是PD患者发生MH的危险因素(均P<0.05)。进一步进行多因素Logistic回归分析显示,HAMD评分高(OR=1.182,95%CI:1.004~1.392,P=0.045)、RBD评分高(OR=4.448,95%CI:1.066~18.557,P=0.041)是PD患者发生MH的独立危险因素。结论初诊未服药的PD患者出现MH的概率较低,且抑郁、RBD为PD患者发生MH的独立危险因素,应重视该类患者的筛查并采取早期的干预措施。

Objective To screen the prevalence and related risk factors of minor hallucinations(MH)in newly diagnosed Parkinson's disease(PD).Methods From November 2018 to December 2022,274 newly diagnosed patients with untreated PD were enrolled in the PD Clinic of Brain Hospital Affiliated to Nanjing Medical University.According to the score of item 2 of the unified PD rating scale I(UPDRS I),the PD patients with MH were selected(MH group,score≥2).The patients matched in age,sex,education and course of disease level were screened in non-MH PD patients(NMH group,score=O).Cognitive function,depressive symptoms,anxiety symptoms,sleep quality,non-motor symptoms,rapid eye movement sleep disorder(RBD)symptoms,activities of daily life,motor function and disease severity were evaluated with appropriate scales.The differences between two groups were compared,and the risk factors of MH in PD patients were analyzed by univariate and multivariate progressive Logistic regression.Results Among the 274 newly diagnosed PD patients,11 cases(4.01%)had MH.Compared with those in NMH group(22 cases),MH group had higher Hamilton depression scale(HAMD)scores,higher Hamilton anxiety scale(HAMA)scores,higher PD non motor symptoms(PDNMS)scores and higher RBD scores(all P<0.05).Univariate Logistic regression analysis showed that high HAMD scores,high HAMA scores,high PDNMS scores and high RBD scores were risk factors for MH in PD patients(all P<O.05).Multivariate Logistic regression analysis showed that high HAMD score(OR=1.182,95%CI:1.004-1.392,P=0.045)and high RBD score(OR=4.448,95%CI:1.066-18.557,P=0.041)were independent risk factors for MH in PD patients.Conclusions MH may occur in newly diagnosed PD patients with probability.Depression and RBD are independent risk factors for MH in PD patients.Attention should be paid to screening patients like this and early intervention measures should be taken.