中华临床医师杂志（电子版）
中華臨床醫師雜誌（電子版）
중화림상의사잡지（전자판）
CHINESE JOURNAL OF CLINICIANS(ELECTRONIC VERSION)
2013年
15期
6898-6903
,共6页
曹辰杰%余舒扬%左丽君%陈泽颉%孙莉%黄曦妍%刘卓%扈杨%王方%张巍
曹辰傑%餘舒颺%左麗君%陳澤頡%孫莉%黃晞妍%劉卓%扈楊%王方%張巍
조신걸%여서양%좌려군%진택힐%손리%황희연%류탁%호양%왕방%장외
帕金森病%自主神经系统疾病%运动症状%非运动症状
帕金森病%自主神經繫統疾病%運動癥狀%非運動癥狀
파금삼병%자주신경계통질병%운동증상%비운동증상
Parkinson disease%Autonomic nervous system diseases%Motor symptoms%Non-motor symptoms
目的：探讨帕金森病患者伴发的自主神经功能障碍与运动症状和其他非运动症状之间的相关性。方法收集2010年6月至2012年6月就诊于北京天坛医院神经内科的帕金森病患者243例，记录人口学资料，采用自主神经症状量表（SCOPA-AUT）评价自主神经功能，评测帕金森病统一评定量表第Ⅲ部分（UPDRSⅢ）、Hoehn-Yahr（H-Y）分期、汉密尔顿焦虑量表（HAMA）、汉密尔顿抑郁量表（HAMD）、蒙特利尔认知评估量表（MoCA）、简易精神状态检查量表（MMSE）、匹茨堡睡眠质量指数（PSQI）量表、疲劳量表（FS-14）、日常生活能力量表（ADL）和39项帕金森病生活质量问卷（PDQL-39），并与SCOPA-AUT评分进行相关分析。结果（1）243例帕金森病患者SCOPA-AUT评分为（36.6±8.0）（23～67）分；与起病年龄[平均（59.8±10.1）岁）]及病程[平均（3.8±4.0）年]呈显著正相关（r＝0.248，P＝0.000；r＝0.234， P＝0.000）。（2）自主神经症状以消化系统症状的发生率最高（83.5%），其中便秘最常见（56.4%），其后依次为排尿障碍（79.0%）、性功能障碍（78.6%）、心血管功能障碍（48.6%）及体温调节障碍（47.3%）。（3）SCOPA-AUT评分与UPDRSⅢ评分[（25.9±13.2）分]和H-Y分期[（2.0±0.8）期]均呈显著正相关（r＝0.390，P＝0.000；r＝0.425，P＝0.000）。（4）有抑郁和焦虑的患者分别为169例和154例，HAMD、HADA评分与SCOPA-AUT评分呈显著正相关（r＝0.457，P＝0.000；r＝0.490，P＝0.000）。（5）帕金森病不伴认知障碍（PD-NCI）组、帕金森病伴轻度认知障碍（PD-MCI）组和帕金森病伴痴呆（PDD）组SCOPA-AUT评分依次明显增高[（34.8±7.3）分、（37.9±8.0）分和（38.5±8.7）分，P＝0.011]。（6）有睡眠障碍患者169例，SCOPA-AUT评分与PSQI评分呈显著正相关（r＝0.508，P＝0.000）。（7）有疲劳患者215例，SCOPA-AUT评分与FS-14评分呈显著正相关（r＝0.423，P＝0.000）。（8）ADL评分为（35.3±13.6）分，与 SCOPA-AUT 评分呈显著正相关（r＝0.391，P＝0.000）；PDQL-39评分为（134.1±26.6）分，与SCOPA-AUT评分呈显著负相关（r＝-0.649，P＝0.000）。结论帕金森病患者自主神经功能障碍发生率高，症状多样，与起病年龄、病程、运动症状及认知、焦虑、抑郁、睡眠障碍及疲劳等非运动症状密切相关，严重影响患者的日常生活能力和生活质量。
目的：探討帕金森病患者伴髮的自主神經功能障礙與運動癥狀和其他非運動癥狀之間的相關性。方法收集2010年6月至2012年6月就診于北京天罈醫院神經內科的帕金森病患者243例，記錄人口學資料，採用自主神經癥狀量錶（SCOPA-AUT）評價自主神經功能，評測帕金森病統一評定量錶第Ⅲ部分（UPDRSⅢ）、Hoehn-Yahr（H-Y）分期、漢密爾頓焦慮量錶（HAMA）、漢密爾頓抑鬱量錶（HAMD）、矇特利爾認知評估量錶（MoCA）、簡易精神狀態檢查量錶（MMSE）、匹茨堡睡眠質量指數（PSQI）量錶、疲勞量錶（FS-14）、日常生活能力量錶（ADL）和39項帕金森病生活質量問捲（PDQL-39），併與SCOPA-AUT評分進行相關分析。結果（1）243例帕金森病患者SCOPA-AUT評分為（36.6±8.0）（23～67）分；與起病年齡[平均（59.8±10.1）歲）]及病程[平均（3.8±4.0）年]呈顯著正相關（r＝0.248，P＝0.000；r＝0.234， P＝0.000）。（2）自主神經癥狀以消化繫統癥狀的髮生率最高（83.5%），其中便祕最常見（56.4%），其後依次為排尿障礙（79.0%）、性功能障礙（78.6%）、心血管功能障礙（48.6%）及體溫調節障礙（47.3%）。（3）SCOPA-AUT評分與UPDRSⅢ評分[（25.9±13.2）分]和H-Y分期[（2.0±0.8）期]均呈顯著正相關（r＝0.390，P＝0.000；r＝0.425，P＝0.000）。（4）有抑鬱和焦慮的患者分彆為169例和154例，HAMD、HADA評分與SCOPA-AUT評分呈顯著正相關（r＝0.457，P＝0.000；r＝0.490，P＝0.000）。（5）帕金森病不伴認知障礙（PD-NCI）組、帕金森病伴輕度認知障礙（PD-MCI）組和帕金森病伴癡呆（PDD）組SCOPA-AUT評分依次明顯增高[（34.8±7.3）分、（37.9±8.0）分和（38.5±8.7）分，P＝0.011]。（6）有睡眠障礙患者169例，SCOPA-AUT評分與PSQI評分呈顯著正相關（r＝0.508，P＝0.000）。（7）有疲勞患者215例，SCOPA-AUT評分與FS-14評分呈顯著正相關（r＝0.423，P＝0.000）。（8）ADL評分為（35.3±13.6）分，與 SCOPA-AUT 評分呈顯著正相關（r＝0.391，P＝0.000）；PDQL-39評分為（134.1±26.6）分，與SCOPA-AUT評分呈顯著負相關（r＝-0.649，P＝0.000）。結論帕金森病患者自主神經功能障礙髮生率高，癥狀多樣，與起病年齡、病程、運動癥狀及認知、焦慮、抑鬱、睡眠障礙及疲勞等非運動癥狀密切相關，嚴重影響患者的日常生活能力和生活質量。
목적：탐토파금삼병환자반발적자주신경공능장애여운동증상화기타비운동증상지간적상관성。방법수집2010년6월지2012년6월취진우북경천단의원신경내과적파금삼병환자243례，기록인구학자료，채용자주신경증상량표（SCOPA-AUT）평개자주신경공능，평측파금삼병통일평정량표제Ⅲ부분（UPDRSⅢ）、Hoehn-Yahr（H-Y）분기、한밀이돈초필량표（HAMA）、한밀이돈억욱량표（HAMD）、몽특리이인지평고량표（MoCA）、간역정신상태검사량표（MMSE）、필자보수면질량지수（PSQI）량표、피로량표（FS-14）、일상생활능역량표（ADL）화39항파금삼병생활질량문권（PDQL-39），병여SCOPA-AUT평분진행상관분석。결과（1）243례파금삼병환자SCOPA-AUT평분위（36.6±8.0）（23～67）분；여기병년령[평균（59.8±10.1）세）]급병정[평균（3.8±4.0）년]정현저정상관（r＝0.248，P＝0.000；r＝0.234， P＝0.000）。（2）자주신경증상이소화계통증상적발생솔최고（83.5%），기중편비최상견（56.4%），기후의차위배뇨장애（79.0%）、성공능장애（78.6%）、심혈관공능장애（48.6%）급체온조절장애（47.3%）。（3）SCOPA-AUT평분여UPDRSⅢ평분[（25.9±13.2）분]화H-Y분기[（2.0±0.8）기]균정현저정상관（r＝0.390，P＝0.000；r＝0.425，P＝0.000）。（4）유억욱화초필적환자분별위169례화154례，HAMD、HADA평분여SCOPA-AUT평분정현저정상관（r＝0.457，P＝0.000；r＝0.490，P＝0.000）。（5）파금삼병불반인지장애（PD-NCI）조、파금삼병반경도인지장애（PD-MCI）조화파금삼병반치태（PDD）조SCOPA-AUT평분의차명현증고[（34.8±7.3）분、（37.9±8.0）분화（38.5±8.7）분，P＝0.011]。（6）유수면장애환자169례，SCOPA-AUT평분여PSQI평분정현저정상관（r＝0.508，P＝0.000）。（7）유피로환자215례，SCOPA-AUT평분여FS-14평분정현저정상관（r＝0.423，P＝0.000）。（8）ADL평분위（35.3±13.6）분，여 SCOPA-AUT 평분정현저정상관（r＝0.391，P＝0.000）；PDQL-39평분위（134.1±26.6）분，여SCOPA-AUT평분정현저부상관（r＝-0.649，P＝0.000）。결론파금삼병환자자주신경공능장애발생솔고，증상다양，여기병년령、병정、운동증상급인지、초필、억욱、수면장애급피로등비운동증상밀절상관，엄중영향환자적일상생활능력화생활질량。
Objective To explore the correlation of autonomic dysfunction with motor symptoms and non-motor symptoms in patients with Parkinson's disease (PD). Methods 243 PD patients were recruited in the department of neurology, Beijing Tiantan Hospital from June 2010 to June 2012 and evaluated by the Scale For Outcomes in PD For Autonomic Symptoms (SCOPA-AUT), Unified Parkinson's Disease Rating Scale (UPDRS)Ⅲ, Hoehn-Yahr (H-Y) Staging, Hamilton Anxiety Scale (HAMA),Hamilton Depression Scale (HAMD), Montreal Cognitive Assessment (MoCA), Mini-Mental State Examination (MMSE), Pittsburgh Sleep Quality Index (PSQI), Fatigue Scale-14 (FS-14), Activity of Daily Living (ADL) and 39-item Parkinson's Disease Questionnaire(PDQL-39), and correlations of SCOPA-AUT score with above scales scores were performed. Results (1) SCOPA-AUT score of PD patients was 36.6±8.0(23-67)points; SCOPA-AUT score was positively correlated with the age of onset, average of (59.8±10.1) years, and disease duration,average of (3.8±4.0)years(r=0.248, P=0.000;r=0.234, P=0.000);(2)Autonomic symptoms with the highest incidence was gastrointestinal dysfunction(83.5%), among which, constipation was the most frequent(56.4%), which was followed by urinary dysfunction(79.0%), sexual dysfunction(78.6%), cardiovascular dysfunction(48.6%)and thermoregulatory dysfunction(47.3%); (3)SCOPA-AUT score was positively correlated with H-Y Stage (2.0±0.8) and UPDRSⅢ score, (25.9±13.2)points (r=0.390, P=0.000;r=0.425, P=0.000);(4)169 cases were with depression and 154 cases with anxiety;SCOPA-AUT score was positively correlated with scores of HAMD and HADA(r=0.457, P=0.000;r=0.490, P=0.000);(5) 33 cases were PD with no cognitive impairment(PD-NCI), 96 were PD with mild cognitive impairment(PD-MCI) and 114 were PD with dementia (PDD); SCOPA-AUT scores in PD-NCI, PD-MCI and PDD groups were significantly increased in turn,(34.8±7.3)points, (37.9±8.0)points and (38.5±8.7)points, P=0.011;(6) 169 cases were with sleep disorders, which SCOPA-AUT score was positively correlated with PSQI score(r=0.508, P=0.000);(7) 215 cases were with fatigue, which SCOPA-AUT score was positively correlated with FS-14 score(r=0.423, P=0.000);(8)ADL score was (35.3±13.6)points, which was positively correlated with SCOPA-AUT score(r=0.391, P=0.000);PDQL-39 score was (134.1±26.6)points, which was negtively correlated with SCOPA-AUT score(r=―0.649, P=0.000). Conclusions PD patients have high incidence of autonomic dysfunction with multiple symptoms. Autonomic dysfunction is closely correlated with the age of onset, disease duration, motor symptoms and non-motor symptoms, including cognition impairment, anxiety, depression, sleep disorder and fatigue, and dramatically compromises ADL and QOL for PD patients.
