重庆医学
重慶醫學
중경의학
CHONGQING MEDICAL JOURNAL
2014年
17期
2142-2144,2148
,共4页
帕金森病%精神病性障碍%认知功能
帕金森病%精神病性障礙%認知功能
파금삼병%정신병성장애%인지공능
Parkinson-disease%psychotc-disorder%cognitive-function
目的：评估帕金森病（PD）患者入院时以及随访12个月伴发精神病性障碍的患病率，并且分析与之相关的临床因素。方法采用问卷评估160例 PD患者入院时以及随访12个月的神经病学、精神病性症状、认知功能，比较 PD伴发精神病性障碍（PDPsy）与不伴发精神病性障碍（Non-PDPsy）患者的临床特征，以及临床特征与PDPsy的相关性。结果（1）PDPsy入院时的患病率是12．5％，随访12个月后的发生率是21．3％，主要以幻觉与妄想为主。（2）入院时，PDPsy 患者与 Non-PDPsy患者在病程（t＝2．173，P＝0．031）、日间睡眠障碍（t＝2．076，P＝0．040）、多巴替代治疗剂量（t＝2．820，P＝0．005）上存在差异，PDPsy患者的病程更长（5．6±2．3 vs．4．7±2．1）、日间思睡的发生率更高（6．9±2．4 vs．6．0±2．2）、左旋多巴胺剂量更大（610．2±246．6 vs．490．1±212．9）。（3）随访12个月，PDPsy患者的 UPDRS-Ⅲ评分[（29．7±9．7）分]、Hoehn-Yahr分级（≤2级占64．7％，＞2级占35．3％）、日间思睡评分[（7．2±2．4）分]、RBD发生率（41．2％）、HAMD评分[（17．3±7．4）分]、HAMA评分[（15．5±6．7）分]及多巴替代治疗剂量[（670．8±251．1）mg]显著高于 Non-PDPsy患者[（26．6±7．1）分、≤2级占90．5％，＞2级占9．5％、（7．2±2．4）分、19．8％、（13．2±7．2）分、（11．7±6．4）分、（520．1±221．4）mg]。而PDPsy患者的 MMSE评分[（26．9±2．7）分]显著低于 Non-PDPsy[（28．7±3．1）分]。（4）病程、Hoehn-Yahr分级、HAMD得分、HAMA得分、ESS得分、RBD发生率均与 PDP-sy显著相关。结论精神病症状可能出现在PD早期，在多巴替代治疗时，与 PD有关的因素有疾病严重程度、认知功能下降和抑郁症状，这可能是PD精神病性症状的潜在基础。病程、Hoehn-Yahr分级、抑郁/焦虑、睡眠障碍是PDPsy的危险因子。
目的：評估帕金森病（PD）患者入院時以及隨訪12箇月伴髮精神病性障礙的患病率，併且分析與之相關的臨床因素。方法採用問捲評估160例 PD患者入院時以及隨訪12箇月的神經病學、精神病性癥狀、認知功能，比較 PD伴髮精神病性障礙（PDPsy）與不伴髮精神病性障礙（Non-PDPsy）患者的臨床特徵，以及臨床特徵與PDPsy的相關性。結果（1）PDPsy入院時的患病率是12．5％，隨訪12箇月後的髮生率是21．3％，主要以幻覺與妄想為主。（2）入院時，PDPsy 患者與 Non-PDPsy患者在病程（t＝2．173，P＝0．031）、日間睡眠障礙（t＝2．076，P＝0．040）、多巴替代治療劑量（t＝2．820，P＝0．005）上存在差異，PDPsy患者的病程更長（5．6±2．3 vs．4．7±2．1）、日間思睡的髮生率更高（6．9±2．4 vs．6．0±2．2）、左鏇多巴胺劑量更大（610．2±246．6 vs．490．1±212．9）。（3）隨訪12箇月，PDPsy患者的 UPDRS-Ⅲ評分[（29．7±9．7）分]、Hoehn-Yahr分級（≤2級佔64．7％，＞2級佔35．3％）、日間思睡評分[（7．2±2．4）分]、RBD髮生率（41．2％）、HAMD評分[（17．3±7．4）分]、HAMA評分[（15．5±6．7）分]及多巴替代治療劑量[（670．8±251．1）mg]顯著高于 Non-PDPsy患者[（26．6±7．1）分、≤2級佔90．5％，＞2級佔9．5％、（7．2±2．4）分、19．8％、（13．2±7．2）分、（11．7±6．4）分、（520．1±221．4）mg]。而PDPsy患者的 MMSE評分[（26．9±2．7）分]顯著低于 Non-PDPsy[（28．7±3．1）分]。（4）病程、Hoehn-Yahr分級、HAMD得分、HAMA得分、ESS得分、RBD髮生率均與 PDP-sy顯著相關。結論精神病癥狀可能齣現在PD早期，在多巴替代治療時，與 PD有關的因素有疾病嚴重程度、認知功能下降和抑鬱癥狀，這可能是PD精神病性癥狀的潛在基礎。病程、Hoehn-Yahr分級、抑鬱/焦慮、睡眠障礙是PDPsy的危險因子。
목적：평고파금삼병（PD）환자입원시이급수방12개월반발정신병성장애적환병솔，병차분석여지상관적림상인소。방법채용문권평고160례 PD환자입원시이급수방12개월적신경병학、정신병성증상、인지공능，비교 PD반발정신병성장애（PDPsy）여불반발정신병성장애（Non-PDPsy）환자적림상특정，이급림상특정여PDPsy적상관성。결과（1）PDPsy입원시적환병솔시12．5％，수방12개월후적발생솔시21．3％，주요이환각여망상위주。（2）입원시，PDPsy 환자여 Non-PDPsy환자재병정（t＝2．173，P＝0．031）、일간수면장애（t＝2．076，P＝0．040）、다파체대치료제량（t＝2．820，P＝0．005）상존재차이，PDPsy환자적병정경장（5．6±2．3 vs．4．7±2．1）、일간사수적발생솔경고（6．9±2．4 vs．6．0±2．2）、좌선다파알제량경대（610．2±246．6 vs．490．1±212．9）。（3）수방12개월，PDPsy환자적 UPDRS-Ⅲ평분[（29．7±9．7）분]、Hoehn-Yahr분급（≤2급점64．7％，＞2급점35．3％）、일간사수평분[（7．2±2．4）분]、RBD발생솔（41．2％）、HAMD평분[（17．3±7．4）분]、HAMA평분[（15．5±6．7）분]급다파체대치료제량[（670．8±251．1）mg]현저고우 Non-PDPsy환자[（26．6±7．1）분、≤2급점90．5％，＞2급점9．5％、（7．2±2．4）분、19．8％、（13．2±7．2）분、（11．7±6．4）분、（520．1±221．4）mg]。이PDPsy환자적 MMSE평분[（26．9±2．7）분]현저저우 Non-PDPsy[（28．7±3．1）분]。（4）병정、Hoehn-Yahr분급、HAMD득분、HAMA득분、ESS득분、RBD발생솔균여 PDP-sy현저상관。결론정신병증상가능출현재PD조기，재다파체대치료시，여 PD유관적인소유질병엄중정도、인지공능하강화억욱증상，저가능시PD정신병성증상적잠재기출。병정、Hoehn-Yahr분급、억욱/초필、수면장애시PDPsy적위험인자。
Objective To evaluate the prevalence rate of complicating psychotic disorders on admission and over 12-month fol-low-up in the patients with Parkinson′s diseaseand to analyze its related clinical factors.Methods The questionnaire investigation was adopted to evaluate the neurology,psychotic symptoms and cognitive function after admission and at 1 2-months follow up in 160 inpatients with Parkinson′s disease.The clinical characteristics were compared between the inpatients with Parkinson′s disease complicating psychosis (PDPsy)and the inpatients without psychosis (non-PDPsy)and their relation with PDPsy was analyzed.Re-sults (1)The prevalence of PDPsy on admission was 12.5%,which at 12-month follow-up was 21.3%,the hallucination and de-lusion were main manifestations.(2)On admission,the inpatients with PDPsy and th einpatients with non-PDPsy had significant differences in the disease duration(t=2.173,P=0.031),daytime sleep disorders (t=2.076,P=0.040)and dosage of dopamine re-placement therapy (t=2.820,P=0.005).The inpatients with PDPsy had the longer disease duration (5.6±2.3 vs.4.7±2.1), higher incidence rate of daytime drowsy(6.9±2.4 vs.6.0±2.2)and higher dosage of dopamine replacement therapy (610.2± 246.6 vs.490.1±212.9).(3)During 12-month follow-up,the UPDRS-Ⅲ score(29.7±9.7),Hoehn-Yahr grading(≤2,64.7%;>2,35.3%),daytime drowsiness score(7.2 ± 2.4),incidence rate of RBD(41.2%),HAMD score(17.3 ± 7.4),HAMA score (15.5±6.7)and dosage of dopamine replacement therapy (670.8±251.1)mg in the inpatients with PDPsy were significant higher than (26.6±7.1),(≤2,90.5%;>2,9.5%),7.2±2.4),(19.8%),(13.2±7.2),(11.7±6.4)and (520.1±221.4)mg in the in-patients with non-PDPsy.However,the MMSE score in the inpatients with PDPsy was (26.9±2.7),which was significantly lower than (28.7±3.1)in the inpatients with non-PDPsy.(4)The disease duration,Hoehn-Yahr grading,HAMD score,HAMA score, ESS score and RBD number were significantly associated with the development of PDPsy (ORs>1 ).Conclusion The psychotic symptoms may occur in the early stages of PD.Under the dopamine replacement therapy,the disease severity,depressive symptoms and cognitive impairment are the PD-related factors,which may underlie the onset of psychotic symptoms.The disease duration, Hoehn-Yahr grading,depression/anxiety and sleep disorders are the risk factors of PDPsy.
