CAJ | 학술논문

目的研究帕金森病便秘(PDC)产生的机制以及影响便秘严重程度的临床相关因素.方法采用随机数字表法人选自2014年4-8月至我院门诊就诊的27例PDC患者作为研究组,30例功能性便秘(FC)患者作为对照组,对帕金森病患者进行统一帕金森病评定量表(UPDRS)、Hoehn-Yahr分级、帕金森病药物剂量、汉密尔顿抑郁量表、汉密尔顿焦虑量表(HAMA)、简易智能精神状态检查量表、便秘严重程度自评量表等资料评估;用直肠测压仪分析所有入组者肛管静息压、直肠排便压、肛门残余压、直肠感觉等相关参数,并对便秘严重程度与临床评估量表进行相关分析.结果 PDC组肛门括约肌最大收缩压(mmHg,1 mmHg=0.133 kPa)、直肠排便压(mmHg)、肛门残余压(mmHg)与FC组差异具有统计学意义(分别为197.7±62.7和245.3±64.5,30.4±17.1和48.1±19.8,84.2±28.1和102.8±34.9,t=-2.822、-3.598、-2.189,均P＜0.05);PDC组排便分型中直肠推进力不足比例为81％ (22/27),FC组直肠推进力不足(16/30)比例为53％,两组构成差异有统计学意义(x2 =5.067,P＜0.05);PDC患者的便秘严重程度与UPDRS、HAMA评分存在相关性(r=0.58、0.63,均P＜0.05).结论 PDC患者在肛门括约肌最大收缩压、直肠排便压、肛门残余压参数上与FC患者差异存在统计学意义,在PDC组与FC组测压分型中,前者直肠推进力不足的比例显著高于后者;PDC患者便秘的严重程度与UPDRS评分、HAMA存在显著相关.
목적 연구파금삼병편비(PDC)산생적궤제이급영향편비엄중정도적림상상관인소.방법 채용수궤수자표법인선자2014년4-8월지아원문진취진적27례PDC환자작위연구조,30례공능성편비(FC)환자작위대조조,대파금삼병환자진행통일파금삼병평정량표(UPDRS)、Hoehn-Yahr분급、파금삼병약물제량、한밀이돈억욱량표、한밀이돈초필량표(HAMA)、간역지능정신상태검사량표、편비엄중정도자평량표등자료평고;용직장측압의분석소유입조자항관정식압、직장배편압、항문잔여압、직장감각등상관삼수,병대편비엄중정도여림상평고량표진행상관분석.결과 PDC조항문괄약기최대수축압(mmHg,1 mmHg=0.133 kPa)、직장배편압(mmHg)、항문잔여압(mmHg)여FC조차이구유통계학의의(분별위197.7±62.7화245.3±64.5,30.4±17.1화48.1±19.8,84.2±28.1화102.8±34.9,t=-2.822、-3.598、-2.189,균P＜0.05);PDC조배편분형중직장추진력불족비례위81％ (22/27),FC조직장추진력불족(16/30)비례위53％,량조구성차이유통계학의의(x2 =5.067,P＜0.05);PDC환자적편비엄중정도여UPDRS、HAMA평분존재상관성(r=0.58、0.63,균P＜0.05).결론 PDC환자재항문괄약기최대수축압、직장배편압、항문잔여압삼수상여FC환자차이존재통계학의의,재PDC조여FC조측압분형중,전자직장추진력불족적비례현저고우후자;PDC환자편비적엄중정도여UPDRS평분、HAMA존재현저상관.
Objective To investigate the mechanism of Parkinson' s disease constipation (PDC) and the related factors that affect the severity of constipation.Methods Twenty-seven PDC patients were enrolled as study group and thirty functional consitipation (FC) patients as control group which were selected randomly in outpatient clinic of the First Affiliated Hospital of Nanjing Medical University from April 2014 to August 2014.Unified Parkinson' s Disease Rating Scale(UPDRS),Hoehn-Yahr Scale,medication for PD,Hamilton Depression Rating Scale,Hamilton Anxiety Rating Scale (HAMA),Mini Mental State Examination,Patient Assessment of Constipation Symptoms were performed for PD.All subjects underwent anorectal manometry to analyze the anal resting pressure,intra-rectum pressure during defecation,anal residual pressure,sensor parameters and other relevant parameters,and multiple regression analysis was used to evaluate the correlations between clinical assessment scales and the severity of constipation.Results Anal pressure on squeezing (mmHg,1 mmHg =0.133 kPa),intra-rectum pressure during defecation (mmHg),anal residual pressure (mmHg) in PDC were significantly different from the FC patients (197.7±62.7vs245.3±64.5,30.4±17.1 vs48.1 ±19.8,84.2±28.1 vs 102.8±34.9,t=-2.822,-3.598,-2.189,all P ＜ 0.05);the proportions of rectum inadequate defecatory propulsion in PDC were 81％ (22/27) and in FC were 53％ (16/30),statistically significant difference existing between these two groups (x2 =5.067,P ＜0.05).The severity of constipation in PD was related with UPDRS score,HAMA score (r =0.58,0.63,all P ＜ 0.05).Conclusions Significant differences in anal pressure on squeezing,intra-rectum pressure during defecation and anal residual pressure are seen between PDC and FC.When categorized into subgroups,the proportions of inadequate defecatory propulsion in PDC are significantly higher than that in FC.UPDRS score,HAMA score are markedly correlated with the severity of constipation in PD.