摘要
目的探讨帕金森病伴很可能的快速眼动睡眠行为障碍( P-RBD)患者的临床特点及相关因素。方法连续收集2012年4月至2013年1月就诊于北京天坛医院神经内科102例帕金森病患者的人口学资料,采用RBD筛查量表(RBDSQ)评估患者RBD的状况,采用相关量表完成运动症状(MS)、非运动症状(NMS)和生活质量的评价。结果(1)102例帕金森病患者中30例伴发P-RBD(RBDSQ评分≥6分),为P-RBD组,发生率为29.41%,RBDSQ平均分为(8.23±1.89)分;72例不伴P-RBD ( RBDSQ 评分<6分),为NP-RBD组,平均分为(2.21±1.33)分;(2)P-RBD 组和NP-RBD 组除病程[3.50(1.13~6.75)年和2.00(1.00~3.00)年]( P=0.022)外,性别、年龄、起病年龄、受教育水平、起病侧别和临床类型均无显著差异(P>0.05);(3)P-RBD组H-Y分期明显高于NP-RBD组[2.25(1.89~3.00)期和1.50(1.50~2.50)期]( P=0.022),两组UPDRSⅢ评分无显著差异;P-RBD组异动症( UPDRSⅣ)评分[2.00(0.00~4.75)分]显著高于NP-RBD组[0.00(0.00~1.00)分](P=0.016),剂末现象的个数[0.00(0.00~9.00)个]显著多于NP-RBD组[0.00(0.00~0.00)个](P=0.042);(4)P-RBD组NMS总个数[(11.03±5.95)个]明显多于NP-RBD组[(7.96±5.30)个](P=0.032);P-RBD组MS期后NMS个数[(8.58±5.59)个]明显多于NP-RBD组[(6.08±5.10)个]( P=0.012);两组MS期前NMS个数无显著差异( P>0.05)。 P-RBD组UPDRSⅠ、汉密尔顿抑郁量表( HAMD)、汉密尔顿焦虑量表( HAMA)、爱泼沃斯瞌睡量表( ESS)、匹兹堡睡眠指数量表(PSQI)、自主神经症状量表(SCOPA-AUT)及疲劳评定量表(FS-14)的评分均显著高于 NP-RBD 组[3.50(1.75~6.00)分和2.00(0.00~4.75)分、(17.00±8.98)分和(11.83±10.36)分、(15.45±9.94)分和(10.65±8.85)分、(6.77±4.22)分和(4.49±3.38)分、(9.22±5.68)分和(6.06±4.14)分、(41.42±9.97)分和(34.81±9.46)分、(9.87±3.09)分和(8.01±4.13)分]( P <0.05);两组简易精神状态检查量表(MMSE)、蒙特利尔认知评估量表(MoCA)、改良淡漠评定量表(MAES)和不宁腿综合征严重程度评定量表(RLSRS)的评分无显著差异(P>0.05);(5)病程、H-Y分期、NMS个数及UPDRSⅠ、HAMD、HAMA、SCOPA-AUT、PQSI、ESS以及FS-14评分与RBDSQ 评分均具有显著相关性( r 分别为0.256、0.311、0.324、0.306、0.275、0.287、0.409、0.352、0.26和0.243, P <0.05);(6) RBDSQ 评分与 PDQL-39评分呈显著负相关(r=-0.203,P<0.05)。结论帕金森病患者P-RBD发生率较高,P-RBD组病程更长,病情更重,NMS更多,与部分NMS,包括情绪、总体睡眠质量、日间过度思睡及自主神经功能障碍显著相关,严重影响帕金森病患者的生活质量。
Objective To explore the clinical features and associated factors of probable rapid eye movement sleep behavior disorder ( P-RBD ) and its influences on life quality in patients with Parkinson′s disease ( PD) .Methods 102 PD patients who visited the department of neurology ,Beijing Tiantan Hospital from April 2012 to January 2013 were consecutively recruited and evaluated by rapid eye movement sleep behavior disorder screening questionnaire ( RBDSQ) ,scales of motor symptoms ( MS) and non-motor symptoms ( NMS) ,Parkinson′s disease quality of life questionnaire-39 ( PDQL-39 ) .Results ( 1 ) 30 of 102 PD patients ( 29.41%) had P-RBD ( RBDSQ≥6 points),which mean RBDSQ score was 8.23 ±1.89;72 of 102(70.59%)PD patients did not have P-RBD,which mean RBDSQ score was 2.21 ±1.3 .( 2 ) P-RBD and NP-RBD groups were not different in gender , age, education level,age of onset,side of onset and clinical phenotypes except disease duration [3.50(1.13-6.75)and 2.00(1.00-3.00)](P=0.022).(3)There was a significant difference in the Hoehn-Yahr stage [2.25(1.89-3.00)and 1.50 (1.50-2.50)](P=0.022 )and no significant difference in Unified Parkinson ′s Disease Rating Scale (UPDRS)Ⅲscore between R-RBD and NP-RBD groups ( P 〉0.05 ) .The score of UPDRSⅣin P-RBD group was significantly higher than that in NP-RBD group [2.00(0.00-4.75)and 0.00(0.00-1.00)](P=0.016);the number of wearing-off in P-RBD group was significantly more than that in NP-RBD group[0.00(0.00-9.00)and 0.00(0.00-0.00)](P=0.042 ) .( 4 ) The total number of NMS in P-RBD group ( 11.03 ±5.95 ) was significantly more than that in NP-RBD group ( 7.96 ±5.30 ) ( P =0.032 );the number of post-MS NMS ( 8.58 ±5.59 ) in P-RBD group was significantly more than that in NP-RBD group(6.08 ±5.10)(P=0.012).There was no significant difference in the number of pre-MS NMS between the two groups .The scores of UPDRSⅠ, Hamilton Depression Scale ( HAMD ) , Hamilton Anxiety Scale(HAMA),Epworth Sleepiness Scale(ESS),Pittsburgh Sleep Quality Index(PSQI),Scales for Outcomes in Parkinson ′s Disease-Autonomic ( SCOPA-AUT ) and Fatigue Scale-14 ( FS-14 ) in P-RBD group were significantly higher than that in NP-RBD group [3.50(1.75-6.00)and 2.00(0.00-4.75),17.00 ±8.98 and 11.83 ±10.36 ,15.45 ±9.94 and 10.65 ±8.85 ,6.77 ±4.22 and 4.49 ±3.38 ,9.22 ±5.68 and 6.06 ±4.14 ,41.42 ± 9.97 and 34.81 ±9.46 ,9.87 ±3.09 and 8.01 ±4.13 ] ( P〈0.05 ) .There were no significant differences in Mini -mental State Examination (MMSE ) , Montreal Cognitive Assessment ( MoCA ) , Modified Apathy Evaluation Scale (MAES)and Restless Leg Syndrome Rating Scale (RLSRS)between the two groups.(5)Multiple linear regression analysis showed that the score of RBDSQ in PD patients was significantly correlated with disease duration ,Hoehn-Yahr staging,number of NMS,score of UPDRSⅠ, anxiety,depression,autonomic dysfunction,universal sleep quality, excessive day time sleepiness and fatigue (r =0.256,0.311,0.324,0.306,0.275,0.287,0.409,0.352,0.269, 0.243 ) ( P〈0.05 ) .( 6 ) P-RBD had a significantly negative correlation with PDQL-39 ( r=-0.203 , P〈0.05 ) . Conclusion PD patients have high incidence of P-RBD;PD patients with P-RBD have a longer disease duration , more severe MS and motor complications ,and more NMS;P-RBD is significantly correlated with some NMS ,including mood disturbances,total sleep quality ,excessive daytime sleepiness and autonomic dysfunction ,and influences the life quality of PD patients.
出处
《中华临床医师杂志(电子版)》
CAS
2013年第12期19-24,共6页
Chinese Journal of Clinicians(Electronic Edition)
基金
国家重点基础研究发展计划资助项目(2011CB504100)
国家自然科学基金项目(81071015)
北京市卫生系统高层次卫生技术人才培养计划资助项目(2009-3-26)
首都临床特色应用研究(Z12110700100000
Z121107001012161)
首都医科大学基础-临床科研合作基金(10JL49)
关键词
帕金森病
生活质量
快速眼动睡眠行为障碍
临床特征
相关因素
Parkinson disease
Quality of life
Rapid eye movement sleep behavior disorder
Clinical features
Related factors