帕金森病患者自主神经功能障碍的临床研究

发布时间：2018-02-13 07:35

本文关键词： 帕金森病非运动症状自主神经功能障碍交感神经皮肤反应　出处：《吉林大学》2017年硕士论文　论文类型：学位论文

【摘要】：研究目的:1.分析帕金森病(Parkinson’s disease,PD)患者自主神经功能障碍的临床特征和影响因素;2.比较自主神经功能障碍与运动症状及其他非运动症状的相关性;3.探讨交感神经皮肤反应(SSR)对自主神经功能损害的临床诊断价值。研究方法:选择2014年10月至2016年10月就诊于吉林大学第一医院神经内科的PD患者98例,同期健康体检者30例。收集所有受试者的基本信息(姓名、性别、年龄、文化程度)及PD患者病程、首发症状、首发部位、Hoehn-Yahr分期(H-Y分期)和服药情况。应用自主神经症状量表(SCOPA-AUT)评价自主神经功能,应用统一帕金森病评定量表第三部分(UPDRSⅢ)、汉密尔顿焦虑量表(HAMA)、汉密尔顿抑郁量表(HAMD)、帕金森睡眠量表(PDSS)、Epworth日间睡眠量表(ESS)、简易精神状态检查量表(MMSE)、蒙特利尔认知评估量表(Mo CA)评估运动症状和焦虑、抑郁、睡眠、认知等非运动症状。选择36例PD患者和16例健康对照者进行了交感神经皮肤反应(SSR)检测。研究结果:1.剔除无效病例8例,共120例受试者入组本研究,其中PD组90例,健康对照组30例。PD组与健康对照组在性别构成、年龄、文化程度上无差异,在运动症状和非运动症状评分上,PD组明显高于健康对照组,提示PD患者除了典型运动症状外,还存在明显的自主神经功能、焦虑、抑郁、认知、睡眠等非运动症状损害。2.经SCOPA-AUT量表评估,90例PD患者76例有自主神经症状,发生率为84.4%,SCOPA-AUT得分0-49分,平均得分(15.72±12.68)分。自主神经功能障碍最常见的是消化(81.1%)和泌尿(76.7%)系统症状,其次是心血管系统(46.7%)、体温调节(41.1%)、性功能(35.6%)和瞳孔运动障碍(13.3%);所有自主神经症状中,便秘的发生率最高,达56.7%(51/90),其次依次为夜尿55.6%(50/90)、吞咽困难48.9%(44/90)、流涎46.7%(42/90)等。30例健康对照组7例存在自主神经功能损害,发生率为23.3%,SCOPA-AUT得分0-7分,平均得分(1.33±2.01)分。两组比较,PD组自主神经功能障碍的发生率及严重程度明显高于健康对照组。3.经SCOPA-AUT量表评分比较,高SCOPA-AUT评分患者年龄更大、病程更长、病情更重,服用美多芭量更多,运动症状更明显,另外,高SCOPA-AUT评分患者的HAMA14、HAMD24、MOCA、MMSE、PDSS评分更高,在性别、首发症状、首发部位、文化程度和ESS评分方面,与SCOPA-AUT量表评分高低无统计学意义,提示PD患者自主神经功能障碍越重,运动症状及焦虑、抑郁、认知、夜间睡眠等非运动症状越明显。经多因素logistic回归分析后发现,自主神经功能障碍的严重程度受病程、病情严重程度、运动症状及夜间睡眠的影响。4.PD合并自主神经功能障碍(PD-AS)组、PD不伴自主神经功能障碍(PD-NAS)组、健康对照组SSR异常率分别为62.5%(15/24)、33.3%(4/12)、12.5%(2/16),三组间SSR存在明显波幅、潜伏期改变。研究结论:1.PD患者普遍存在自主神经功能损害,以消化和泌尿系统最常见,以便秘、夜尿症状最突出。2.PD患者自主神经功能障碍越重,运动症状及其他非运动症状亦越明显;其严重程度受病程、病情、运动症状及夜间睡眠的影响。3.SSR可以客观评价PD患者的自主神经功能,还有助于发现自主神经的亚临床损害。
[Abstract]:Research purposes: 1. analysis of Parkinson disease (Parkinson 's disease, PD) clinical characteristics and influential factors of autonomic dysfunction in patients with autonomic dysfunction; correlation of 2. compared with other motor symptoms and non motor symptoms; 3. of sympathetic skin response (SSR) in diagnosis of autonomic dysfunction. Methods: 98 patients with PD from October 2014 to October 2016 in No.1 Hospital of Jilin University from the Department of Neurology, 30 healthy people. The basic information were collected from all subjects (name, gender, age, education level) and PD patients, the first symptoms, the first part, Hoehn-Yahr staging (H-Y staging) and medication. Application of autonomic nerve symptom scale (SCOPA-AUT) assessment of autonomic nervous function, using the unified Parkinson's disease rating scale third (UPDRS III), Hamilton Anxiety Scale (HAMA), Hamill Hamilton Depression Rating Scale (HAMD), Parkinson Sleep Scale (PDSS), Epworth daytime sleep scale (ESS), Mini Mental State Examination (MMSE), Montreal cognitive assessment (Mo CA) to assess motor symptoms and anxiety, depression, sleep, cognitive and other non motor symptoms in 36 cases of PD. Patients and 16 healthy subjects were sympathetic skin response (SSR) detection. Results: 1. invalid cases 8 cases, a total of 120 subjects were enrolled in this study, including 90 cases in PD group and healthy control group of 30 cases of.PD group and healthy control group in gender, age, culture no difference in extent, motor and non motor symptoms score, PD group was significantly higher than that of the control group, suggesting that PD in patients with typical motor symptoms, there are obvious autonomic nervous function, anxiety, depression, cognition, sleep and other non motor symptoms of.2. damage by SCOPA-AUT assessment, 90 cases of PD were 76 with self The main neurological symptoms, the incidence rate was 84.4%, SCOPA-AUT scored 0-49 points, scoring average (15.72 + 12.68). The most common digestive autonomic dysfunction (81.1%) and (76.7%) urinary system symptoms, followed by cardiovascular system (46.7%), (41.1%), body temperature regulation function (35.6%) and pupil movement disorder (13.3%); all autonomic symptoms, the highest incidence of constipation was 56.7% (51/90), followed by nocturia 55.6% (50/90), dysphagia in 48.9% (44/90), 46.7% (42/90).30 ptyalism healthy control group of 7 cases in autonomic dysfunction, the incidence rate was 23.3% SCOPA-AUT, scoring 0-7 points, scoring average (1.33 + 2.01). The two groups, PD group of autonomic dysfunction incidence and severity were significantly higher than the control group by.3. SCOPA-AUT scale score, high SCOPA-AUT scores were older, longer duration, more severe disease, taking Madopar amount More exercise, the more obvious symptoms, in addition, the high SCOPA-AUT score in patients with HAMA14, HAMD24, MOCA, MMSE, PDSS score higher in gender, onset, starting place, cultural level and the ESS score, and SCOPA-AUT score level was not statistically significant, suggesting that PD autonomic nerve dysfunction in patients with more severe motor symptoms and the anxiety, depression, cognition, sleep and other non motor symptoms more obvious. Multivariate logistic regression analysis showed that the severity of autonomic dysfunction by duration, severity, effect of.4.PD motor symptoms and night sleep associated with autonomic dysfunction (PD-AS) group, PD patients without autonomic nerve dysfunction (PD-NAS the healthy control group) group, the abnormal rate of SSR were 62.5% (15/24), 33.3% (4/12), 12.5% (2/16), SSR in the three groups have obvious amplitude, latency change. Conclusion: 1.PD is prevalent in patients with autonomic nervous function Can damage, with the most common, digestive and urinary system with constipation, nocturia.2.PD most prominent autonomic nerve dysfunction in patients with more severe motor symptoms and non motor symptoms are more obvious; the severity of disease, illness, effect of.3.SSR motor symptoms and sleep at night can objectively evaluate the autonomic nervous function in patients with PD. It can help find the subclinical autonomic nerve damage.

【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R742.5

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