重庆市帕金森病患者临床特征分析

发布时间：2018-05-08 04:01

  本文选题：帕金森病 + 临床特征　； 参考：《重庆医科大学》2015年硕士论文

【摘要】：目的：分析重庆市帕金森病患者的人口统计学特征及临床特征,探讨帕金森病运动症状、非运动症状、运动并发症的危险因素,为指导帕金森病的早期诊断以及长期治疗和全面管理方案的制定提供临床依据。方法：连续收集我院门诊及住院的帕金森病患者177名的人口学资料及临床资料。对不同起病年龄、不同病程PD患者的临床特征进行比较；分析H-Y分级与年龄、病程、LEDD等之间的关系；探讨部分运动症状、非运动症状、运动并发症的危险因素。结果：177例帕金森病患者(门诊75例,住院部102例)中,男性占59.9%,平均年龄66.16±9.53岁,平均病程5.09±4.52年,平均身高体重指数(BMI)22.45±2.80kg/m2。平均起病年龄60.86±10.92岁,早发型(起病≤49岁)占16.4%。57.1%的患者以右侧肢体起病,49.2%的患者以震颤为首发症状。平均改良H-Y分级为2.53±1.15级,且病程越长、LEDD值越高,H-Y分级越高。有36.2%的患者出现冻结步态,12.4%的患者发生过跌倒。且H-Y分级越高,发生跌倒及冻结的风险越高。52.5%的患者首选药物为LD,而早发型患者中首选LD的患者占57.1%。LD治疗的平均时间为3.45±4.10年,LEDD平均值为413.36±282.76mg。MAO-B抑制剂、COMT抑制剂类药物的使用率非常低。还有9.6%的患者尚未服药。组间比较显示,PD发病年龄越小、病程越长,症状波动及异动症的发生率越高。多因素分析显示起病年龄50-69岁、H-Y分级3-5级、同时服用LD+DAs及LEDD≥400mg是症状波动的独立危险因素,而起病年龄≤49岁、病程长、LEDD≥400mg是异动症的独立危险因素。神经精神症状、自主神经功能紊乱、感觉异常的发生率分别为85.9%、81.9%、74%。多因素分析提示,起病后LD延迟加入治疗的时间越长,疼痛的发生率越高。结论：1、重庆市PD患者运动症状较重,非运动症状的发生率较高；2、重庆PD患者服用的抗帕金森病药物结构较单一,可能与患者经济状况及医疗保险报销范畴有关；3、早发型PD患者多数首选左旋多巴作为治疗药物,而少部分患者尚未予以抗帕金森病药物治疗,因此早发型和初诊患者的治疗有待进一步规范；4、需要重视以单侧肢体乏力,伴或不伴运动迟缓为主要症状的门诊患者,密切随访,这些患者有可能逐渐出现PD的核心症状；5、H-Y分级与病程、LEDD值呈正相关；6、起病年龄50-69岁、H-Y分级3-5级、同时服用LD+DAs及LEDD≥400mg是症状波动的独立危险因素,而起病年龄≤49岁、病程长、LEDD≥400mg是异动症的独立危险因素;7、PD患者药物治疗方案的制定,需要综合考虑患者的起病年龄、运动症状、非运动症状及运动并发症等因素。
[Abstract]:Objective : To analyze the demographic characteristics and clinical characteristics of Parkinson ' s disease in Chongqing , to discuss the risk factors of Parkinson ' s disease ( Parkinson ' s disease ) , non - motor symptoms and motor complications , and to provide clinical basis for the early diagnosis of Parkinson ' s disease and the development of long - term treatment and comprehensive management . Methods : 177 patients with Parkinson ' s disease in our hospital and in hospital were collected continuously .
To analyze the relationship between H - Y classification and age , course , LEDD , etc .
Results : Among 177 patients with Parkinson ' s disease ( 75 patients , 102 in the inpatient department ) , 59.9 % of patients with Parkinson ' s disease ( n = 75 , 102 in the inpatient department ) , the average duration was 5.09 卤 4.52 years , the higher the average body mass index ( BMI ) was 22.45 卤 2.80kg / m2 .
2 . The drug structure of Parkinson ' s disease which is taken by PD patients in Chongqing is relatively single , which may be related to the economic situation of the patient and the reimbursement category of medical insurance .
3 . Most of the patients with early - onset PD were treated with left - dopa as a therapeutic drug , while some patients had yet to be treated with anti - Parkinson ' s disease , so the treatment of early - onset and early - onset patients was to be further standardized ;
4 . It is necessary to pay attention to outpatients with symptoms of unilateral limb fatigue , with or without exercise retardation , and follow - up closely , and these patients may gradually develop the core symptoms of PD ;
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