帕金森病伴快速眼动期睡眠行为障碍的小样本病例分析及文献回顾

发布时间：2018-05-15 13:11

  本文选题：帕金森病 + 快速眼动期睡眠行为障碍　； 参考：《浙江大学》2016年博士论文

【摘要】：目的：快速眼动期睡眠期行为障碍(Rapid eye movement sleep behavior disorder, RBD)是近年帕金森病(Parkinson's disease, PD)的研究热点之一。最新RBD的诊断标准需结合临床病史及视频多导睡眠监测(video-Polysomnography, v-PSG),然目前大部分的临床研究仍采用RBD的最低诊断标准。本研究通过总结经v-PSG确诊的本院PD伴RBD患者的病例特征,并结合文献研究中经多导睡眠监测确诊的病例研究,分析伴与不伴RBD的PD患者的一般情况、临床特征及睡眠参数等。方法：本研究纳入2015年6月至2016年3月,就诊于浙江大学医学院附属第二医院神经科睡眠中心的PD患者,进行临床病史采集,同时进行视频多导睡眠(v-PSG)监测,收集所有PD患者的临床资料及睡眠参数的数据。参照国际睡眠疾病分类标准第三版(International Classification of Sleep Disorders third edition, ICSD-3)中RBD的诊断标准,分为PD合并RBD (PD+RBD)组与PD不合并RBD (PD-RBD)组,对临床特征及睡眠参数进行分析。同时,收集2005年1月至2016年3月之间公开发表的关于PD与RBD的临床研究,选择经过多导睡眠监测确诊RBD的研究,整理相应临床资料,进行文献荟萃分析,分析PD+RBD组与PD-RBD组临床特征及睡眠参数。结果：1.结合临床病史和多导睡眠监测,病例分析中PD患者RBD的发生率为50%(8/16),文献分析中PD患者RBD的患病率波动于45～58%之间。2.病例分析中,PD+RBD组的Hoehn Yahr分级较PD-RBD组更高[3(2.5-3)vs 2(1.5-2),p=0.002]; PD+RBD组患者与PD-RBD组PD病程,年龄和左旋多巴等效日剂量(LED)差异无统计学意义(PD病程：76.5±47.1 vs 40.7±37.1月,p=0.114)(年龄：62.8±9.6 vs 59.9±14岁, p=0.646) (LED:557.8±218.2vs481.2±27.3mg,p=0.4)。3.文献分析中,PD+RBD组患者较PD-RBD组患者年龄更大(WMD=2.646, 95%CI:1.385-3.908, P=0.000), Hoehn-Yahr分级更高(WMD=0.344,95%CI: 0.151-0.536, P=0.000), UPDRSⅢ评分(开期)更高(WMD=2.501,95%CI: 0.739-4.263, P=0.005),左旋多巴等效日剂量(LED)更多(WMD=134.447,95%CI: 74.158-194.736mg, P=0.000); PD+RBD组患者较PD-RBD组患者体位性低血压发生频率更高(OR=3.684,95%CI:2.125～6.387; P=0.000); PD+RBD组患者较PD-RBD组PD病程差异及性别差异无统计学意义。4.病例分析中PD+RBD组与PD-RBD组的睡眠参数差异无统计学意义。结论：本研究通过我院多导睡眠监测确诊的RBD相关PD的病例分析和多导睡眠监测确诊的PD与RBD的文献研究,发现结合临床病史和多导睡眠监测诊断RBD稳定性高,并总结了伴RBD的PD的病例特点。伴有RBD的PD患者具有更严重的病情,伴与不伴RBD的PD患者在性别和PD病程方面差异无统计学意义。
[Abstract]:Objective: in recent years, rapid eye movement sleep behavior disorder, RBD) is one of the hotspots in the study of parkinsonian disease (PDD) in patients with parkinsonian disease (PD). The latest diagnostic criteria of RBD should be combined with clinical history and video-Polysomnography (v-PSG). However, most clinical studies still adopt the minimum diagnostic criteria of RBD. This study analyzed the general situation, clinical features and sleep parameters of PD patients with and without RBD by summarizing the case characteristics of PD patients with RBD diagnosed by v-PSG, and combining with the case studies confirmed by polysomnography in the literature. Methods: from June 2015 to March 2016, PD patients in the sleep center of Department of Neurology, second affiliated Hospital of Zhejiang University Medical College, were enrolled for clinical history collection and video polysomnography v-PSG monitoring. The clinical data and sleep parameters of all PD patients were collected. According to the diagnostic criteria of RBD in International Classification of Sleep Disorders third edition, ICSD-3 (the third edition of the International Classification of Sleep Diseases), the patients were divided into two groups: PD combined with RBD and PD-RBD, and PD was not associated with PD-RBD. The clinical characteristics and sleep parameters were analyzed. At the same time, the clinical studies on PD and RBD published between January 2005 and March 2016 were collected, and polysomnography confirmed RBD were selected, the corresponding clinical data were sorted out, and the literature meta-analysis was carried out. The clinical features and sleep parameters of PD RBD group and PD-RBD group were analyzed. The result is 1: 1. Combined with clinical history and polysomnography, the incidence of RBD in PD patients was 50 to 8 / 16 in case analysis, and the prevalence rate of RBD in PD patients fluctuated from 45 to 58% in literature analysis. In the case analysis, the Hoehn Yahr grade of PD RBD group was higher than that of PD-RBD group [3(2.5-3)vs 21.5-2P0. 002] there was no significant difference in the course of PD, age and levodopa equivalent daily dose between; PD RBD group and PD-RBD group. There was no significant difference in the course of PD: 76.5 卤47.1 vs 40.7 卤37.1-month (age: 62.8 卤9.6 vs 59.9 卤14 years, p 0.646). 鏂囩尞鍒嗘瀽涓，

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