便秘与帕金森病患者中轴症状的相关性研究

发布时间：2018-05-31 11:52

  本文选题：帕金森病 + 便秘　； 参考：《苏州大学》2016年硕士论文

【摘要】：研究背景:帕金森病(Parkinson’s Disease,PD)是一种中老年常见的神经变性疾病,其临床表现具有高度异质性。不同PD患者表型不同,非运动症状及临床进展各异。有学者认为不同PD亚型其发病机制和病理生理过程存在差异。便秘是PD常见的非运动症状,但其在PD病程中出现与否、出现的时间在个体PD患者中表现较大差异。目的:本研究旨在初步探讨便秘与运动症状发生的关系,并分析可能的机制。方法:收集2014年5月至2015年5月在苏州大学附属第二医院PD专科门诊就诊的PD患者的一般资料。对所有PD患者进行帕金森病统一评分量表(Unified Parkinson's disease Rating Scale,UPDRS)第三部分评分及简易智力状态检查量表(mini-mental state examination,MMSE)评估。根据便秘罗马Ⅲ诊断标准,分为PD合并便秘组与PD不合并便秘组;根据便秘与运动症状出现时间的先后顺序将PD伴便秘组再分为便秘PD(便秘发生在PD运动症状之前)及便秘PD(在PD运动症状出现之后出现便秘)。对PD合并便秘组与PD不合并便秘组、便秘PD组与便秘PD的一般人口资料及运动症状特征进行组间比较,并分析PD合并便秘的影响因素。结果:158例PD患者,伴便秘患者96例(60.8%),不伴便秘的患者62例(39.2%),便秘发生于运动症状前的患者41例(42.7%),便秘发生于运动症状之后的患者共55例(57.3%)。与不伴便秘的PD患者比较,伴便秘的PD患者每日左旋多巴等效剂量大[350(150~500)mg/d比300(19~413)mg/d,z=-2.113,P=0.035],UPDRSⅢ总分更高[(22±10)分比(18±9)分,t=-2.693,P=0.008],伴便秘较不伴便秘的PD患者中轴分、姿势步态分高[(6.8±3.4)分比(4.3±2.5)分,t=-4.887,P=0.000;(3.9±2.4)分比(2.4±1.5)分,t=-4.529,P=0.000],中轴分及姿势步态分分别在UPDRSⅢ总分中所占的比例大(32%±11%比25%±12%,t=-3.485,P=0.001;18%±9%比15%±10%,t=-2.278,P=0.024),中轴症状及姿势步态症状进展快[0.147(0.100~0.248)分/月比0.121(0.058~0.222)分/月,z=-2.085,P=0.037;0.08(0.05~0.14)分/月0.07(0.03~0.11)分/月,z=-2.052,P=0.04],其他亚运动症状分及运动症状进展组间比较差异无统计学意义(P0.05)。运动症状出现前出现便秘的患者与运动症状出现后出现便秘的PD患者比较,中轴分及姿势步态分在UPDRSⅢ总分中占的比例高(35%±11%比30%±10%,t=2.167,P=0.033;21%±9%比16%±8%,t=2.733,P=0.008),中轴症状及姿势步态症状的进展更快[0.174(0.120~0.286)分/月比0.123(0.089~0.229)分/月,z=-1.974,P=0.048;0.10(0.07~0.17)分/月比0.07(0.05~0.12)分/月,z=-2.530,P=0.011],起病年龄大[(64±8)岁比(61±7)岁,t=2.301,P=0.024],病程短[(41±25)月比(55±37)月,t=-2.274,P=0.025]。非条件二分类Logistic回归分析显示,中轴分是PD发生便秘的影响因素(P=0.000,OR=1.330)。结论:伴便秘尤其是在运动症状出现前出现便秘的PD患者中轴症状严重,进展快。中轴症状是PD发生便秘的影响因素。
[Abstract]:Background: Parkinsonian disease (PD) is a common neurodegenerative disease in the middle and old age, and its clinical manifestations are highly heterogeneous. Different PD patients have different phenotypes, non-motor symptoms and clinical progress. Some scholars believe that the pathogenesis and pathophysiological process of different PD subtypes are different. Constipation is a common non-motor symptom of PD, but it appears or not in the course of PD, and the time of constipation is different in individual PD patients. Objective: to explore the relationship between constipation and motor symptoms and analyze the possible mechanism. Methods: from May 2014 to May 2015, the general data of PD patients in the second affiliated Hospital of Suzhou University were collected. All PD patients were evaluated with Unified Parkinson's disease Rating scale (Unified Parkinson's disease Rating scale) and mini-mental state examination scale (MMSE). According to the Rome 鈪，

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