帕金森病非运动症状与血清TNF-α，IL-6，sIL-2R和hs-CRP的相关性研究

发布时间：2018-06-07 16:29

本文选题：帕金森病 + 非运动症状　；参考：《大连医科大学》2014年硕士论文

【摘要】：研究背景：帕金森病(Parkinson disease PD),又称震颤麻痹（paralysisagitans),是仅次于阿尔茨海默病病，位居第二的中枢神经系统退行性疾病[1]。由英国医生James Parkinson(1817)首先描述，是一种中老年人常见的运动障碍性疾病，以黑质多巴胺能神经元变性缺失和路易小体的形成为病理特征，临床表现为静止性震颤、运动迟缓、肌强直和姿势步态异常等。65岁以上的老年人群患病率为2%。目前，我国的帕金森患者人数已超过200万。帕金森病给患者的正常生活带来了极大的困扰，给其家属带来了沉重的负担。过去190多年PD的运动症状一直是研究的重点，随着对PD疾病的深入认识，非运动症状（例如：疲劳，情绪紊乱，睡眠障碍和焦虑症状）逐渐得到人们的重视。非运动症状给患者带来的痛苦更持久，但目前人们对帕金森病人的非运动性症状的病理生理学机制还不是很清楚。研究目的：1.分别采用UPDRS、Webster、Fatigue Scale-14疲劳量表、HRSD焦虑量表、HRSD抑郁量表、NMSS、MOCA、匹兹堡睡眠质量指数量表、日本嗅觉检测试剂盒对PD患者的病情及非运动症状进行评估。 2.通过检测帕金森病患者外周血促炎症物质（TNF-α, IL-6,sIL-2R, hs-CRP）的含量，，探讨TNF-α,IL-6, sIL-2R, hs-CRP与疲劳、焦虑、抑郁、睡眠障碍间的关系，研究其在帕金森病非运动症状发生发展中的作用，探讨非运动症状的病理机制，为帕金森病非运动症状的预防和治疗提供新的思路。 3.提出免疫炎性机制可能参与PD非运动症状观点研究方法：病例组从2012年12月-2013年5月于大连市中心医院就诊的原发性PD患者（符合1992年英国PD脑库原发性PD的诊断标准）。对照组选择在该时间段在本院体检并显示健康的人群。病例组入选标准：年龄：40-75岁，临床诊断为帕金森氏病并伴有非运动症状，所有患者均签署知情同意书。健康对照组为随机体检的健康的年龄在40-75岁之间的健康中老年人。排除脑血管疾病、脑炎等原因所导致的帕金森综合征。排除标准适用于患者和对照组。分别对PD组进行UPDRS、Webster、NMSS量表、Fatigue Scale-14、HRSD焦虑量表、HRSD抑郁量表、匹兹堡睡眠质量指数量表、MOCA量表进行评估及嗅觉检测，对健康对照组进行NMSS量表、Fatigue Scale-14、HRSD焦虑量表、HRSD抑郁量表、匹兹堡睡眠质量指数量表、MOCA量表进行评估。检测PD患者及健康对照组血清中TNF-α,IL-6, sIL-2R, hs-CRP含量。结果：1.PD患者的HRSD焦虑量表、HRSD抑郁量表、NMSS、匹兹堡睡眠质量指数量表、Fatigue Scale-14疲劳量表评分明显高于健康对照组，并有显著差异。MOCA量表评PD患者组与健康对照组间无显著差异。 2.大多数PD患者出现运动症状之前都有不同程度的嗅觉损害。 3.PD患者的hsCRP、TNF-α、IL-6的水平与健康对照组相比有显著差异（p0.05）。 4.sIL-2R和抑郁、焦虑症状之间具有明显的正相关关系。C反应蛋白与焦虑和抑郁成负相关。结论：1.PD患者的非运动症状表现形式多样并严重影响着患者的日常生活质量。 2.PD的发病及发展可能和炎症相关。 3.炎症因子sIL-2R可能参与了PD患者的焦虑、抑郁症状的发生、发展。
[Abstract]:Background: Parkinson's disease (Parkinson disease PD), also known as tremor paralysis (paralysisagitans), is second only to Alzheimer's disease, the second of the central nervous system degenerative disease [1]., first described by the British doctor James Parkinson (1817), is a common dyskinesia of middle and old people, with dopamine in the dark matter. Degenerative degeneration and the formation of Louis corpuscle are pathological features. The prevalence rate of the aged people above.65 years old is 2%. at the age of static tremor, motion retardation, myotonic and postural gait, and the number of Parkinson patients in our country has exceeded 2 million. Parkinson's disease has brought great trouble to the normal life of the patients. Family members have brought a heavy burden. The symptoms of PD movement over the past 190 years have been the focus of research. With the deep understanding of PD diseases, non motor symptoms (such as fatigue, emotional disorders, sleep disorders, and anxiety symptoms) have been gradually paid attention to. The pain of non motor symptoms is more lasting, but Parkinson is currently on the people's side. The pathophysiological mechanism of the patient's non motor symptoms is not yet clear.
Objective: 1. using UPDRS, Webster, Fatigue Scale-14 fatigue scale, HRSD anxiety scale, HRSD depression scale, NMSS, MOCA, Pittsburgh sleep quality index scale, and Japanese olfactory detection kit to evaluate the condition and non motor symptoms of patients with PD.
2. to explore the relationship between TNF- alpha, IL-6, sIL-2R, hs-CRP and fatigue, anxiety, depression and sleep disorders by detecting the contents of TNF- alpha, IL-6, sIL-2R, and hs-CRP in the peripheral blood of patients with Parkinson's disease, and to study its role in the development of non motor symptoms in Parkinson's disease and to explore the pathological mechanism of non motor symptoms for the non transport of Parkinson's disease. The prevention and treatment of dynamic symptoms provide a new way of thinking.
3. suggest that the immune inflammatory mechanism may be involved in PD's non motor symptoms.
Methods: the case group was diagnosed with primary PD patients in Dalian Central Hospital, Dalian, December 2012, in May, -2013, in accordance with the diagnostic criteria for primary PD in the British PD brain in 1992. The control group selected the healthy population at this time period in the hospital. The standard of the case group was 40-75 years old, and the clinical diagnosis was Parkinson's disease. With non motor symptoms, all patients signed the informed consent. The healthy control group was a healthy middle-aged and old aged 40-75 years old. The Parkinson syndrome caused by the elimination of cerebrovascular disease, encephalitis, and other reasons. The exclusion criteria were applied to the patients and the group. UPDRS, Webster, and NMSS were used in the PD group respectively. Table, Fatigue Scale-14, HRSD anxiety scale, HRSD depression scale, Pittsburgh sleep quality index scale, MOCA scale evaluation and olfactory detection, NMSS scale, Fatigue Scale-14, HRSD anxiety scale, HRSD depression scale, Pittsburgh sleep quality index scale, MOCA scale were evaluated in healthy control group. PD patients and healthy controls were measured. The content of TNF- alpha, IL-6, sIL-2R and hs-CRP in the serum of the group.
Results: the HRSD anxiety scale of 1.PD, the HRSD depression scale, the NMSS, the Pittsburgh sleep quality index scale, the Fatigue Scale-14 Fatigue Scale score were significantly higher than those of the healthy control group, and there were significant differences between the PD patients and the healthy controls with the.MOCA scale.
2. most PD patients have different degrees of olfactory damage before they develop motor symptoms.
The levels of hsCRP, TNF- alpha and IL-6 in 3.PD patients were significantly different from those in healthy controls (P0.05).
There was a significant positive correlation between 4.sIL-2R and depression and anxiety symptoms..C reactive protein was negatively correlated with anxiety and depression.
Conclusion: the manifestations of non motor symptoms in 1.PD patients are various and seriously affect the quality of daily life of patients.
The onset and development of 2.PD may be associated with inflammation.
3. inflammatory factor sIL-2R may be involved in the development of anxiety and depressive symptoms in PD patients.
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R742.5

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