快动眼期睡眠行为障碍和帕金森病患者嗅觉分析及价值

发布时间：2018-06-16 23:35

本文选题：帕金森病 + 快动眼睡眠行为障碍　；参考：《复旦大学》2014年博士论文

【摘要】：背景：嗅觉障碍是帕金森病(Parkinson's Disease, PD)的非运动症状之一,其阳性率高达90%以上,可先于PD运动症状数年出现。快动眼睡眠行为障碍(Rapid Eye Movement Sleep Behavior Disorder, RBD)是PD的重要危险因素,被认为是PD运动障碍发生前的前驱表现。纵向研究提示,该病与PD有相似的病理变化,且大部分特发性RBD病人最终将进展为PD或路易体痴呆,故特发性RBD人群是研究PD早期诊断的极佳人群。国外研究提示RBD患者亦可出现PD的一些早期非运动症状,包括嗅觉减退,但目前对比RBD病人和PD病人嗅觉情况的研究仍非常少,且结果并不一致。嗅觉检测的结果受文化差异影响,国内尚未见有关于特发性RBD嗅觉情况的报道。目的：本研对中国特发性RBD患者及PD患者嗅觉障碍程度及特点进行分析,研究PD病人运动前期嗅觉减退的特点,以及哪种气味对中国PD病人早期诊断更有价值,探讨嗅觉检测在PD早期诊断中的应用价值。方法：本研究收集以睡眠异常行为为主诉就诊于睡眠门诊的患者,经过多导睡眠图(Polysomnography, PSG)监测确认为RBD,共55例；收集神经科门诊及病房的患者,严格按照英国伦敦脑库PD诊断标准(UK PD Brain Bank Criteria)确诊为PD,选择其中性别、年龄与RBD组相匹配,且无睡眠异常病史者55例：收集与RBD组性别、年龄相匹配的社区来源,无神经科疾病的健康对照55例。所有病例及对照均排除存在可能影响嗅觉的其他因素者及认知功能障碍者。使用‘'SniffinStick”嗅觉检测笔对上述三组病人进行嗅觉测定。该套检测共有12种气味的笔,分别为橙子、皮革、桂皮、薄荷、香蕉、柠檬、甘草、咖啡、丁香、菠萝、玫瑰、鱼。每种气味有四个备选答案供受试者选择,选对一种得一分。分别对比各组间总分以及单项气味识别正确率的差异。结果：研究发现,RBD病人、PD病人、正常对照的嗅觉测试总分中位数分别为6(5,7)、4(3,6)、9(8,10),三组间存在统计学差异(P0.001)；RBD病人嗅觉测试总分明显低于正常人群(P0.001),且RBD组嗅觉总分较PD组高(P0.01)。PD组与对照对照组相比较,除桂皮、菠萝外,其他气味识别正确率均有显著差异；RBD组与对照组相比,除了皮革、丁香、菠萝外,其他气味识别正确率均有显著差异,其中薄荷、香蕉、玫瑰差异最明显(P0.0001)。结论：RBD患者和PD患者均存在显著嗅觉功能减退,PD病人嗅觉减退程度较RBD病人重,且不能识别的气味种类更多。香蕉、玫瑰、薄荷、橙子、柠檬五种气味识别障是临床前期PD的敏感指标。而桂皮、菠萝两种气味不适合中国人群的检测。RBD患者嗅觉测定得分高低可能与近期发展为PD有联系,需继续随访及研究明确。
[Abstract]:Background: olfactory disorder is one of the non-motor symptoms of Parkinsonian disease (PDD). Its positive rate is more than 90%, which can occur several years before PD. Rapid Eye Movement Sleep behavior Disorder (RBD) is an important risk factor for PD and is considered to be the precursor of PD before the onset of dyskinesia. Longitudinal studies suggest that the disease has similar pathological changes to PD, and most of idiopathic RBD patients will eventually develop PD or Lewy body dementia, so idiopathic RBD population is the best group to study the early diagnosis of PD. Foreign studies suggest that RBD patients may also have some early non-motor symptoms of PD, including olfactory decline, but there are still very few studies comparing the olfactory status of RBD patients and PD patients, and the results are not consistent. The results of olfactory detection are affected by cultural differences, but there are no reports of idiopathic RBD olfaction in China. Objective: to analyze the degree and characteristics of olfactory disorders in idiopathic RBD patients and PD patients in China, and to study the characteristics of premotor olfactory decline in PD patients and which odors are more valuable for the early diagnosis of PD patients in China. To explore the value of olfactory detection in early diagnosis of PD. Methods: a total of 55 patients with abnormal sleep behavior were collected and confirmed as RBD by polysomnography (PSG) monitoring. According to the diagnostic criteria of UK PD brain Bank criteria (UK PD brain Bank criteria), 55 cases of PDD were selected, including sex, age matched with RBD group, and no history of abnormal sleep. Community sources matched with sex and age of RBD group were collected. There were 55 healthy controls without neurologic diseases. All cases and controls excluded the presence of other factors that might affect olfaction and cognitive impairment. The olfactory test pen was used to measure the olfactory ability of the three groups of patients. A total of 12 scents were tested for orange, leather, cinnamon, mint, banana, lemon, licorice, coffee, clove, pineapple, rose, fish. Each odour had four alternatives for the subjects to choose from, with the right one getting a point. The difference of the total score and the accuracy rate of individual odour recognition were compared. Results: it was found that the median of total olfactory test scores of patients with PD in RBD patients in normal control group was 6: 5, 7, 3, 6, 6, 9, 8, 10, respectively. There was a statistical difference among the three groups (P 0.001). The results showed that the total score of olfactory test was significantly higher than that of control group (P < 0.05). The total score of olfactory test in RBD patients was significantly lower than that in normal subjects (P 0.001), and the total olfactory score of RBD group was higher than that of PD group. The total olfactory score of RBD group was higher than that of PD group, and there were significant differences between RBD group and control group, except cinnamon and pineapple, the rate of odour recognition in RBD group was higher than that in control group. Except for leather, clove and pineapple, there were significant differences in the rate of odour recognition, among which the difference of mint, banana and rose was the most obvious (P 0.0001). Conclusion both the patients with RBD and the patients with PD have significant loss of olfactory function. The degree of hypoolfaction in patients with PD is more serious than that in patients with RBD, and there are more kinds of odors that can not be recognized. Banana, rose, mint, orange and lemon are sensitive indexes of PD in preclinical stage. The olfactory score of RBD patients may be related to the recent development of PD, which needs to be further followed up and studied to make sure that the two odors of cinnamon and pineapple are not suitable for Chinese population.
【学位授予单位】：复旦大学
【学位级别】：博士
【学位授予年份】：2014
【分类号】：R742.5;R740

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