帕金森病冻结步态临床特征及相关性研究

发布时间：2018-07-28 18:07

【摘要】：第一部分帕金森病患者冻结步态的临床特征、相关因素分析目的：分析伴冻结步态（Freezingofgait,FOG）的帕金森病（Parkinson’sDisease,PD）患者临床特征，探讨FOG发生率、临床表现、伴随症状以及其影响因素。方法：连续收集PD患者191名，根据冻结步态量表，将患者分为PD+FOG组和PD-FOG组。记录患者的临床资料，对所有患者行关期UPDRS评分和H-Y分期评定。采用汉密尔顿抑郁量表（HAMD）-24对患者抑郁及程度进行评定。采用蒙特利尔认知评估量表（MoCA）北京版对患者的认知功能水平进行评定。结果：PD患者中FOG的发生率为54.4%，其中启步冻结、转弯冻结、行走中冻结发生率分别为77.8%、61.5%、33.7%。PD+FOG患者较PD-FOG患者病程更长（P=0.000），以强直少动为首发症状比率更高（P=0.007），H-Y分期更高（P=0.000）、UPDRS Ⅰ、Ⅱ、Ⅲ各分值更大（P=0.000），服用左旋多巴日剂量和等效剂量更大（P=0.000），发生抑郁和跌倒比率更高（P=0.006、P=0.000），HAMD评分更高（P=0.000）。PD+FOG组视空间及执行功能损害重于PD-FOG组（P=0.014）。H-Y分期、UPDRS Ⅱ、跌倒是PD患者冻结步态的主要影响因素。结论：PD患者中冻结步态的发生率较高，其中启步冻结、转弯冻结较行走中冻结更为常见。伴FOG的PD患者病程更长，疾病严重程度更重，且常伴有轻度抑郁和明显的认知功能损害，跌倒的危险更大。疾病严重程度、日常生活能力及跌倒对FOG有显著的影响。第二部分帕金森病冻结步态患者的认知、情感障碍目的：研究FOG患者认知障碍及情感障碍的发生情况，并探究运动障碍、认知、情感障碍是否共同影响FOG，三者是否可以为FOG的独立预测因子。方法：对104例PD+FOG患者行冻结步态量表（FOGQ）评分。用UPDRS Ⅲ和H-Y分期评定PD患者运动症状的严重程度，用蒙特利尔认知评估量表（MoCA）北京版评定患者的认知功能水平，用汉密尔顿抑郁量表（HAMD）-24评定患者的抑郁程度。结果：104例患者中，UPDRS Ⅲ31.98±13.98分，H-Y分期2.50±0.67期，FOGQ9.23±5.11分，MoCA20.10±5.89分，HAMD10.91±9.35分，男性和女性之间无统计学差异；认知障碍发生率为82.9%，抑郁发生率为55.8%。86例认知障碍患者的视空间和执行能力认知域评分明显降低（P=0.000）。FOGQ与H-Y、UPDRS、HAMD评分呈正相关，与MoCA呈负相关。MoCA、UPDRS Ⅱ、UPDRS Ⅲ、HAMD均为FOGQ的独立影响因素。结论：PD伴冻结步态患者运动症状较重，并伴有明显认知功能障碍及抑郁，两者发生率均较高，其中认知障碍主要表现为执行和视空间障碍。患者冻结步态症状越重，抑郁评分越高，发生率越高；而冻结步态症状越重，患者认知障碍越严重。运动障碍、认知受损及情感异常共同影响FOG，三者均是FOG的独立预测因子。第三部分帕金森病冻结步态患者血尿酸水平变化目的：观察PD冻结步态患者的血尿酸水平变化，探讨冻结步态与血尿酸水平的关系，为冻结步态的研究寻找生物学指标。方法：选取93例PD患者，根据FOGQ将其分为PD+FOG组和PD-FOG组。收集患者的临床资料，并行FOGQ评分。同时选取同时间段社区的健康人64例作为对照组，早晨空腹测定血尿酸、肌酐，对有无冻结步态的两组及正常对照组的血尿酸进行比较。结果：PD+FOG组血尿酸258.58±58.15μmol/L，PD-FOG组285.58±64.65μmol/L，健康对照组327.77±60.23μmol/L。PD+FOG组血尿酸显著低于PD-FOG组（P=0.034,0.05）和健康对照组（P=0.000,0.01）。PD-FOG组血尿酸显著低于健康照组（P=0.000,0.01）。PD+FOG组、PD-FOG组和健康对照组内生肌酐清除率分别为81.77±29.58、82.04±20.66、82.85±21.39ml/min，三组之间均无显著性差异（P0.05）。血尿酸水平与FOGQ相关因素分析示两者无直线相关关系。结论：PD患者冻结步态组血尿酸水平明显低于非冻结步态组和正常健康人群，提示血尿酸水平与冻结步态有关，，但不能作为判断冻结步态严重程度的一个指标。
[Abstract]:Part one clinical characteristics and related factors of frozen gait in patients with Parkinson's disease
Objective: to analyze the clinical features of patients with Parkinson's disease (Parkinson 'sDisease, PD) with Freezingofgait (FOG), and to explore the incidence of FOG, clinical manifestations, accompanying symptoms and its influencing factors.
Methods: 191 PD patients were collected continuously. According to the frozen gait scale, the patients were divided into PD+FOG group and PD-FOG group. The patients' clinical data were recorded. All patients were evaluated by UPDRS score and H-Y staging. The Hamilton Depression Scale (HAMD) -24 was used to evaluate the patients' depression and degree. The Montreal cognitive assessment scale (MoCA) was used. The Beijing edition assessed the cognitive function of the patients.
Results: the incidence of FOG in PD patients was 54.4%, in which the starting freezing and turning freezing were 77.8%, 61.5%, and 33.7%.PD+FOG patients were longer than the PD-FOG patients (P=0.000), and the ratio of the first symptom was higher (P=0.007), H-Y stage was higher (P=0.000), UPDRS I, II, and III were higher (P=0.000). The daily dose of levodopa and the equivalent dose (P=0.000) increased the rate of depression and fall (P=0.006, P=0.000), and the HAMD score was higher (P=0.000) in group.PD+FOG, the visual space and the impairment of executive function were heavier than the.H-Y staging of PD-FOG group (P=0.014), UPDRS II, and the fall was the main influencing factor of the frozen gait of PD patients.
Conclusion: the incidence of frozen gait in PD patients is higher, in which the freezing step is more common than the freezing in walking. The duration of the disease is longer, the severity of the disease is more serious, and the severity of the disease is more severe, and the risk of falling is greater. The severity of disease, the daily living ability and the fall to FOG are more common. There is a significant impact.
The second part is the cognition and affective disorder of Parkinson's disease patients with frozen gait.
Objective: To investigate the occurrence of cognitive impairment and affective disorder in FOG patients, and to explore whether or not dyskinesia, cognition, and affective disorders affect FOG, and whether the three can be an independent predictor of FOG.
Methods: the frozen gait scale (FOGQ) score was performed in 104 patients with PD+FOG. The severity of the movement symptoms in PD patients was assessed by UPDRS III and H-Y staging. The cognitive function level of the patients was assessed by the Beijing edition of Montreal cognitive assessment scale (MoCA), and the depression degree of the patients was assessed with the Hamilton Depression Scale (HAMD) -24.
Results: in the 104 patients, UPDRS III 31.98 + 13.98 points, H-Y staging 2.50 + 0.67 stages, FOGQ9.23 + 5.11, MoCA20.10 + 5.89, HAMD10.91 9.35, there was no statistical difference between men and women; the incidence of cognitive impairment was 82.9%, and the incidence of depression was significantly reduced in visual space and executive ability in 55.8%.86 patients with cognitive impairment. Low (P=0.000).FOGQ was positively correlated with H-Y, UPDRS and HAMD scores, and negatively correlated with MoCA..MoCA, UPDRS II, UPDRS III and HAMD were independent factors of FOGQ.
Conclusion: the symptoms of PD with frozen gait are heavier, with obvious cognitive impairment and depression. The incidence of cognitive impairment is high, and cognitive impairment is mainly manifested in execution and visual space barriers. The heavier the symptoms of frozen gait, the higher the score of depression, the higher the incidence of depression, and the more severe the frozen gait symptoms, the more strict cognitive impairment in patients. Heavy. Dyskinesia, cognitive impairment and affective disorder jointly affect FOG. Both of these three are independent predictors of FOG.
The third part is the change of serum uric acid level in frozen patients with Parkinson's disease.
Objective: To observe the changes of serum uric acid level in patients with PD frozen gait, and to explore the relationship between the frozen gait and the level of blood uric acid, and to find the biological index for the study of the frozen gait.
Methods: 93 patients with PD were selected and divided into PD+FOG group and PD-FOG group according to FOGQ. The clinical data of the patients were collected and the FOGQ scores were collected. At the same time, 64 healthy people in the same time community were selected as the control group. The blood uric acid and creatinine were measured in the morning on the empty stomach. The blood uric acid in the two groups with no frozen gait and the normal control group was compared.
Results: the serum uric acid in PD+FOG group was 258.58 + 58.15 mu mol/L, group PD-FOG was 285.58 + 64.65 mol/L, and the blood uric acid in group 327.77 + 60.23 mol/L.PD+FOG was significantly lower than that of group PD-FOG (P=0.034,0.05) and healthy control group (P=0.000,0.01) group.PD-FOG lower than that of healthy group (P=0.000,0.01).PD+FOG group, PD-FOG group and healthy control group. The scavenging rate of creatinine was 81.77 + 29.58,82.04 + 20.66,82.85 + 21.39ml/min respectively. There was no significant difference between the three groups (P0.05). There was no linear correlation between the serum uric acid level and the analysis of FOGQ related factors.
Conclusion: the level of uric acid in the frozen gait group of PD patients is significantly lower than that of the non frozen gait group and the normal healthy population. It is suggested that the level of uric acid is related to the frozen gait, but it can not be used as an indicator to judge the severity of the frozen gait.
【学位授予单位】：苏州大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R742.5

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