帕金森病运动症状首发部位的相关因素研究

发布时间：2019-03-19 18:24

【摘要】：研究背景帕金森病(Parkinson's disease,PD)是一种常见于中老年的慢性进行性神经系统变性疾病,是中老年人致残的主要原因之一[1,2]。其主要临床表现是由于纹状体多巴胺神经递质的减少而引起肌强直、行动迟缓及震颤等运动症状及嗅觉功能减退、便秘、抑郁焦虑及认知障碍等非运动症状[3]。人口流行病学调查显示,大约有0.3%的世界人口正在经受帕金森病的折磨,其中在60岁及以上的人群中大约占1%,在85岁以上的人口中,患病几率增加至4-5%。经过10-20年的病程,大约有40%-75%的患者因帕金森病去世,约50%失去生活自理能力,需专人看护由于具有高发病率及致残性,因此帕金森病成为继阿尔茨海默病(Alzheimer's disease.AD)后第二位的神经变性疾病。PD患者的运动症状首发部位是多样化的,有的患者以上肢起病,有的患者以下肢或上下肢起病,有的以左侧起病,或右侧,或双侧同时起病,其与pD的相关危险因素是否存在相关性未可知。已有研究报道,饮酒、吸烟、饮茶、脑力劳动、杀虫剂接触史与帕金森病的发病有关[6],而帕金森病的发病与文化程度、高血压病史、2型糖尿病、阳性家族史等无显著相关性[7]。未有报道PD运动症状首发部位的多样性与相关因素的相关性的研究。我们主要探讨年龄、性别、文化程度等相关因素与PD患者首发运动症状起病部位是否存在相关性,并就结果讨论其对PD的意义。研究目的研究帕金森病患者运动症状首发部位与相关因素的相关性分析。研究方法对在2013年1月份至2016年12月份之间于山东省立医院神经内科病房住院的85例帕金森病患者的临床资料进行回顾性分析,采用单项及多项Logistic回归分析,筛选与上肢起病存在相关性的危险因素。研究结果1.我们本次研究共纳入85例符合入组标准的帕金森病患者,其中以上肢起病的有54人(63.5%),不以上肢起病的有31人(36.5%),其中男性42人(49.4%),女性43人(50.6);年龄分三个层次:小于等于44岁(青年)、45岁至59岁(中年),大于等于60岁(老年),纳入的病例数分别为10(11.8%),33(38.8%),42(49.4%);文化程度也分三类:小学及以下、初中至高中、高中以上,分别有46(54.1%)、29(34.1%)、10(11.8%)个患者,职业主要分三类:农民、工人、离退人员,纳入的病例数分别为43(50.6%)、13(15.3%)、29(34.1%);特殊嗜好分四类:无特殊嗜好、吸烟、饮酒、吸烟同时饮酒,各自的病例数为60(70.6%)、6(7.1%)、9(10.6%)、10(11.8%)。罹患糖尿病与高血压的患者分别有 9(10.6%)、28(32.9%)人。2、logistic单因素相关性分析结果显示:在性别、起病年龄、文化程度、职业、特殊嗜好、高血压病史及糖尿病病史7类因素中,对以上肢作为帕金森病运动症状首发部位的影响各自的P值分别为:0.449、0.003、0.713、0.226、0.022、0.184、0.128(p0.05有统计学意义),由此可见,起病年龄及特殊嗜好对帕金森病患者以上肢作为首发部位有影响。3.我们又采用多因素的logistic回归分析,结果显示起病年龄与上肢发病存在明显的相关性,其中小于等于44岁(青年)、45岁至59岁(中年)危险因素的p值分别为0.020、0.011,OR值分别为0.160、0.249,B值分别为-1.833,-1.892。而特殊嗜好与上肢起病无有意义的相关性,p值均0.05。此外,危险因素起病年龄中B值均为负值,说明起病年龄越小,越倾向于以上肢起病。研究结论1、性别、文化程度、职业、特殊嗜好、高血压病史、糖尿病病史六个因素与帕金森病的起病部位不存在有意义的相关性。2、起病年龄与帕金森病患者的运动症状首发部位存在明显的相关性,且起病年龄越小,越倾向于以上肢起病,起病年龄每增加一个年龄段,其以上肢起病的风险就减少0.1-0.2倍左右。
[Abstract]:Parkinson's disease (PD), a chronic progressive neurodegenerative disease, is one of the main causes of the disability of the middle-aged and the elderly[1,2]. The main clinical manifestation of the invention is that, due to the reduction of the dopamine neurotransmitter in the striatum, the symptoms of the motor, such as muscle rigidity, slow movement and tremor, and the non-motion symptoms such as the loss of olfaction, constipation, depression and anxiety, and the cognitive disorder[3]. An epidemiological survey shows that about 0.3 per cent of the world's population is suffering from parkinson's disease, of which about 1 per cent of the population aged 60 and above is in the range of 4-5 per cent of the population over the age of 85. After 10-20 years of disease, about 40% to 75% of patients died from Parkinson's disease, about 50% of them lost their self-care ability, and a special person was assigned to care for their high morbidity and disability, and therefore, Parkinson's disease became the second-place neurodegenerative disease following Alzheimer's disease. The first part of the movement symptoms of PD patients is diverse, and some of the patients are sick with upper limb. Some of the patients are sick with lower limbs or upper and lower limbs, some of them are on the left, or the right side or both sides, and the relevant risk factors of the pD are not known. The history of exposure to drinking, smoking, tea, brain and insecticide was related to the pathogenesis of parkinson's disease[6], but the incidence and culture of parkinson's disease, the history of hypertension, type 2 diabetes, and the positive family history of parkinson's disease had no significant correlation[7]. There was no study on the relationship between the diversity of the first part of PD motion and the related factors. We mainly discuss the correlation between the related factors such as age, gender and culture, and the onset of the first-episode motion of PD patients, and discuss their significance to PD. Objective To study the correlation between the first part of the motion symptoms and the related factors in the patients with Parkinson's disease. The clinical data of 85 patients with Parkinson's disease (PD) from January 2013 to December 2016 between January 2013 and December 2016 were analyzed retrospectively, and the risk factors associated with the onset of upper extremity diseases were selected by single and multiple logistic regression analysis. Study Results 1. In this study,85 patients with Parkinson's disease who met the criteria for enrollment were included, including 54 (63.5%) of upper limb diseases and 31 (36.5%) of upper limb diseases, of which 42 (49.4%) were male and 43 (50.6) for women; the age was divided into three levels: The number of cases of less than or equal to 44 years (youth),45 to 59 years (middle age), greater than or equal to 60 years (old), the number of cases included is 10 (11.8%),33 (38.8%),42 (49.4%), and the degree of culture is also divided into three categories: primary and lower, middle school to high school, high school,46 (54.1%),29 (34.1%),10 (11.8%) of patients, and the occupation is mainly divided into three categories: There were 43 (50.6%),13 (15.3%),29 (34.1%) of the patients,13 (15.3%),29 (34.1%), and the special preference was divided into four categories: no specific hobbies, smoking, drinking, smoking and drinking, the number of cases was 60 (70.6%),6 (7.1%),9 (10.6%), and 10 (11.8%). There were 9 (10.6%) and 28 (32.9%) of the patients with diabetes and hypertension. The P values of the first part of the upper limb as the first part of the motion of the Parkinson's disease were: 0.449, 0.003, 0.713, 0.226, 0.022, 0.184, 0.128 (P0.05). The multivariate logistic regression analysis was used to study the correlation between the onset age and the onset of upper extremity. The p-value of the risk factors was 0.020, 0.011 and the OR value of 0.160, 0.249 and the value of B were-1.833 and-1.892, respectively. There was no significant correlation between the special preference and the onset of the upper limb, and the p-value was 0.05. In addition, the value of B in the age of the risk factors was negative, indicating that the younger the onset of the disease, the more prone to the onset of the upper limb. (1) There was no significant correlation between the sex, the degree of culture, the occupation, the special hobby, the history of hypertension, the history of diabetes, and the position of the onset of Parkinson's disease.2. There was a significant correlation between the onset age and the first part of the disease in the patients with Parkinson's disease. And the smaller the onset age, the more prone to the onset of the upper limb, the onset of the disease is increased by one age group, and the risk of the onset of the upper limb is reduced by about 0.1 to about 0.2 times.
【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R742.5

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