帕金森病患者自主神经功能障碍的研究
发布时间：2019-06-22 14:56
【摘要】：目的：1）研究帕金森病（Parkinson’s disease, PD）患者自主神经功能障碍的特点；2）探讨皮肤交感反应（sympathetic skin response, SSR）及自主神经功能评定量表（the Scale for Outcomes in PD for AutonomicSymptoms, SCOPA-OUT）对PD患者自主神经障碍检测的敏感性。 方法： 选取2011年10月-2013年10月就诊于河北医科大学第一医院的71例原发性PD患者。应用PD患者一般情况信息表、修订后Hoehn-Yahr分期（the Modified Hoehn and Yahr Staging）、统一帕金森病评定量表（Unified Parkinson’s Disease Rating Scale, UPDRS）分别调查PD患者的基本信息（包括患者性别、年龄、文化程度等）及患者病程、疾病的发生发展和严重程度；应用汉密尔顿焦虑量表14项版本（HAMA14）、汉密尔顿焦虑抑郁量表24项版本（HAMD24）评估患者情绪状况；应用简易精神状态检查量表（MMSE）、蒙特利尔认知评估量表（MoCA）评估患者认知情况；应用匹兹堡睡眠质量指数（PSQI）评估患者睡眠质量情况。应用自主神经症状量表（the Scale for Outcomes in PD for AutonomicSymptoms, SCOPA-OUT）评估患者的自主神经功能障碍，应用皮肤交感反应（sympathetic skin response, SSR）对患者进行植物神经功能检测。 按本研究中的标准分为正常组（PD-N）、轻度认知功能障碍组（PD-MCI）、帕金森病痴呆组（PDD）、焦虑组、抑郁组、睡眠障碍组。其中MOCA≥26、MMSE≥26分为正常组（PD-N），认知功能障碍组包括轻度认知功能障碍组（PD-MCI）和帕金森病痴呆组（PDD），其中MOCA26、MMSE≥26分为PD-MCI，MOCA26、MMSE26分为PDD；HAMA14≥7分为焦虑组；HAMD24≥8分为抑郁组；PQSI≥6分为睡眠障碍组；SCOPA-OUT分为0分（无症状）；1分（轻）；2分（中等）；3分（重）四个等级，总得分为0分为正常组、1-12分为轻度异常组、13-69分为重度异常组。分别对这几组进行SSR检测，采用SPSS13.0软件对患者基本信息进行统计描述，应用秩和检验和卡方检验分析各组的异同点。 结果： 1剔除5例无效问卷，剩余PD患者中男性37例，女性29例；年龄46~84岁，平均（66.5±9.5）岁；病程1~20年，平均（6.0±4.4）年；受教育程度0~18年，平均（10.9±3.7）年；UPDRS得分为10~74分，平均（41.5±15.4）分；H-Y分期1.0~5期，平均（2.3±0.7）期；HAMA14得分2~22分，平均（11.2±4.7）分；经HAMD24得分1~22分，平均（10.2±5.2）分；MMSE得分16~30分，平均（26.1±3.5）分；MOCA得分10~30分，平均（21.4±5.2）分；PSQI得分1~19分，平均（7.5±4.7）分。 2本研究中同女性PD患者相比，男性PD患者的病情更加严重（UPSRS：P=0.004，H-Y：P=0.005）。 3从临床特征看，PD患者自主神经功能障碍中便秘症状最为突出（46例，占69.07％），其次发生率较高的症状依次为：流涎（35例，占53.03％）；多汗（29例，占43.94%）、夜尿增多（29例，占43.94%）、尿频（27例，占40.91%）、尿急（25例，占37.88%）、吞咽困难（21例，占31.82%）、体温调节障碍（16例，占24.24%）、尿失禁（14例，占21.21%）、体位性低血压（12例，占18.18%）、性功能障碍（5例，占7.58%）。PD患者自主神经功能障碍经SCOPA-OUT检出率为100%；经SSR检测出率为63.6%。提示SCOPA-OUT敏感性更高。 4经SCOPA-OUT量表评估发现自主神经功能重度异常患者与自主神经轻度异常患者相比，前者在年龄、病程、疾病严重程度、焦虑情绪和认知功能障碍等方面的病情更为严重（P0.05)，而两组在受教育程度、抑郁情绪和睡眠等方面的病情无差别（P0.05）。SSR异常患者与SSR正常患者相比，SSR异常患者的年龄更高（P0.05)，而两组在病程、受教育程度、疾病严重程度、焦虑、抑郁情绪、认知功能障碍和睡眠等方面的病情无差别（P0.05）。 5本研究发现：认知功能正常PD患者17例（25.76%），PD-MCI患者26例（39.39%），PDD患者23例（34.85%）；伴有焦虑患者56例（84.85%），伴有抑郁患者为43例（65.15%），焦虑抑郁共病患者为40例（60.61%）；伴有睡眠障碍患者为34例（51.52%）。对于伴有焦虑、抑郁情绪和认知功能障碍的患者，SCOPA-OUT对自主神经功能障碍的敏感性较SSR更高（P0.05）。但对PDD、PD-MCI及伴有睡眠障碍患者，SCOPA-OUT和SSR两者之间敏感性相同（P0.05)。 结论:（1）本研究所有PD患者中，男性的病情较女性更为严重。（2）本研究提示PD患者普遍存在自主神经功能障碍，其中以便秘症状最为突出。（3）经SCOPA-OUT评估，自主神经功能重度异常患者在年龄、病程、疾病严重程度、焦虑情绪和认知功能障碍等方面的病情比自主神经功能轻度异常患者更为严重。经SSR检测，SSR异常PD患者的年龄更大。（4）对于伴有焦虑、抑郁情绪和认知功能障碍的PD患者，SCOPA-OUT较SSR更敏感。
[Abstract]:Objective:1) To study the characteristics of autonomic dysfunction in the patients with Parkinson's disease (PD), and to explore the sensitivity of the skin sympathetic response (SSR) and the autonomic nervous function rating scale (SCOPA-OUT) to the detection of autonomic dysfunction in PD patients. square Method:71 cases of primary P were selected from October 2011 to October,2013 in the first hospital of Hebei Medical University. The basic information of PD patients (including the patient's sex, age, cultural degree, etc.) and the patient's risk were investigated by using the general information table of PD patients, the revised Hoehn-Yahr staging, and the unified Parkinson's Disease Rating Scale (VRS), respectively. The course of the disease, the development and severity of the disease, the application of the Hamilton anxiety scale 14 (HAMA14), the Hamilton anxiety and depression scale (24) (HAMD24) to assess the mood of the patient, and the application of a simple mental state examination scale (MM SE), the Montreal Cognitive Assessment Scale (MoCA) for assessing the patient's cognitive condition; using the Pittsburgh Sleep Quality Index (PSQI) to assess the patient's sleep The autonomic nervous function of the patient was assessed by the Scale for Outlines in PD for Autonomy Symptoms (SCOPA-OUT), and the autonomic nerve function was applied to the patient by using the skin sympathetic response (SSR). The criteria of this study were divided into normal group (PD-N), mild cognitive impairment group (PD-MCI), Parkinson's disease dementia group (PDD), anxiety group, and depression group. The MOCA-26 and MMSE-26 were divided into normal group (PD-N), and the cognitive impairment group included mild cognitive impairment group (PD-MCI) and Parkinson's disease dementia group (PDD), among which, MOCA 26 and MMSE-26 were divided into PD-MCI, MOCA 26, and MMSE26 into PDD; HAMA14-7 was divided into anxiety group; HAMD24-8 It is divided into depression group; PQSI-6 is divided into sleep disorder group; SCOPA-OUT is divided into 0 (asymptomatic);1 point (light);2 (medium);3 (heavy) four grades, the score of 0 is divided into normal group,1-12 is divided into mild abnormal group, and 13-69 is divided into two groups: The basic information of the patients was statistically described by using the SPSS13.0 software, and the rank sum test and the chi-square test were used to analyze the basic information of the patients. the difference of the group The results were as follows:1 out of 5 invalid questionnaires,37 in the remaining PD patients and 29 in the female; the age was 46 to 84 years, the average (66.5 to 9.5) years; the course of the disease ranged from 1 to 20 years, with an average (6.0 to 4.4) years; the education level was 0 to 18 years, with an average (10.9% 3.7) years; and the RRS It is divided into 10-74 points, average (41.5-15.4) points, H-Y stage 1.0-5, average (2.3-0.7) period, HAMA14 score of 2-22 points, average (11.2-4.7) points, HAMA 24 scores of 1-22, average (10.2-5.2) points, MMSE score of 16-30, average (26.1-3.5) points, and MOCA score of 10-30 points, average (2 1.4 (5.2) points; PSQI score of 1-19 points, average ( 7.5 (4.7) score. The condition of the male PD patient was more severe in the study compared to the female PD (UPSRS: P = 0.004, H -Y: P = 0.005). From the clinical features, the symptoms of constipation in the patients with PD were the most prominent (46 cases, 69.07%), followed by high incidence of salivation (35 cases, 53.03%), hyperhidrosis (29 cases, 43.94%), and increased night urine. (29 cases, 43.94%), frequent micturition (27 cases, 40.91%), urgency (25 cases, 37.88%), dysphagia (21 cases, 31.82%), body temperature regulation disorder (16 cases, 24.24%), urinary incontinence (14 cases, 21.21%), orthostatic hypotension (12 cases,18.18). 18%), sexual function (5 cases, 7.58%). The detection rate of autonomic dysfunction in PD patients was 100% by SCOPA-OUT. The SSR detection rate was 63.6%. The sensitivity of COPA-OUT was higher. (0.05) There was no difference between the two groups in the degree of education, depression and sleep (P0.05). , severity of the disease, anxiety, depression, cognitive impairment, and sleep There were 17 cases (25.76%) of patients with normal PD,26 (39.39%) of PD-MCI,23 (34.85%) of PDD patients,56 (84.85%) of patients with anxiety and 43 (65.15%) of patients with depression. 40 (60.61%) of the patients with depression, with sleep 34 (51.52%) patients with sleep disorder (51.52%). In patients with anxiety, depression, and cognitive impairment, SCOPA-OUT was responsible for autonomic dysfunction. The sensitivity was higher than that of SSR (P0.05). But for PDD, PD-MCI and patients with sleep disorder, SCOPA-OUT and SS The sensitivity of R is the same (P0.05). Conclusion: (1) This study In PD patients, the condition of the male is more serious than that of the female. (2) This study suggests that PD patients are endemic The main neurological function disorder, in which the symptoms of constipation are the most prominent. (3) With the evaluation of SCOPA-OUT, the patients with severe abnormal autonomic function are in the aspects of age, course of disease, severity of disease, anxiety and cognitive function, etc. The condition of the disease is more serious than that of the patients with mild abnormal autonomic function. (4) for PD with anxiety, depression and cognitive impairment
【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R742.5
本文编号：2504690
[Abstract]:Objective:1) To study the characteristics of autonomic dysfunction in the patients with Parkinson's disease (PD), and to explore the sensitivity of the skin sympathetic response (SSR) and the autonomic nervous function rating scale (SCOPA-OUT) to the detection of autonomic dysfunction in PD patients. square Method:71 cases of primary P were selected from October 2011 to October,2013 in the first hospital of Hebei Medical University. The basic information of PD patients (including the patient's sex, age, cultural degree, etc.) and the patient's risk were investigated by using the general information table of PD patients, the revised Hoehn-Yahr staging, and the unified Parkinson's Disease Rating Scale (VRS), respectively. The course of the disease, the development and severity of the disease, the application of the Hamilton anxiety scale 14 (HAMA14), the Hamilton anxiety and depression scale (24) (HAMD24) to assess the mood of the patient, and the application of a simple mental state examination scale (MM SE), the Montreal Cognitive Assessment Scale (MoCA) for assessing the patient's cognitive condition; using the Pittsburgh Sleep Quality Index (PSQI) to assess the patient's sleep The autonomic nervous function of the patient was assessed by the Scale for Outlines in PD for Autonomy Symptoms (SCOPA-OUT), and the autonomic nerve function was applied to the patient by using the skin sympathetic response (SSR). The criteria of this study were divided into normal group (PD-N), mild cognitive impairment group (PD-MCI), Parkinson's disease dementia group (PDD), anxiety group, and depression group. The MOCA-26 and MMSE-26 were divided into normal group (PD-N), and the cognitive impairment group included mild cognitive impairment group (PD-MCI) and Parkinson's disease dementia group (PDD), among which, MOCA 26 and MMSE-26 were divided into PD-MCI, MOCA 26, and MMSE26 into PDD; HAMA14-7 was divided into anxiety group; HAMD24-8 It is divided into depression group; PQSI-6 is divided into sleep disorder group; SCOPA-OUT is divided into 0 (asymptomatic);1 point (light);2 (medium);3 (heavy) four grades, the score of 0 is divided into normal group,1-12 is divided into mild abnormal group, and 13-69 is divided into two groups: The basic information of the patients was statistically described by using the SPSS13.0 software, and the rank sum test and the chi-square test were used to analyze the basic information of the patients. the difference of the group The results were as follows:1 out of 5 invalid questionnaires,37 in the remaining PD patients and 29 in the female; the age was 46 to 84 years, the average (66.5 to 9.5) years; the course of the disease ranged from 1 to 20 years, with an average (6.0 to 4.4) years; the education level was 0 to 18 years, with an average (10.9% 3.7) years; and the RRS It is divided into 10-74 points, average (41.5-15.4) points, H-Y stage 1.0-5, average (2.3-0.7) period, HAMA14 score of 2-22 points, average (11.2-4.7) points, HAMA 24 scores of 1-22, average (10.2-5.2) points, MMSE score of 16-30, average (26.1-3.5) points, and MOCA score of 10-30 points, average (2 1.4 (5.2) points; PSQI score of 1-19 points, average ( 7.5 (4.7) score. The condition of the male PD patient was more severe in the study compared to the female PD (UPSRS: P = 0.004, H -Y: P = 0.005). From the clinical features, the symptoms of constipation in the patients with PD were the most prominent (46 cases, 69.07%), followed by high incidence of salivation (35 cases, 53.03%), hyperhidrosis (29 cases, 43.94%), and increased night urine. (29 cases, 43.94%), frequent micturition (27 cases, 40.91%), urgency (25 cases, 37.88%), dysphagia (21 cases, 31.82%), body temperature regulation disorder (16 cases, 24.24%), urinary incontinence (14 cases, 21.21%), orthostatic hypotension (12 cases,18.18). 18%), sexual function (5 cases, 7.58%). The detection rate of autonomic dysfunction in PD patients was 100% by SCOPA-OUT. The SSR detection rate was 63.6%. The sensitivity of COPA-OUT was higher. (0.05) There was no difference between the two groups in the degree of education, depression and sleep (P0.05). , severity of the disease, anxiety, depression, cognitive impairment, and sleep There were 17 cases (25.76%) of patients with normal PD,26 (39.39%) of PD-MCI,23 (34.85%) of PDD patients,56 (84.85%) of patients with anxiety and 43 (65.15%) of patients with depression. 40 (60.61%) of the patients with depression, with sleep 34 (51.52%) patients with sleep disorder (51.52%). In patients with anxiety, depression, and cognitive impairment, SCOPA-OUT was responsible for autonomic dysfunction. The sensitivity was higher than that of SSR (P0.05). But for PDD, PD-MCI and patients with sleep disorder, SCOPA-OUT and SS The sensitivity of R is the same (P0.05). Conclusion: (1) This study In PD patients, the condition of the male is more serious than that of the female. (2) This study suggests that PD patients are endemic The main neurological function disorder, in which the symptoms of constipation are the most prominent. (3) With the evaluation of SCOPA-OUT, the patients with severe abnormal autonomic function are in the aspects of age, course of disease, severity of disease, anxiety and cognitive function, etc. The condition of the disease is more serious than that of the patients with mild abnormal autonomic function. (4) for PD with anxiety, depression and cognitive impairment
【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R742.5
【参考文献】
相关期刊论文 前3条
1 焦玲;王立侠;楚兰;;帕金森病患者自主神经功能障碍相关研究[J];中风与神经疾病杂志;2009年06期
2 邵明;;双侧苍白球腹后部毁损术治疗帕金森病5年随访研究[J];中国微侵袭神经外科杂志;2011年02期
3 张庆云;董晓东;郝媛;陈玉敏;;帕金森病发病机制研究[J];医学研究与教育;2013年03期
，本文编号：2504690
本文链接：https://www.wllwen.com/yixuelunwen/shenjingyixue/2504690.html
最近更新
教材专著
