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帕金森病伴慢性疼痛患者的临床特征及认知功能的相关性分析

发布时间:2019-06-28 10:15
【摘要】:目的:1.初步研究帕金森病(Parkinson's disease, PD)伴慢性疼痛患者的临床特征;2.分析帕金森病慢性疼痛与认知功能的相关性。 方法:收集2009年1月至2013年7月苏州大学附属第二医院神经内科门诊就诊的343例PD患者的临床资料,随机选择同期150例年龄、性别、文化程度与之相匹配的健康成人作对照组,询问是否伴有慢性疼痛,对两组慢性疼痛患者进行视觉模拟评分法(visual analogue scale, VAS)、疼痛简明记录表(Brief pain inventory, BPI)评估,分析比较PD伴疼痛组(90例)与正常人伴疼痛组(50例)疼痛的部位、程度、治疗、及其对生活质量7项指标的影响;对180例伴或不伴慢性疼痛的原发性PD患者进行帕金森病统一评定量表(Unified Parkinson's Disease Rating Scale, UPDRS)、 Hoehn-Yahr (H-Y)分期、汉密顿抑郁量表(Hamilton Rating Scale for Depression, HRSD,24项)、简明智能状态检查量表(Mini-Mental State Examination, MMSE)、帕金森病生活质量问卷(PD Quality of Life Questionnaire, PDQL)、PD非运动症状问卷(non-motor Symptom Quest, NMSQ)等评估,行PD患者慢性疼痛的危险因素分析;针对2012年6月至12月间就诊的56例PD伴慢性疼痛患者,需判断其疼痛的类型,进行蒙特利尔认知评估量表(Montreal Cognitive Assessment, MoCA)等评估。 结果:1.PD组疼痛的发生率为47.8%,正常对照组疼痛的发生率33.3%,差异有统计学意义(P=0.003);PD患者疼痛程度最重的部位主要集中在四肢,而对照组疼痛的部位集中在头颈、腰痛;对PD组与对照组的BPI7项指标进行比较,PD伴慢性疼痛患者在日常生活、情绪、正常工作、行走能力、睡眠、生活乐趣方面得分均高于正常对照组,差异有统计学意义(P=0.001,0.001,0.004,0.01,0.003,0.00);2.PD伴慢性疼痛组在UPDRS各项评分、H-Y分期、HRSD、PDQL、左旋多巴日等效剂量、与PD不伴慢性疼痛组相比,差异均具有统计学意义;Logistic回归分析示只有HRSD得分具有统计学意义(OR=1.16P=0.000):3.PD伴慢性疼痛患者的延迟记忆得分(1.9±1.3)低于不伴疼痛者(2.5±1.3),差异有统计学意义(P=0.02);疼痛出现在运动症状之前患者的延迟记忆得分(1.2±1.2)明显低于疼痛出现于运动症状以后的患者(2.2±1.3),差异有统计学意义(P=0.015)。 结论:1.PD患者疼痛的发生率明显高于正常人,疼痛在PD患者中很普遍,但PD疼痛缺乏有效的治疗,且其生活质量较差;2.PD患者与正常人疼痛的机制可能不同,PD疼痛的发生与其运动症状之间可能存在相同的机制;3.抑郁可能是导致PD合并疼痛的独立危险因素;4.骨骼肌疼痛是PD患者最为常见的疼痛类型;PD伴慢性疼痛患者的认知功能损害主要表现为延迟记忆障碍。
[Abstract]:Objective:1. To study the clinical features of Parkinson's disease (PD) with chronic pain. The relationship between chronic pain and cognitive function of Parkinson's disease was analyzed. Methods: The clinical data of 343 patients with PD from January 2009 to July 2013 were collected and 150 healthy adults matched with age, sex and culture were randomly selected for the control group. The pain, the visual analogue scale (VAS) and the brief history record (BPI) of the two groups of patients with chronic pain were evaluated and compared with the pain group (50 cases) in the PD with the pain group (50 cases). Patients with primary PD with or without chronic pain were treated with the unified Parkinson's Disease Rating Scale (RRS), Hoehn-Yahr (H-Y) stage, and the Hamilton Rating Scale for Expression, HRSD,24 items. ). The risk factors of chronic pain in PD patients were assessed by the evaluation of the Mini-Mental State Examination (MMSE), the PD Quality of Life Questionnaire (PDQL), the PD Non-motor Symptom Quest (NMSQ), and the like. Analysis of 56 patients with PD with chronic pain from June to December 2012, the type of pain should be judged, and the Montreal Cognitive Assessment (MoCA) evaluation should be conducted. Results:1. The incidence of pain in the PD group was 47.8%, the incidence of pain in the normal control group was 33.3%, the difference was statistically significant (P = 0.003), the most severe pain in the PD patients was mainly in the limbs, and the pain in the control group was concentrated in the head and neck. The scores of PD with chronic pain in daily life, mood, normal work, walking ability, sleep and life were higher than that of normal control group (P = 0.001, 0.001, 0.004, 0.01, 0.003, 0.00). The scores, H-Y stages, HRSD, PDQL, and levodopa-day equivalent doses were statistically significant as compared to the PD non-chronic pain group; the logistic regression analysis showed that only the HRSD score was statistically significant (OR = 1.16 P = 0.0 00):3. The delayed memory score (1.9% 1.3) in patients with PD with chronic pain was lower than those without pain (2.5% 1.3), and the difference was statistically significant (P = 0. 02); the pain in the patient's delayed memory score (1.2% 1.2) was significantly lower than that of the patient (2.2% 1.3) after the exercise symptoms, with a statistically significant difference (P = 0.0 15) Conclusion:1. The incidence of pain in PD patients is higher than that of normal people, and the pain is common in PD patients, but PD pain lacks effective treatment, and the quality of life of PD patients is poor;2. The patients with PD and the normal person's pain The system may be different, and the occurrence of PD pain may be the same as the symptoms of its motion a mechanism;3. depression may be an independent risk that leads to the combined pain of the pd Risk factors;4. Skeletal muscle pain is the most common type of pain in PD patients; the cognitive function damage in PD patients with chronic pain is mainly delayed
【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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