涂丽;田锦勇;
TU Li;TIAN Jinyong;Guizhou Medical University;Emergency Department of Internal Medicine,Guizhou Provincial People's Hospital;

• 1:贵州医科大学
• 2:贵州省人民医院急诊内科

摘要(Abstract)：

目的:探讨帕金森病(PD)的临床特征及PD运动症状的影响因素。方法:收集102例原发性PD患者的一般资料(性别构成、年龄、病程、起病年龄及起病类型),比较运动症状特征(起病肢体、首发症状、H-Y分级、临床亚型),比较各运动症状的发生率、不同药物治疗PD患者比例;采用单因素Logistic回归分析PD运动并发症的影响因素,多因素Logistic回归分析PD运动并发症的独立危险因素。结果:男性患者发病率较高(56.86%),晚发型为主(75.49%),50.00%的患者以右侧肢体起病,65.69%的患者以震颤为首发症状,运动并发症发生率为20.59%,80.39%的患者选用药物为单用左旋多巴(LD),LD治疗的平均时间为(1.55±1.99)年,左旋多巴等效剂量(LED)平均值为(250±143.98)mg,患者病程、H-Y分级、LD、LED用量及联合≥3类药是PD运动并发症的影响因素(P<0.05),LED是PD症状波动的独立危险因素(P=0.02)。结论:PD是以震颤为首发症状、运动症状较重、男性患者为主、以右侧肢体为起病侧为特征,LED是症状波动的独立危险因素。
Objective:To investigate the clinical features of motor symptoms in patients with Parkinson's disease(PD) and the influential factors of motor symptoms of PD,and provide clinical basis for long-term treatment of PD.Methods:The clinical data of 102 PD patients were registered by specially trained neurological physicians.The clinical features of PD patients with different courses were compared,including Hoehn-Yahr(H-Y) staging,clinical subtypes and the onset types,and the correlation among motor symptoms,gender,age,course of disease,H-Y stage,LEDD,clinical subtypes and onset types were analyzed,so as to explore the occurrence and the development rule of motor symptoms and motor complications.Results:Among 102 cases with PD,the incidence of male patients was higher(56.86%),and the ratio of male and female was 1.31∶ 1.Initial symptoms appeared on the right side in 50% patients.The initial symptom of 65.69% patients was tremor.Motor complications occurred in 20.59%.LEDD was an independent risk factor for symptom fluctuation(P = 0.02).Levodopa(LD) was chosen in 80.39% of the patients.The mean duration of LD treatment was 1.55 ±1.99 years,and the mean LEDD was 250 ± 143.98 mg.MAO-B inhibitors and COMT inhibitors were rarely introduced in the patients.Patients without treatment accounted for 1.96%.Conclusions:Motor symptoms of PD patients are severe,and the majority are males.The onset side is in the right limbs and tremor was the primary symptom.Inflexible movements may be an early symptom of PD.LED is an independent risk factor for symptom fluctuations.

关键词(KeyWords)： 帕金森病;左旋多巴;运动症状;每日左旋多巴等效剂量;临床特征;回归分析;独立危险因素
Parkinson's disease;Levodopa;motor symptoms;Equivalent dose of daily levodopa;clinical characteristics;regression analysis;independent risk factors

Abstract:

Keywords:

基金项目(Foundation): 国家自然科学基金(81560201)

作者(Author): 涂丽;田锦勇;
TU Li;TIAN Jinyong;Guizhou Medical University;Emergency Department of Internal Medicine,Guizhou Provincial People's Hospital;

Email:

DOI: 10.19367/j.cnki.1000-2707.2018.02.012

参考文献(References)：

• [1]DELAU L M,BRETELER.Epidemiology of Parkinson's disease[J].Lancet Neurol,2006,5(6):525-535.
• [2]ALVES G,FORSAA EB,PEDERSEN K F,et al.Epidemiology of Parkinson's disease[J].J Neurol,2008,255(Suppl 5):18-32.
• [3]ZHANG Z X,ROMAN G C,HONG Z,et al.Parkinson's disease in China:prevalence in Beijing,Xian,and Shanghai[J].Lancet,2005,365(9459):595-597.
• [4]刘疏影,陈彪.帕金森病流行现状[J].中国现代神经疾病杂志,2016,16(2):98-101.
• [5]POSTUMA R B,BERG D,STERN M,et al.MDS clinical diagnostic criteria for Parkinson's disease[J].Mov Disord,2015,30(12):1591-1601.
• [6]DELIL S,BOLOKBASI F,YENI N,et al.Re-emergent Tongue Tremor as the Presenting Symptom of Parkinson's Disease[J].Balkan Med J,2015 Jan,32(1):127-128.
• [7]冯涛.解读中国帕金森病治疗指南[J].中国实用内科杂志,2010,30(11):986-988.
• [8]中华医学会神经病学分会帕金森病及运动障碍学组,中国医师协会神经内科医师分会帕金森病及运动障碍专业委员会.中国帕金森病的诊断标准(2016版)[J].中华神经科杂志,2016,49(4):268-271.
• [9]DEUSCHL G,SCHADE-BRITTINGER C,KRACK P,et al.A randomized trial of deep-brain stimulation for Parkinson's disease[J].New England Journal of Medicine,2006,355(9):896-908.
• [10]LEWIS S J,FOLTYNIE T,BLACKWELL A D,et a.Heterogeneity of Parkinson disease in the early clinical stages using a data driven approach[J].J Neurol Neurosurg Psychiatry,2005,76(3):343-348.
• [11]陈慧敏,李芳菲,冯涛.早发型帕金森病及其基因研究进展[J].中华神经科杂志,2015,48(8):729-731.
• [12]IREGRAGUI W,LACHHAB L,RAZINE R,et al.Profile of idiopathic parkinson's disease in Moroccan patients[J].Int Arch Med,2014,7(1):10.
• [13]MEHANNA R,MOORE S,HOU J G,et al.Comparing clinical features of young onset,middle onset and late onset Parkinson's disease[J].Parkinsonism&Related Disorders,2014,20(5):530-534.
• [14]IREGRAGUI W,LACHHAB L,RAZINE R,et al.Profile of idiopathic parkinson's disease in Moroccan patients[J].Int Arch Med,2014,7(1):10.
• [15]POST B,SPEELMAN J D,DE HAAN R J,et al.Clinical heterogeneity in newly diagnosed Parkinson's disease[J].Journal of Neurology,2008,255(5):716-722.
• [16]YUST-KATZ S,TESLER D,TREVES T A,et al.Handedness as a predictor of side of onset of Parkinson's disease[J].Parkinsonism&Related Disorders,2008,14(8):633-635.
• [17]DJALDETTI R,ZIV I,MELAMED E.The mystery of motor asymmetry in Parkinson's disease[J].Lancet Neurol,2006,5(9):796-802.
• [18]王晓,刘卫国,华平,等.帕金森病运动症状进展分析[J].临床神经病学杂志,2016,21(9):46-48.
• [19]WARREN OLANOW C,KIEBURTZ K,RASCOL O,et al.Factors predictive of the development of Levodopa-induced dyskinesia and wearing-off in Parkinson's disease[J].Mov Disord,2013,28(8):1064-1071.
• [20]LIU Z G.Understanding and treatment of the motor complications of Parkinson's disease[J].Journal of Clinical Internal Medicine,2011,28(12):800-803.
• [21]GAREIA-RUIZ P J,DEL VAL J,FERNDNDEZ I M,et a1.What factors influence motor complications in Parkinson disease?a 10-year prospective study[J].Clin Neuropharmacol,2012;35(1):1-5.
• [22]陈生弟.帕金森病运动并发症的防治策略[J].中华老年医学杂志,2016,35(4):343-346.
• [23]马兆雷,焦玲.帕金森病患者血尿酸水平分析[J].贵阳医学院学报,2015,(8):867-869.
• [24]蔡立君,詹玮,李旭红,等.3.0T MRI磁敏感加权成像观察α-硫辛酸对帕金森病患者黑质的铁螯合作用[J].贵州医科大学学报,2016,41(07):821-825.

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