發(fā)布時(shí)間：2018-02-13 07:35

  本文關(guān)鍵詞： 帕金森病 非運(yùn)動(dòng)癥狀 自主神經(jīng)功能障礙 交感神經(jīng)皮膚反應(yīng)　出處：《吉林大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：研究目的:1.分析帕金森病(Parkinson’s disease,PD)患者自主神經(jīng)功能障礙的臨床特征和影響因素;2.比較自主神經(jīng)功能障礙與運(yùn)動(dòng)癥狀及其他非運(yùn)動(dòng)癥狀的相關(guān)性;3.探討交感神經(jīng)皮膚反應(yīng)(SSR)對(duì)自主神經(jīng)功能損害的臨床診斷價(jià)值。研究方法:選擇2014年10月至2016年10月就診于吉林大學(xué)第一醫(yī)院神經(jīng)內(nèi)科的PD患者98例,同期健康體檢者30例。收集所有受試者的基本信息(姓名、性別、年齡、文化程度)及PD患者病程、首發(fā)癥狀、首發(fā)部位、Hoehn-Yahr分期(H-Y分期)和服藥情況。應(yīng)用自主神經(jīng)癥狀量表(SCOPA-AUT)評(píng)價(jià)自主神經(jīng)功能,應(yīng)用統(tǒng)一帕金森病評(píng)定量表第三部分(UPDRSⅢ)、漢密爾頓焦慮量表(HAMA)、漢密爾頓抑郁量表(HAMD)、帕金森睡眠量表(PDSS)、Epworth日間睡眠量表(ESS)、簡(jiǎn)易精神狀態(tài)檢查量表(MMSE)、蒙特利爾認(rèn)知評(píng)估量表(Mo CA)評(píng)估運(yùn)動(dòng)癥狀和焦慮、抑郁、睡眠、認(rèn)知等非運(yùn)動(dòng)癥狀。選擇36例PD患者和16例健康對(duì)照者進(jìn)行了交感神經(jīng)皮膚反應(yīng)(SSR)檢測(cè)。研究結(jié)果:1.剔除無(wú)效病例8例,共120例受試者入組本研究,其中PD組90例,健康對(duì)照組30例。PD組與健康對(duì)照組在性別構(gòu)成、年齡、文化程度上無(wú)差異,在運(yùn)動(dòng)癥狀和非運(yùn)動(dòng)癥狀評(píng)分上,PD組明顯高于健康對(duì)照組,提示PD患者除了典型運(yùn)動(dòng)癥狀外,還存在明顯的自主神經(jīng)功能、焦慮、抑郁、認(rèn)知、睡眠等非運(yùn)動(dòng)癥狀損害。2.經(jīng)SCOPA-AUT量表評(píng)估,90例PD患者76例有自主神經(jīng)癥狀,發(fā)生率為84.4%,SCOPA-AUT得分0-49分,平均得分(15.72±12.68)分。自主神經(jīng)功能障礙最常見的是消化(81.1%)和泌尿(76.7%)系統(tǒng)癥狀,其次是心血管系統(tǒng)(46.7%)、體溫調(diào)節(jié)(41.1%)、性功能(35.6%)和瞳孔運(yùn)動(dòng)障礙(13.3%);所有自主神經(jīng)癥狀中,便秘的發(fā)生率最高,達(dá)56.7%(51/90),其次依次為夜尿55.6%(50/90)、吞咽困難48.9%(44/90)、流涎46.7%(42/90)等。30例健康對(duì)照組7例存在自主神經(jīng)功能損害,發(fā)生率為23.3%,SCOPA-AUT得分0-7分,平均得分(1.33±2.01)分。兩組比較,PD組自主神經(jīng)功能障礙的發(fā)生率及嚴(yán)重程度明顯高于健康對(duì)照組。3.經(jīng)SCOPA-AUT量表評(píng)分比較,高SCOPA-AUT評(píng)分患者年齡更大、病程更長(zhǎng)、病情更重,服用美多芭量更多,運(yùn)動(dòng)癥狀更明顯,另外,高SCOPA-AUT評(píng)分患者的HAMA14、HAMD24、MOCA、MMSE、PDSS評(píng)分更高,在性別、首發(fā)癥狀、首發(fā)部位、文化程度和ESS評(píng)分方面,與SCOPA-AUT量表評(píng)分高低無(wú)統(tǒng)計(jì)學(xué)意義,提示PD患者自主神經(jīng)功能障礙越重,運(yùn)動(dòng)癥狀及焦慮、抑郁、認(rèn)知、夜間睡眠等非運(yùn)動(dòng)癥狀越明顯。經(jīng)多因素logistic回歸分析后發(fā)現(xiàn),自主神經(jīng)功能障礙的嚴(yán)重程度受病程、病情嚴(yán)重程度、運(yùn)動(dòng)癥狀及夜間睡眠的影響。4.PD合并自主神經(jīng)功能障礙(PD-AS)組、PD不伴自主神經(jīng)功能障礙(PD-NAS)組、健康對(duì)照組SSR異常率分別為62.5%(15/24)、33.3%(4/12)、12.5%(2/16),三組間SSR存在明顯波幅、潛伏期改變。研究結(jié)論:1.PD患者普遍存在自主神經(jīng)功能損害,以消化和泌尿系統(tǒng)最常見,以便秘、夜尿癥狀最突出。2.PD患者自主神經(jīng)功能障礙越重,運(yùn)動(dòng)癥狀及其他非運(yùn)動(dòng)癥狀亦越明顯;其嚴(yán)重程度受病程、病情、運(yùn)動(dòng)癥狀及夜間睡眠的影響。3.SSR可以客觀評(píng)價(jià)PD患者的自主神經(jīng)功能,還有助于發(fā)現(xiàn)自主神經(jīng)的亞臨床損害。
[Abstract]:Research purposes: 1. analysis of Parkinson disease (Parkinson 's disease, PD) clinical characteristics and influential factors of autonomic dysfunction in patients with autonomic dysfunction; correlation of 2. compared with other motor symptoms and non motor symptoms; 3. of sympathetic skin response (SSR) in diagnosis of autonomic dysfunction. Methods: 98 patients with PD from October 2014 to October 2016 in No.1 Hospital of Jilin University from the Department of Neurology, 30 healthy people. The basic information were collected from all subjects (name, gender, age, education level) and PD patients, the first symptoms, the first part, Hoehn-Yahr staging (H-Y staging) and medication. Application of autonomic nerve symptom scale (SCOPA-AUT) assessment of autonomic nervous function, using the unified Parkinson's disease rating scale third (UPDRS III), Hamilton Anxiety Scale (HAMA), Hamill Hamilton Depression Rating Scale (HAMD), Parkinson Sleep Scale (PDSS), Epworth daytime sleep scale (ESS), Mini Mental State Examination (MMSE), Montreal cognitive assessment (Mo CA) to assess motor symptoms and anxiety, depression, sleep, cognitive and other non motor symptoms in 36 cases of PD. Patients and 16 healthy subjects were sympathetic skin response (SSR) detection. Results: 1. invalid cases 8 cases, a total of 120 subjects were enrolled in this study, including 90 cases in PD group and healthy control group of 30 cases of.PD group and healthy control group in gender, age, culture no difference in extent, motor and non motor symptoms score, PD group was significantly higher than that of the control group, suggesting that PD in patients with typical motor symptoms, there are obvious autonomic nervous function, anxiety, depression, cognition, sleep and other non motor symptoms of.2. damage by SCOPA-AUT assessment, 90 cases of PD were 76 with self The main neurological symptoms, the incidence rate was 84.4%, SCOPA-AUT scored 0-49 points, scoring average (15.72 + 12.68). The most common digestive autonomic dysfunction (81.1%) and (76.7%) urinary system symptoms, followed by cardiovascular system (46.7%), (41.1%), body temperature regulation function (35.6%) and pupil movement disorder (13.3%); all autonomic symptoms, the highest incidence of constipation was 56.7% (51/90), followed by nocturia 55.6% (50/90), dysphagia in 48.9% (44/90), 46.7% (42/90).30 ptyalism healthy control group of 7 cases in autonomic dysfunction, the incidence rate was 23.3% SCOPA-AUT, scoring 0-7 points, scoring average (1.33 + 2.01). The two groups, PD group of autonomic dysfunction incidence and severity were significantly higher than the control group by.3. SCOPA-AUT scale score, high SCOPA-AUT scores were older, longer duration, more severe disease, taking Madopar amount More exercise, the more obvious symptoms, in addition, the high SCOPA-AUT score in patients with HAMA14, HAMD24, MOCA, MMSE, PDSS score higher in gender, onset, starting place, cultural level and the ESS score, and SCOPA-AUT score level was not statistically significant, suggesting that PD autonomic nerve dysfunction in patients with more severe motor symptoms and the anxiety, depression, cognition, sleep and other non motor symptoms more obvious. Multivariate logistic regression analysis showed that the severity of autonomic dysfunction by duration, severity, effect of.4.PD motor symptoms and night sleep associated with autonomic dysfunction (PD-AS) group, PD patients without autonomic nerve dysfunction (PD-NAS the healthy control group) group, the abnormal rate of SSR were 62.5% (15/24), 33.3% (4/12), 12.5% (2/16), SSR in the three groups have obvious amplitude, latency change. Conclusion: 1.PD is prevalent in patients with autonomic nervous function Can damage, with the most common, digestive and urinary system with constipation, nocturia.2.PD most prominent autonomic nerve dysfunction in patients with more severe motor symptoms and non motor symptoms are more obvious; the severity of disease, illness, effect of.3.SSR motor symptoms and sleep at night can objectively evaluate the autonomic nervous function in patients with PD. It can help find the subclinical autonomic nerve damage.

【學(xué)位授予單位】：吉林大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R742.5

【相似文獻(xiàn)】

相關(guān)期刊論文 前10條

1 陳秋惠;胡國(guó)華;韓艷秋;張海娜;張穎;;帕金森病非運(yùn)動(dòng)癥狀的臨床研究[J];中國(guó)老年學(xué)雜志;2008年18期

2 劉宇慶;關(guān)淑風(fēng);;新疆地區(qū)維、漢族帕金森病患者運(yùn)動(dòng)癥狀和非運(yùn)動(dòng)癥狀的特點(diǎn)[J];臨床神經(jīng)病學(xué)雜志;2014年02期

3 劉卓;孫莉;黃曦妍;曹辰杰;余舒揚(yáng);左麗君;楊雅琴;樸英善;張巍;;帕金森病伴發(fā)焦慮與運(yùn)動(dòng)癥狀及非運(yùn)動(dòng)癥狀關(guān)系的研究[J];中華臨床醫(yī)師雜志(電子版);2012年02期

4 馮霞;張懿;;農(nóng)村與城市帕金森病運(yùn)動(dòng)癥狀與非運(yùn)動(dòng)癥狀比較研究[J];重慶醫(yī)學(xué);2012年20期

5 包華;鄭曉明;王瑾;陳碧琳;;帕金森病非運(yùn)動(dòng)癥狀研究進(jìn)展[J];醫(yī)學(xué)綜述;2013年03期

6 趙國(guó)華;孫菲;馮學(xué)功;高敏;;龜羚帕安顆粒治療帕金森病肝腎不足證非運(yùn)動(dòng)癥狀的多中心隨機(jī)雙盲對(duì)照研究[J];中國(guó)中西醫(yī)結(jié)合雜志;2013年04期

7 鄭玉敏;劉娜;羅曉光;高超;;帕金森非運(yùn)動(dòng)癥狀表現(xiàn)特點(diǎn)及對(duì)生活質(zhì)量的影響[J];中國(guó)實(shí)用神經(jīng)疾病雜志;2013年15期

8 李社宣;趙國(guó)華;;帕金森病運(yùn)動(dòng)癥狀的中西醫(yī)甄別[J];環(huán)球中醫(yī)藥;2008年02期

9 李二鳳;劉佳佳;于翠玉;華平;趙燕燕;劉衛(wèi)國(guó);;帕金森病患者運(yùn)動(dòng)和非運(yùn)動(dòng)癥狀的性別差異[J];臨床神經(jīng)病學(xué)雜志;2014年01期

10 高俊華;閆兆芬;孫莉;劉卓;黃曦妍;張巍;;帕金森病患者非運(yùn)動(dòng)癥狀的臨床研究[J];中國(guó)全科醫(yī)學(xué);2010年23期

相關(guān)會(huì)議論文 前10條

1 陳秋惠;胡國(guó)華;韓艷秋;;32例帕金森病患者的非運(yùn)動(dòng)癥狀臨床研究[A];第十一屆全國(guó)神經(jīng)病學(xué)學(xué)術(shù)會(huì)議論文匯編[C];2008年

2 陳志剛;;30例帕金森病患者非運(yùn)動(dòng)癥狀的中醫(yī)證候?qū)W特點(diǎn)研究[A];2012中國(guó)醫(yī)師協(xié)會(huì)中西醫(yī)結(jié)合醫(yī)師分會(huì)神經(jīng)病學(xué)專家委員會(huì)學(xué)術(shù)年會(huì)論文匯編[C];2012年

3 戴利菊;張寶榮;;帕金森病運(yùn)動(dòng)癥狀和非運(yùn)動(dòng)癥狀的對(duì)比分析[A];2009年浙江省神經(jīng)病學(xué)學(xué)術(shù)年會(huì)論文匯編[C];2009年

4 干靜;劉振國(guó);周明珠;周楨源;應(yīng)黎;陳偉;;帕金森病患者非運(yùn)動(dòng)癥狀的研究[A];第十一屆全國(guó)神經(jīng)病學(xué)學(xué)術(shù)會(huì)議論文匯編[C];2008年

5 干靜;劉振國(guó);周明珠;周楨源;應(yīng)黎;陳偉;;帕金森病患者非運(yùn)動(dòng)癥狀的研究[A];第2屆中國(guó)睡眠醫(yī)學(xué)論壇論文匯編[C];2007年

6 王軍;黃煥新;魏其林;郝傳錚;顧曉松;;神經(jīng)生長(zhǎng)液改善老年帕金森病非運(yùn)動(dòng)癥狀的臨床研究[A];第三屆江浙滬三地老年醫(yī)學(xué)高峰論壇暨2012年浙江省老年醫(yī)學(xué)學(xué)術(shù)年會(huì)論文集[C];2012年

7 李銳銘;張錦鳳;;帕金森病的非運(yùn)動(dòng)癥狀[A];中華醫(yī)學(xué)會(huì)第十三次全國(guó)神經(jīng)病學(xué)學(xué)術(shù)會(huì)議論文匯編[C];2010年

8 周潔;袁燦興;;熟地平顫湯治療帕金森氏病的運(yùn)動(dòng)癥狀研究[A];2010中國(guó)醫(yī)師協(xié)會(huì)中西醫(yī)結(jié)合醫(yī)師大會(huì)摘要集[C];2010年

9 裴中;周鴻雁;邵明;張素平;潘速躍;秦琴保;祁風(fēng);劉焯霖;張振馨;;廣州地區(qū)107例帕金森病患者非運(yùn)動(dòng)癥狀情況的調(diào)查[A];第十一屆全國(guó)神經(jīng)病學(xué)學(xué)術(shù)會(huì)議論文匯編[C];2008年

10 劉承偉;李曉莉;劉曉非;陳敏;周智鵬;盧昕;;PD運(yùn)動(dòng)癥狀前老年小鼠模型的建立及研究[A];中國(guó)解剖學(xué)會(huì)2013年年會(huì)論文文摘匯編[C];2013年

相關(guān)重要報(bào)紙文章 前2條

1 首都醫(yī)科大學(xué)宣武醫(yī)院 趙國(guó)華　徐春波 曾慧敏;帕金森病非運(yùn)動(dòng)癥狀的辨證思路[N];中國(guó)醫(yī)藥報(bào);2009年

2 北京協(xié)和醫(yī)院神經(jīng)內(nèi)科教授 張振馨;帕金森病非運(yùn)動(dòng)癥狀須積極控制[N];健康報(bào);2012年

相關(guān)博士學(xué)位論文 前3條

1 趙玨;帕金森病運(yùn)動(dòng)障礙異質(zhì)性及與認(rèn)知功能障礙的關(guān)聯(lián)[D];復(fù)旦大學(xué);2014年

2 王粟實(shí);多系統(tǒng)萎縮非運(yùn)動(dòng)癥狀量表研制及其證候規(guī)律和溫腎健腦方療效觀察[D];北京中醫(yī)藥大學(xué);2017年

3 梁晉川;腦深部電刺激術(shù)治療帕金森病非運(yùn)動(dòng)癥狀和腦功能影像學(xué)的隊(duì)列研究[D];第二軍醫(yī)大學(xué);2012年

相關(guān)碩士學(xué)位論文 前10條

1 張惠鈞;維生素D與帕金森病非運(yùn)動(dòng)癥狀的關(guān)系[D];蘇州大學(xué);2016年

2 趙馨;帕金森病伴快動(dòng)眼睡眠行為障礙患者的非運(yùn)動(dòng)癥狀特征及彌散張量成像研究[D];南方醫(yī)科大學(xué);2016年

3 姜昆;蓯蓉顆粒治療帕金森病非運(yùn)動(dòng)癥狀的臨床研究[D];南京中醫(yī)藥大學(xué);2016年

4 董玲玲;帕金森病運(yùn)動(dòng)癥狀首發(fā)部位的相關(guān)因素研究[D];山東大學(xué);2017年

5 孫洪揚(yáng);帕金森病患者自主神經(jīng)功能障礙的臨床研究[D];吉林大學(xué);2017年

6 楊俊峰;帕金森病非運(yùn)動(dòng)癥狀及核磁腦鐵沉積研究[D];天津醫(yī)科大學(xué);2009年

7 金英姬;90例帕金森病患者非運(yùn)動(dòng)癥狀的臨床研究[D];吉林大學(xué);2013年

8 趙建高;定顫湯對(duì)肝腎陰虛型帕金森病非運(yùn)動(dòng)癥狀的療效觀察[D];南京中醫(yī)藥大學(xué);2008年

9 戴利菊;帕金森病運(yùn)動(dòng)癥狀和非運(yùn)動(dòng)癥狀的對(duì)比分析[D];浙江大學(xué);2009年

10 黃翔;93例帕金森病患者非運(yùn)動(dòng)癥狀的臨床分析[D];浙江大學(xué);2009年

，

本文編號(hào)：1507643