本文選題：帕金森病　切入點：糖尿病　出處：《山東大學(xué)》2014年碩士論文

【摘要】：研究背景 近年來,全球糖尿病的發(fā)病率迅速上升,臨床上帕金森病合并糖尿病的患者越來越多見,糖尿病能夠加重帕金森病患者的某些運動癥狀如肌強直和步態(tài)異常,國內(nèi)外已有報道,但對于非運動癥狀的影響尚缺乏相關(guān)報道。目前隨著帕金森病治療理念的更新,除了改善運動癥狀,帕金森病患者的非運動癥狀正逐漸受到重視。 研究目的本研究利用帕金森病非運動癥狀量表(NMSS)調(diào)查評估糖尿病對帕金森病非運動癥狀的影響,分析并總結(jié)合并糖尿病的帕金森病患者非運動癥狀的臨床特點。 研究方法 一、研究對象 連續(xù)收集于2013年2月至2014年1月在齊魯醫(yī)院神經(jīng)內(nèi)科門診就診的帕金森病患者200例,從中選出有糖尿病病史的患者30例及無糖尿病病史的患者30例,根據(jù)性別、帕金森病程(±1年)進行(1：1)配對研究。 二、研究方法 (一)收集兩組患者(60例)的基本資料,包括姓名、性別、年齡、病程、H-Y分級、藥物劑量等。 (二)應(yīng)用NMSS評估兩組患者的非運動癥狀,每項非運動癥狀的分值為疾病嚴重程度(0分～3分)與發(fā)生頻率(1分～4分)的乘積。為了研究非運動癥狀的發(fā)生率,把每項非運動癥狀劃分為“是”或“否”兩種狀態(tài),統(tǒng)計糖尿病組與對照組每項非運動癥狀的頻數(shù)。 三、統(tǒng)計分析 應(yīng)用SPSS17.0軟件進行統(tǒng)計學(xué)分析。應(yīng)用配對設(shè)計的符號秩和檢驗(Wilcoxon符號秩和檢驗)對糖尿病組患者和對照組患者人口統(tǒng)計學(xué)資料(性別、年齡、病程)進行分析。應(yīng)用配對t檢驗對糖尿病組患者和對照組患者H-Y分級、美多巴等效劑量、非運動癥狀總分值進行比較；應(yīng)用配對設(shè)計的符號秩和檢驗(Wilcoxon符號秩和檢驗)對糖尿病組患者和對照組患者每項非運動癥狀分值進行比較；應(yīng)用卡方檢驗對糖尿病組患者和對照組患者非運動癥狀頻數(shù)進行比較。所有的P值均為雙側(cè)P值,P0.05表示差異有統(tǒng)計學(xué)意義。 研究結(jié)果 一、糖尿病組患者H-Y分級平均為2.63±1.29級,對照組患者H-Y分級平均為2.40±0.86級,兩組患者H-Y分級差異無統(tǒng)計學(xué)意義(p=0.152)。糖尿病組美多巴等效劑量平均值為(530.63±261.09)mg,對照組美多巴等效劑量平均值為(522.95±246.03)mg,兩組患者美多巴等效劑量差異無統(tǒng)計學(xué)意義(p=0.632)。 二、在糖尿病組,每位患者出現(xiàn)非運動癥狀數(shù)目的平均值是18.27±3.39,對照組為16.20±3.75,糖尿病組與對照組每位患者出現(xiàn)非運動癥狀的數(shù)目差異具有統(tǒng)計學(xué)意義(p=0.011)；與對照組相比,糖尿病組患者非運動癥狀數(shù)目多12.8%。在糖尿病組,每位患者的非運動癥狀總分值的平均值是97.00±31.39,對照組為91.73±40.33,糖尿病組與對照組每位患者出現(xiàn)的非運動癥狀總分值差異無統(tǒng)計學(xué)意義(p=0.438)。糖尿病組與對照組比較,各項非運動癥狀頻數(shù)差異具有統(tǒng)計學(xué)意義的是嗜睡(p=0.011)以及知覺與幻覺(p=0.037)和胃腸道癥狀(p=0.024)；糖尿病組與對照組比較,每項非運動癥狀分值差異具有統(tǒng)計學(xué)意義的是嗜睡(p=0.001)、情緒低落(p=0.016)及性功能改變(p=0.011)。 結(jié)論 糖尿病可以增加帕金森病患者非運動癥的數(shù)目,總體上,合并糖尿病的原發(fā)性帕金森病患者比無糖尿病的患者表現(xiàn)出更多的非運動癥狀。合并糖尿病的原發(fā)性帕金森病患者嗜睡、知覺與幻覺及胃腸道癥狀的發(fā)生率明顯高于無糖尿病的患者。糖尿病對帕金森病患者非運動癥狀總體的嚴重程度無明顯影響,但合并糖尿病的原發(fā)性帕金森病患者個別非運動癥狀如嗜睡、情緒低落及性功能改變較無糖尿病的患者表現(xiàn)明顯嚴重。
[Abstract]:Background of the study

In recent years , the incidence of diabetes in the world has been rising rapidly , and more and more patients with Parkinson ' s disease complicated with diabetes are more and more frequently seen .

Objective To investigate the effect of diabetes on non - motor symptoms of Parkinson ' s disease ( Parkinson ' s disease ) and to summarize the clinical features of non - exercise symptoms in patients with Parkinson ' s disease .

Research Methods

I . Study Object

A total of 200 patients with Parkinson ' s disease were continuously collected from February 2013 to January 2014 in the Department of Neuroendocrine in Qu Hospital . 30 patients with history of diabetes and 30 patients with no history of diabetes were selected . According to sex , Parkinson ' s disease ( 鹵 1 year ) was carried out ( 1 : 1 ) .

II . Research Methodology

( 1 ) The basic data of two groups ( 60 cases ) were collected , including name , sex , age , course , H - Y grade , drug dose , etc .

( 2 ) Using NMSS to evaluate the non - motor symptoms of the two groups , the score of each non - sports symptom was the product of the severity of disease ( 0 - 3 ) and the frequency ( 1 - 4 ) . To study the incidence of non - motor symptoms , each non - motor symptom was divided into " yes " or " No " , and the frequency of each non - exercise symptom in the diabetic group and the control group was statistically analyzed .

III . Statistical Analysis

Statistical analysis was carried out by SPSS 17.0 software . The statistical data ( sex , age , duration ) of the patients with diabetes and the control group were analyzed by using the paired t test ( Wilcoxon signed rank sum test ) .
The non - exercise symptom scores were compared between the diabetic group and the control group by the sign rank sum test ( Wilcoxon signed rank sum test ) of the paired design ;
The frequency of non - exercise symptoms in the diabetic group and the control group were compared by using the Chi - square test . All the P values were bilateral p - values , and the difference was statistically significant .

Results of the study

The mean values of H - Y in diabetic group were 2.63 鹵 1.29 and 2.40 鹵 0.86 respectively in the control group . The mean value of MDOPA in diabetic group was ( 530.63 鹵 269.09 ) mg and ( 529.95 鹵 246.03 ) mg in control group . There was no significant difference between the two groups ( p = 0.632 ) .

2 . In the diabetes group , the mean value of the number of non - sports symptoms in each patient was 18.27 鹵 3.39 , the control group was 16.20 鹵 3.75 , and the number of non - motor symptoms in the diabetic group and the control group was statistically significant ( p = 0 . 011 ) ;
Compared with the control group , the number of non - exercise symptoms in the diabetic group was more than 12.8 % . In the diabetic group , the mean value of the total score of non - exercise symptoms was 97.00 鹵 31.39 in each patient , 91.73 鹵 40.33 in the control group , and there was no significant difference in the total score of non - exercise symptoms in the diabetic group and the control group ( p = 0 . 011 ) , and that of consciousness and illusion ( p = 0.037 ) and gastrointestinal symptoms ( p = 0 . 024 ) .
Compared with the control group , the difference of score of each non - exercise symptom score was statistically significant ( p = 0.001 ) , depression ( p = 0 . 016 ) and sexual function change ( p = 0 . 011 ) .

Conclusion

Diabetes mellitus can increase the number of non - exercise symptoms in patients with Parkinson ' s disease . In general , patients with primary Parkinson ' s disease combined with diabetes show more non - exercise symptoms than those without diabetes . Patients with primary Parkinson ' s disease combined with diabetes have a significantly higher incidence of non - exercise symptoms in patients with Parkinson ' s disease .

【學(xué)位授予單位】：山東大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R742.5;R587.1

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