發(fā)布時(shí)間：2018-05-15 13:11

  本文選題：帕金森病 + 快速眼動(dòng)期睡眠行為障礙　； 參考：《浙江大學(xué)》2016年博士論文

【摘要】：目的：快速眼動(dòng)期睡眠期行為障礙(Rapid eye movement sleep behavior disorder, RBD)是近年帕金森病(Parkinson's disease, PD)的研究熱點(diǎn)之一。最新RBD的診斷標(biāo)準(zhǔn)需結(jié)合臨床病史及視頻多導(dǎo)睡眠監(jiān)測(cè)(video-Polysomnography, v-PSG),然目前大部分的臨床研究仍采用RBD的最低診斷標(biāo)準(zhǔn)。本研究通過(guò)總結(jié)經(jīng)v-PSG確診的本院PD伴RBD患者的病例特征,并結(jié)合文獻(xiàn)研究中經(jīng)多導(dǎo)睡眠監(jiān)測(cè)確診的病例研究,分析伴與不伴RBD的PD患者的一般情況、臨床特征及睡眠參數(shù)等。方法：本研究納入2015年6月至2016年3月,就診于浙江大學(xué)醫(yī)學(xué)院附屬第二醫(yī)院神經(jīng)科睡眠中心的PD患者,進(jìn)行臨床病史采集,同時(shí)進(jìn)行視頻多導(dǎo)睡眠(v-PSG)監(jiān)測(cè),收集所有PD患者的臨床資料及睡眠參數(shù)的數(shù)據(jù)。參照國(guó)際睡眠疾病分類標(biāo)準(zhǔn)第三版(International Classification of Sleep Disorders third edition, ICSD-3)中RBD的診斷標(biāo)準(zhǔn),分為PD合并RBD (PD+RBD)組與PD不合并RBD (PD-RBD)組,對(duì)臨床特征及睡眠參數(shù)進(jìn)行分析。同時(shí),收集2005年1月至2016年3月之間公開(kāi)發(fā)表的關(guān)于PD與RBD的臨床研究,選擇經(jīng)過(guò)多導(dǎo)睡眠監(jiān)測(cè)確診RBD的研究,整理相應(yīng)臨床資料,進(jìn)行文獻(xiàn)薈萃分析,分析PD+RBD組與PD-RBD組臨床特征及睡眠參數(shù)。結(jié)果：1.結(jié)合臨床病史和多導(dǎo)睡眠監(jiān)測(cè),病例分析中PD患者RBD的發(fā)生率為50%(8/16),文獻(xiàn)分析中PD患者RBD的患病率波動(dòng)于45～58%之間。2.病例分析中,PD+RBD組的Hoehn Yahr分級(jí)較PD-RBD組更高[3(2.5-3)vs 2(1.5-2),p=0.002]; PD+RBD組患者與PD-RBD組PD病程,年齡和左旋多巴等效日劑量(LED)差異無(wú)統(tǒng)計(jì)學(xué)意義(PD病程：76.5±47.1 vs 40.7±37.1月,p=0.114)(年齡：62.8±9.6 vs 59.9±14歲, p=0.646) (LED:557.8±218.2vs481.2±27.3mg,p=0.4)。3.文獻(xiàn)分析中,PD+RBD組患者較PD-RBD組患者年齡更大(WMD=2.646, 95%CI:1.385-3.908, P=0.000), Hoehn-Yahr分級(jí)更高(WMD=0.344,95%CI: 0.151-0.536, P=0.000), UPDRSⅢ評(píng)分(開(kāi)期)更高(WMD=2.501,95%CI: 0.739-4.263, P=0.005),左旋多巴等效日劑量(LED)更多(WMD=134.447,95%CI: 74.158-194.736mg, P=0.000); PD+RBD組患者較PD-RBD組患者體位性低血壓發(fā)生頻率更高(OR=3.684,95%CI:2.125～6.387; P=0.000); PD+RBD組患者較PD-RBD組PD病程差異及性別差異無(wú)統(tǒng)計(jì)學(xué)意義。4.病例分析中PD+RBD組與PD-RBD組的睡眠參數(shù)差異無(wú)統(tǒng)計(jì)學(xué)意義。結(jié)論：本研究通過(guò)我院多導(dǎo)睡眠監(jiān)測(cè)確診的RBD相關(guān)PD的病例分析和多導(dǎo)睡眠監(jiān)測(cè)確診的PD與RBD的文獻(xiàn)研究,發(fā)現(xiàn)結(jié)合臨床病史和多導(dǎo)睡眠監(jiān)測(cè)診斷RBD穩(wěn)定性高,并總結(jié)了伴RBD的PD的病例特點(diǎn)。伴有RBD的PD患者具有更嚴(yán)重的病情,伴與不伴RBD的PD患者在性別和PD病程方面差異無(wú)統(tǒng)計(jì)學(xué)意義。
[Abstract]:Objective: in recent years, rapid eye movement sleep behavior disorder, RBD) is one of the hotspots in the study of parkinsonian disease (PDD) in patients with parkinsonian disease (PD). The latest diagnostic criteria of RBD should be combined with clinical history and video-Polysomnography (v-PSG). However, most clinical studies still adopt the minimum diagnostic criteria of RBD. This study analyzed the general situation, clinical features and sleep parameters of PD patients with and without RBD by summarizing the case characteristics of PD patients with RBD diagnosed by v-PSG, and combining with the case studies confirmed by polysomnography in the literature. Methods: from June 2015 to March 2016, PD patients in the sleep center of Department of Neurology, second affiliated Hospital of Zhejiang University Medical College, were enrolled for clinical history collection and video polysomnography v-PSG monitoring. The clinical data and sleep parameters of all PD patients were collected. According to the diagnostic criteria of RBD in International Classification of Sleep Disorders third edition, ICSD-3 (the third edition of the International Classification of Sleep Diseases), the patients were divided into two groups: PD combined with RBD and PD-RBD, and PD was not associated with PD-RBD. The clinical characteristics and sleep parameters were analyzed. At the same time, the clinical studies on PD and RBD published between January 2005 and March 2016 were collected, and polysomnography confirmed RBD were selected, the corresponding clinical data were sorted out, and the literature meta-analysis was carried out. The clinical features and sleep parameters of PD RBD group and PD-RBD group were analyzed. The result is 1: 1. Combined with clinical history and polysomnography, the incidence of RBD in PD patients was 50 to 8 / 16 in case analysis, and the prevalence rate of RBD in PD patients fluctuated from 45 to 58% in literature analysis. In the case analysis, the Hoehn Yahr grade of PD RBD group was higher than that of PD-RBD group [3(2.5-3)vs 21.5-2P0. 002] there was no significant difference in the course of PD, age and levodopa equivalent daily dose between; PD RBD group and PD-RBD group. There was no significant difference in the course of PD: 76.5 鹵47.1 vs 40.7 鹵37.1-month (age: 62.8 鹵9.6 vs 59.9 鹵14 years, p 0.646). 鏂囩尞鍒嗘瀽涓，

本文編號(hào)：1892603