本文選題：帕金森病 + 臨床異質(zhì)性��； 參考：《復(fù)旦大學(xué)》2014年博士論文

【摘要】：背景：帕金森病(Parkinson' sdisease, PD)具有臨床異質(zhì)性,這種異質(zhì)性體現(xiàn)在運(yùn)動(dòng)癥狀、非運(yùn)動(dòng)癥狀(認(rèn)知)等多方面。PD臨床表現(xiàn)的異質(zhì)性促使人們尋找神經(jīng)功能缺損的不同模式,進(jìn)而將PD更合理分型、探索潛在疾病機(jī)制、提供更有針對(duì)性治療、及預(yù)測(cè)疾病預(yù)后。目的：探討PD的臨床亞型及其特點(diǎn)。結(jié)合神經(jīng)心理量表檢查,進(jìn)行PD的亞型分析和運(yùn)動(dòng)和認(rèn)知障礙等非運(yùn)動(dòng)癥狀相關(guān)性的分析,研究結(jié)果將有助于深入認(rèn)識(shí)PD運(yùn)動(dòng)障礙、認(rèn)知障礙及其他非運(yùn)動(dòng)障礙的關(guān)聯(lián)及可能機(jī)制。方法：檢索華山醫(yī)院帕金森臨床數(shù)據(jù)庫(kù),以UPDRS-Ⅲ、認(rèn)知量表、自評(píng)量表為關(guān)注點(diǎn),導(dǎo)出2010年7月1日至2014年3月5日完成隨訪的臨床確診的帕金森病人的相關(guān)數(shù)據(jù),進(jìn)行統(tǒng)計(jì)分析。因子分析探討運(yùn)動(dòng)障礙的不同模式,聚類分析、亞組分析探討不同亞型PD病人的特點(diǎn)。相關(guān)及回歸分析探討運(yùn)動(dòng)癥狀-認(rèn)知等非運(yùn)動(dòng)癥狀的相關(guān)性。結(jié)果：PD的運(yùn)動(dòng)障礙主要有震顫、少動(dòng)/強(qiáng)直、中軸癥狀-PIGD、中軸癥狀-言語表情這四大類型。采用2分類聚類分析統(tǒng)計(jì)方法將142名PD病人分為早發(fā)組(n=45)和晚發(fā)組(n=99)兩個(gè)亞組。采用4分類聚類分析可分為早發(fā)組(n=24)、晚發(fā)-早期組(n=52)、晚發(fā)-中期組(n=47)及晚發(fā)-晚期組(n=19)。各組UPDRS-Ⅲ總分有顯著差異。早發(fā)組進(jìn)展速度較慢,認(rèn)知功能功能較好,抑郁程度較同病程的晚發(fā)組PD病人重：晚發(fā)組病人運(yùn)動(dòng)癥狀越重,疾病的進(jìn)展速度越慢,抑郁和認(rèn)知功能損害等非運(yùn)動(dòng)癥狀也越嚴(yán)重。對(duì)100名PD病人行亞組分析,分為3組：震顫組(n=40)、混合組(n=18)、PIGD組(n=42)。3組在年齡、性別、病程、教育程度等差異無統(tǒng)計(jì)學(xué)意義。震顫組較另外兩組非運(yùn)動(dòng)癥狀自評(píng)量表評(píng)分較高,差異有統(tǒng)計(jì)學(xué)意義。震顫組和PIGD組的認(rèn)知各領(lǐng)域差異無統(tǒng)計(jì)學(xué)意義。對(duì)100名PD病人進(jìn)行運(yùn)動(dòng)癥狀-認(rèn)知等非運(yùn)動(dòng)癥狀的相關(guān)性分析。起病年齡、年齡、性別、教育程度與認(rèn)知相關(guān)。少動(dòng)/強(qiáng)直與執(zhí)行功能,中軸癥狀-言語表情和語言流暢性相關(guān)。震顫與圖形回憶相關(guān)。震顫、中軸癥狀-言語表情與非運(yùn)動(dòng)癥狀自評(píng)量表總分相關(guān)。結(jié)論：PD運(yùn)動(dòng)障礙可分為震顫、少動(dòng)/強(qiáng)直、中軸癥狀-PIGD、中軸癥狀-言語表情4種形式。PD的起病年齡和疾病嚴(yán)重程度可對(duì)聚類分析產(chǎn)生影響。亞組分析不適用于比較PD運(yùn)動(dòng)亞型的認(rèn)知功能。PD的運(yùn)動(dòng)功能和認(rèn)知障礙具有相關(guān)性,這可能與不同的神經(jīng)功能缺損模式相關(guān)。使用神經(jīng)心理測(cè)評(píng)評(píng)估PD認(rèn)知有其局限性。
[Abstract]:Background: Parkinson's disease (PDD) has clinical heterogeneity, which is reflected in the heterogeneity of motor symptoms, non-motor symptoms (cognition) and other clinical manifestations. Furthermore, PD can be classified more reasonably to explore the underlying disease mechanism, to provide more targeted treatment, and to predict the prognosis of the disease. Objective: to investigate the clinical subtypes and characteristics of PD. The subtypes of PD and the correlation between motor and cognitive disorders were analyzed in combination with the neuropsychological scale. The results of the study will be helpful to the understanding of PD motor disorders. The association and possible mechanism of cognitive impairment and other non-motor disorders. Methods: the clinical database of Parkinson's disease in Huashan Hospital was searched. The data of clinically confirmed Parkinson's disease patients who were followed up from July 1, 2010 to March 5, 2014 were derived with the attention of UPDRS- 鈪，

本文編號(hào)：1972122