本文選題：帕金森病 + 非運(yùn)動(dòng)癥狀�。� 參考：《大連醫(yī)科大學(xué)》2014年碩士論文

【摘要】：研究背景：帕金森病(Parkinson disease PD),又稱震顫麻痹（paralysisagitans),是僅次于阿爾茨海默病病，位居第二的中樞神經(jīng)系統(tǒng)退行性疾病[1]。由英國醫(yī)生James Parkinson(1817)首先描述，是一種中老年人常見的運(yùn)動(dòng)障礙性疾病，以黑質(zhì)多巴胺能神經(jīng)元變性缺失和路易小體的形成為病理特征，臨床表現(xiàn)為靜止性震顫、運(yùn)動(dòng)遲緩、肌強(qiáng)直和姿勢步態(tài)異常等。65歲以上的老年人群患病率為2%。目前，我國的帕金森患者人數(shù)已超過200萬。帕金森病給患者的正常生活帶來了極大的困擾，給其家屬帶來了沉重的負(fù)擔(dān)。過去190多年P(guān)D的運(yùn)動(dòng)癥狀一直是研究的重點(diǎn)，隨著對(duì)PD疾病的深入認(rèn)識(shí)，非運(yùn)動(dòng)癥狀（例如：疲勞，情緒紊亂，睡眠障礙和焦慮癥狀）逐漸得到人們的重視。非運(yùn)動(dòng)癥狀給患者帶來的痛苦更持久，但目前人們對(duì)帕金森病人的非運(yùn)動(dòng)性癥狀的病理生理學(xué)機(jī)制還不是很清楚。 研究目的：1.分別采用UPDRS、Webster、Fatigue Scale-14疲勞量表、HRSD焦慮量表、HRSD抑郁量表、NMSS、MOCA、匹茲堡睡眠質(zhì)量指數(shù)量表、日本嗅覺檢測試劑盒對(duì)PD患者的病情及非運(yùn)動(dòng)癥狀進(jìn)行評(píng)估。 2.通過檢測帕金森病患者外周血促炎癥物質(zhì)（TNF-α, IL-6,sIL-2R, hs-CRP）的含量，，探討TNF-α,IL-6, sIL-2R, hs-CRP與疲勞、焦慮、抑郁、睡眠障礙間的關(guān)系，研究其在帕金森病非運(yùn)動(dòng)癥狀發(fā)生發(fā)展中的作用，探討非運(yùn)動(dòng)癥狀的病理機(jī)制，為帕金森病非運(yùn)動(dòng)癥狀的預(yù)防和治療提供新的思路。 3.提出免疫炎性機(jī)制可能參與PD非運(yùn)動(dòng)癥狀觀點(diǎn) 研究方法：病例組從2012年12月-2013年5月于大連市中心醫(yī)院就診的原發(fā)性PD患者（符合1992年英國PD腦庫原發(fā)性PD的診斷標(biāo)準(zhǔn)）。對(duì)照組選擇在該時(shí)間段在本院體檢并顯示健康的人群。病例組入選標(biāo)準(zhǔn)：年齡：40-75歲，臨床診斷為帕金森氏病并伴有非運(yùn)動(dòng)癥狀，所有患者均簽署知情同意書。健康對(duì)照組為隨機(jī)體檢的健康的年齡在40-75歲之間的健康中老年人。排除腦血管疾病、腦炎等原因所導(dǎo)致的帕金森綜合征。排除標(biāo)準(zhǔn)適用于患者和對(duì)照組。分別對(duì)PD組進(jìn)行UPDRS、Webster、NMSS量表、Fatigue Scale-14、HRSD焦慮量表、HRSD抑郁量表、匹茲堡睡眠質(zhì)量指數(shù)量表、MOCA量表進(jìn)行評(píng)估及嗅覺檢測，對(duì)健康對(duì)照組進(jìn)行NMSS量表、Fatigue Scale-14、HRSD焦慮量表、HRSD抑郁量表、匹茲堡睡眠質(zhì)量指數(shù)量表、MOCA量表進(jìn)行評(píng)估。檢測PD患者及健康對(duì)照組血清中TNF-α,IL-6, sIL-2R, hs-CRP含量。 結(jié)果：1.PD患者的HRSD焦慮量表、HRSD抑郁量表、NMSS、匹茲堡睡眠質(zhì)量指數(shù)量表、Fatigue Scale-14疲勞量表評(píng)分明顯高于健康對(duì)照組，并有顯著差異。MOCA量表評(píng)PD患者組與健康對(duì)照組間無顯著差異。 2.大多數(shù)PD患者出現(xiàn)運(yùn)動(dòng)癥狀之前都有不同程度的嗅覺損害。 3.PD患者的hsCRP、TNF-α、IL-6的水平與健康對(duì)照組相比有顯著差異（p0.05）。 4.sIL-2R和抑郁、焦慮癥狀之間具有明顯的正相關(guān)關(guān)系。C反應(yīng)蛋白與焦慮和抑郁成負(fù)相關(guān)。 結(jié)論：1.PD患者的非運(yùn)動(dòng)癥狀表現(xiàn)形式多樣并嚴(yán)重影響著患者的日常生活質(zhì)量。 2.PD的發(fā)病及發(fā)展可能和炎癥相關(guān)。 3.炎癥因子sIL-2R可能參與了PD患者的焦慮、抑郁癥狀的發(fā)生、發(fā)展。
[Abstract]:Background: Parkinson's disease (Parkinson disease PD), also known as tremor paralysis (paralysisagitans), is second only to Alzheimer's disease, the second of the central nervous system degenerative disease [1]., first described by the British doctor James Parkinson (1817), is a common dyskinesia of middle and old people, with dopamine in the dark matter. Degenerative degeneration and the formation of Louis corpuscle are pathological features. The prevalence rate of the aged people above.65 years old is 2%. at the age of static tremor, motion retardation, myotonic and postural gait, and the number of Parkinson patients in our country has exceeded 2 million. Parkinson's disease has brought great trouble to the normal life of the patients. Family members have brought a heavy burden. The symptoms of PD movement over the past 190 years have been the focus of research. With the deep understanding of PD diseases, non motor symptoms (such as fatigue, emotional disorders, sleep disorders, and anxiety symptoms) have been gradually paid attention to. The pain of non motor symptoms is more lasting, but Parkinson is currently on the people's side. The pathophysiological mechanism of the patient's non motor symptoms is not yet clear.
Objective: 1. using UPDRS, Webster, Fatigue Scale-14 fatigue scale, HRSD anxiety scale, HRSD depression scale, NMSS, MOCA, Pittsburgh sleep quality index scale, and Japanese olfactory detection kit to evaluate the condition and non motor symptoms of patients with PD.
2. to explore the relationship between TNF- alpha, IL-6, sIL-2R, hs-CRP and fatigue, anxiety, depression and sleep disorders by detecting the contents of TNF- alpha, IL-6, sIL-2R, and hs-CRP in the peripheral blood of patients with Parkinson's disease, and to study its role in the development of non motor symptoms in Parkinson's disease and to explore the pathological mechanism of non motor symptoms for the non transport of Parkinson's disease. The prevention and treatment of dynamic symptoms provide a new way of thinking.
3. suggest that the immune inflammatory mechanism may be involved in PD's non motor symptoms.
Methods: the case group was diagnosed with primary PD patients in Dalian Central Hospital, Dalian, December 2012, in May, -2013, in accordance with the diagnostic criteria for primary PD in the British PD brain in 1992. The control group selected the healthy population at this time period in the hospital. The standard of the case group was 40-75 years old, and the clinical diagnosis was Parkinson's disease. With non motor symptoms, all patients signed the informed consent. The healthy control group was a healthy middle-aged and old aged 40-75 years old. The Parkinson syndrome caused by the elimination of cerebrovascular disease, encephalitis, and other reasons. The exclusion criteria were applied to the patients and the group. UPDRS, Webster, and NMSS were used in the PD group respectively. Table, Fatigue Scale-14, HRSD anxiety scale, HRSD depression scale, Pittsburgh sleep quality index scale, MOCA scale evaluation and olfactory detection, NMSS scale, Fatigue Scale-14, HRSD anxiety scale, HRSD depression scale, Pittsburgh sleep quality index scale, MOCA scale were evaluated in healthy control group. PD patients and healthy controls were measured. The content of TNF- alpha, IL-6, sIL-2R and hs-CRP in the serum of the group.
Results: the HRSD anxiety scale of 1.PD, the HRSD depression scale, the NMSS, the Pittsburgh sleep quality index scale, the Fatigue Scale-14 Fatigue Scale score were significantly higher than those of the healthy control group, and there were significant differences between the PD patients and the healthy controls with the.MOCA scale.
2. most PD patients have different degrees of olfactory damage before they develop motor symptoms.
The levels of hsCRP, TNF- alpha and IL-6 in 3.PD patients were significantly different from those in healthy controls (P0.05).
There was a significant positive correlation between 4.sIL-2R and depression and anxiety symptoms..C reactive protein was negatively correlated with anxiety and depression.
Conclusion: the manifestations of non motor symptoms in 1.PD patients are various and seriously affect the quality of daily life of patients.
The onset and development of 2.PD may be associated with inflammation.
3. inflammatory factor sIL-2R may be involved in the development of anxiety and depressive symptoms in PD patients.
【學(xué)位授予單位】：大連醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R742.5

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