帕金森病凍結(jié)步態(tài)臨床特征及相關(guān)性研究
發(fā)布時(shí)間：2018-07-28 18:07
【摘要】：第一部分帕金森病患者凍結(jié)步態(tài)的臨床特征、相關(guān)因素分析 目的：分析伴凍結(jié)步態(tài)（Freezingofgait,FOG）的帕金森�。≒arkinson’sDisease,PD）患者臨床特征，探討FOG發(fā)生率、臨床表現(xiàn)、伴隨癥狀以及其影響因素。 方法：連續(xù)收集PD患者191名，根據(jù)凍結(jié)步態(tài)量表，將患者分為PD+FOG組和PD-FOG組。記錄患者的臨床資料，對(duì)所有患者行關(guān)期UPDRS評(píng)分和H-Y分期評(píng)定。采用漢密爾頓抑郁量表（HAMD）-24對(duì)患者抑郁及程度進(jìn)行評(píng)定。采用蒙特利爾認(rèn)知評(píng)估量表（MoCA）北京版對(duì)患者的認(rèn)知功能水平進(jìn)行評(píng)定。 結(jié)果：PD患者中FOG的發(fā)生率為54.4%，其中啟步凍結(jié)、轉(zhuǎn)彎凍結(jié)、行走中凍結(jié)發(fā)生率分別為77.8%、61.5%、33.7%。PD+FOG患者較PD-FOG患者病程更長(zhǎng)（P=0.000），以強(qiáng)直少動(dòng)為首發(fā)癥狀比率更高（P=0.007），H-Y分期更高（P=0.000）、UPDRS Ⅰ、Ⅱ、Ⅲ各分值更大（P=0.000），服用左旋多巴日劑量和等效劑量更大（P=0.000），發(fā)生抑郁和跌倒比率更高（P=0.006、P=0.000），HAMD評(píng)分更高（P=0.000）。PD+FOG組視空間及執(zhí)行功能損害重于PD-FOG組（P=0.014）。H-Y分期、UPDRS Ⅱ、跌倒是PD患者凍結(jié)步態(tài)的主要影響因素。 結(jié)論：PD患者中凍結(jié)步態(tài)的發(fā)生率較高，其中啟步凍結(jié)、轉(zhuǎn)彎凍結(jié)較行走中凍結(jié)更為常見(jiàn)。伴FOG的PD患者病程更長(zhǎng)，疾病嚴(yán)重程度更重，且常伴有輕度抑郁和明顯的認(rèn)知功能損害，跌倒的危險(xiǎn)更大。疾病嚴(yán)重程度、日常生活能力及跌倒對(duì)FOG有顯著的影響。 第二部分帕金森病凍結(jié)步態(tài)患者的認(rèn)知、情感障礙 目的：研究FOG患者認(rèn)知障礙及情感障礙的發(fā)生情況，并探究運(yùn)動(dòng)障礙、認(rèn)知、情感障礙是否共同影響FOG，三者是否可以為FOG的獨(dú)立預(yù)測(cè)因子。 方法：對(duì)104例PD+FOG患者行凍結(jié)步態(tài)量表（FOGQ）評(píng)分。用UPDRS Ⅲ和H-Y分期評(píng)定PD患者運(yùn)動(dòng)癥狀的嚴(yán)重程度，用蒙特利爾認(rèn)知評(píng)估量表（MoCA）北京版評(píng)定患者的認(rèn)知功能水平，用漢密爾頓抑郁量表（HAMD）-24評(píng)定患者的抑郁程度。 結(jié)果：104例患者中，UPDRS Ⅲ31.98±13.98分，H-Y分期2.50±0.67期，F(xiàn)OGQ9.23±5.11分，MoCA20.10±5.89分，HAMD10.91±9.35分，男性和女性之間無(wú)統(tǒng)計(jì)學(xué)差異；認(rèn)知障礙發(fā)生率為82.9%，抑郁發(fā)生率為55.8%。86例認(rèn)知障礙患者的視空間和執(zhí)行能力認(rèn)知域評(píng)分明顯降低（P=0.000）。FOGQ與H-Y、UPDRS、HAMD評(píng)分呈正相關(guān)，與MoCA呈負(fù)相關(guān)。MoCA、UPDRS Ⅱ、UPDRS Ⅲ、HAMD均為FOGQ的獨(dú)立影響因素。 結(jié)論：PD伴凍結(jié)步態(tài)患者運(yùn)動(dòng)癥狀較重，并伴有明顯認(rèn)知功能障礙及抑郁，兩者發(fā)生率均較高，其中認(rèn)知障礙主要表現(xiàn)為執(zhí)行和視空間障礙�；颊邇鼋Y(jié)步態(tài)癥狀越重，抑郁評(píng)分越高，發(fā)生率越高；而凍結(jié)步態(tài)癥狀越重，患者認(rèn)知障礙越嚴(yán)重。運(yùn)動(dòng)障礙、認(rèn)知受損及情感異常共同影響FOG，三者均是FOG的獨(dú)立預(yù)測(cè)因子。 第三部分帕金森病凍結(jié)步態(tài)患者血尿酸水平變化 目的：觀察PD凍結(jié)步態(tài)患者的血尿酸水平變化，探討凍結(jié)步態(tài)與血尿酸水平的關(guān)系，為凍結(jié)步態(tài)的研究尋找生物學(xué)指標(biāo)。 方法：選取93例PD患者，根據(jù)FOGQ將其分為PD+FOG組和PD-FOG組。收集患者的臨床資料，并行FOGQ評(píng)分。同時(shí)選取同時(shí)間段社區(qū)的健康人64例作為對(duì)照組，早晨空腹測(cè)定血尿酸、肌酐，對(duì)有無(wú)凍結(jié)步態(tài)的兩組及正常對(duì)照組的血尿酸進(jìn)行比較。 結(jié)果：PD+FOG組血尿酸258.58±58.15μmol/L，PD-FOG組285.58±64.65μmol/L，健康對(duì)照組327.77±60.23μmol/L。PD+FOG組血尿酸顯著低于PD-FOG組（P=0.034,0.05）和健康對(duì)照組（P=0.000,0.01）。PD-FOG組血尿酸顯著低于健康照組（P=0.000,0.01）。PD+FOG組、PD-FOG組和健康對(duì)照組內(nèi)生肌酐清除率分別為81.77±29.58、82.04±20.66、82.85±21.39ml/min，三組之間均無(wú)顯著性差異（P0.05）。血尿酸水平與FOGQ相關(guān)因素分析示兩者無(wú)直線相關(guān)關(guān)系。 結(jié)論：PD患者凍結(jié)步態(tài)組血尿酸水平明顯低于非凍結(jié)步態(tài)組和正常健康人群，提示血尿酸水平與凍結(jié)步態(tài)有關(guān)，，但不能作為判斷凍結(jié)步態(tài)嚴(yán)重程度的一個(gè)指標(biāo)。
[Abstract]:Part one clinical characteristics and related factors of frozen gait in patients with Parkinson's disease
Objective: to analyze the clinical features of patients with Parkinson's disease (Parkinson 'sDisease, PD) with Freezingofgait (FOG), and to explore the incidence of FOG, clinical manifestations, accompanying symptoms and its influencing factors.
Methods: 191 PD patients were collected continuously. According to the frozen gait scale, the patients were divided into PD+FOG group and PD-FOG group. The patients' clinical data were recorded. All patients were evaluated by UPDRS score and H-Y staging. The Hamilton Depression Scale (HAMD) -24 was used to evaluate the patients' depression and degree. The Montreal cognitive assessment scale (MoCA) was used. The Beijing edition assessed the cognitive function of the patients.
Results: the incidence of FOG in PD patients was 54.4%, in which the starting freezing and turning freezing were 77.8%, 61.5%, and 33.7%.PD+FOG patients were longer than the PD-FOG patients (P=0.000), and the ratio of the first symptom was higher (P=0.007), H-Y stage was higher (P=0.000), UPDRS I, II, and III were higher (P=0.000). The daily dose of levodopa and the equivalent dose (P=0.000) increased the rate of depression and fall (P=0.006, P=0.000), and the HAMD score was higher (P=0.000) in group.PD+FOG, the visual space and the impairment of executive function were heavier than the.H-Y staging of PD-FOG group (P=0.014), UPDRS II, and the fall was the main influencing factor of the frozen gait of PD patients.
Conclusion: the incidence of frozen gait in PD patients is higher, in which the freezing step is more common than the freezing in walking. The duration of the disease is longer, the severity of the disease is more serious, and the severity of the disease is more severe, and the risk of falling is greater. The severity of disease, the daily living ability and the fall to FOG are more common. There is a significant impact.
The second part is the cognition and affective disorder of Parkinson's disease patients with frozen gait.
Objective: To investigate the occurrence of cognitive impairment and affective disorder in FOG patients, and to explore whether or not dyskinesia, cognition, and affective disorders affect FOG, and whether the three can be an independent predictor of FOG.
Methods: the frozen gait scale (FOGQ) score was performed in 104 patients with PD+FOG. The severity of the movement symptoms in PD patients was assessed by UPDRS III and H-Y staging. The cognitive function level of the patients was assessed by the Beijing edition of Montreal cognitive assessment scale (MoCA), and the depression degree of the patients was assessed with the Hamilton Depression Scale (HAMD) -24.
Results: in the 104 patients, UPDRS III 31.98 + 13.98 points, H-Y staging 2.50 + 0.67 stages, FOGQ9.23 + 5.11, MoCA20.10 + 5.89, HAMD10.91 9.35, there was no statistical difference between men and women; the incidence of cognitive impairment was 82.9%, and the incidence of depression was significantly reduced in visual space and executive ability in 55.8%.86 patients with cognitive impairment. Low (P=0.000).FOGQ was positively correlated with H-Y, UPDRS and HAMD scores, and negatively correlated with MoCA..MoCA, UPDRS II, UPDRS III and HAMD were independent factors of FOGQ.
Conclusion: the symptoms of PD with frozen gait are heavier, with obvious cognitive impairment and depression. The incidence of cognitive impairment is high, and cognitive impairment is mainly manifested in execution and visual space barriers. The heavier the symptoms of frozen gait, the higher the score of depression, the higher the incidence of depression, and the more severe the frozen gait symptoms, the more strict cognitive impairment in patients. Heavy. Dyskinesia, cognitive impairment and affective disorder jointly affect FOG. Both of these three are independent predictors of FOG.
The third part is the change of serum uric acid level in frozen patients with Parkinson's disease.
Objective: To observe the changes of serum uric acid level in patients with PD frozen gait, and to explore the relationship between the frozen gait and the level of blood uric acid, and to find the biological index for the study of the frozen gait.
Methods: 93 patients with PD were selected and divided into PD+FOG group and PD-FOG group according to FOGQ. The clinical data of the patients were collected and the FOGQ scores were collected. At the same time, 64 healthy people in the same time community were selected as the control group. The blood uric acid and creatinine were measured in the morning on the empty stomach. The blood uric acid in the two groups with no frozen gait and the normal control group was compared.
Results: the serum uric acid in PD+FOG group was 258.58 + 58.15 mu mol/L, group PD-FOG was 285.58 + 64.65 mol/L, and the blood uric acid in group 327.77 + 60.23 mol/L.PD+FOG was significantly lower than that of group PD-FOG (P=0.034,0.05) and healthy control group (P=0.000,0.01) group.PD-FOG lower than that of healthy group (P=0.000,0.01).PD+FOG group, PD-FOG group and healthy control group. The scavenging rate of creatinine was 81.77 + 29.58,82.04 + 20.66,82.85 + 21.39ml/min respectively. There was no significant difference between the three groups (P0.05). There was no linear correlation between the serum uric acid level and the analysis of FOGQ related factors.
Conclusion: the level of uric acid in the frozen gait group of PD patients is significantly lower than that of the non frozen gait group and the normal healthy population. It is suggested that the level of uric acid is related to the frozen gait, but it can not be used as an indicator to judge the severity of the frozen gait.
【學(xué)位授予單位】：蘇州大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R742.5
本文編號(hào)：2151171
[Abstract]:Part one clinical characteristics and related factors of frozen gait in patients with Parkinson's disease
Objective: to analyze the clinical features of patients with Parkinson's disease (Parkinson 'sDisease, PD) with Freezingofgait (FOG), and to explore the incidence of FOG, clinical manifestations, accompanying symptoms and its influencing factors.
Methods: 191 PD patients were collected continuously. According to the frozen gait scale, the patients were divided into PD+FOG group and PD-FOG group. The patients' clinical data were recorded. All patients were evaluated by UPDRS score and H-Y staging. The Hamilton Depression Scale (HAMD) -24 was used to evaluate the patients' depression and degree. The Montreal cognitive assessment scale (MoCA) was used. The Beijing edition assessed the cognitive function of the patients.
Results: the incidence of FOG in PD patients was 54.4%, in which the starting freezing and turning freezing were 77.8%, 61.5%, and 33.7%.PD+FOG patients were longer than the PD-FOG patients (P=0.000), and the ratio of the first symptom was higher (P=0.007), H-Y stage was higher (P=0.000), UPDRS I, II, and III were higher (P=0.000). The daily dose of levodopa and the equivalent dose (P=0.000) increased the rate of depression and fall (P=0.006, P=0.000), and the HAMD score was higher (P=0.000) in group.PD+FOG, the visual space and the impairment of executive function were heavier than the.H-Y staging of PD-FOG group (P=0.014), UPDRS II, and the fall was the main influencing factor of the frozen gait of PD patients.
Conclusion: the incidence of frozen gait in PD patients is higher, in which the freezing step is more common than the freezing in walking. The duration of the disease is longer, the severity of the disease is more serious, and the severity of the disease is more severe, and the risk of falling is greater. The severity of disease, the daily living ability and the fall to FOG are more common. There is a significant impact.
The second part is the cognition and affective disorder of Parkinson's disease patients with frozen gait.
Objective: To investigate the occurrence of cognitive impairment and affective disorder in FOG patients, and to explore whether or not dyskinesia, cognition, and affective disorders affect FOG, and whether the three can be an independent predictor of FOG.
Methods: the frozen gait scale (FOGQ) score was performed in 104 patients with PD+FOG. The severity of the movement symptoms in PD patients was assessed by UPDRS III and H-Y staging. The cognitive function level of the patients was assessed by the Beijing edition of Montreal cognitive assessment scale (MoCA), and the depression degree of the patients was assessed with the Hamilton Depression Scale (HAMD) -24.
Results: in the 104 patients, UPDRS III 31.98 + 13.98 points, H-Y staging 2.50 + 0.67 stages, FOGQ9.23 + 5.11, MoCA20.10 + 5.89, HAMD10.91 9.35, there was no statistical difference between men and women; the incidence of cognitive impairment was 82.9%, and the incidence of depression was significantly reduced in visual space and executive ability in 55.8%.86 patients with cognitive impairment. Low (P=0.000).FOGQ was positively correlated with H-Y, UPDRS and HAMD scores, and negatively correlated with MoCA..MoCA, UPDRS II, UPDRS III and HAMD were independent factors of FOGQ.
Conclusion: the symptoms of PD with frozen gait are heavier, with obvious cognitive impairment and depression. The incidence of cognitive impairment is high, and cognitive impairment is mainly manifested in execution and visual space barriers. The heavier the symptoms of frozen gait, the higher the score of depression, the higher the incidence of depression, and the more severe the frozen gait symptoms, the more strict cognitive impairment in patients. Heavy. Dyskinesia, cognitive impairment and affective disorder jointly affect FOG. Both of these three are independent predictors of FOG.
The third part is the change of serum uric acid level in frozen patients with Parkinson's disease.
Objective: To observe the changes of serum uric acid level in patients with PD frozen gait, and to explore the relationship between the frozen gait and the level of blood uric acid, and to find the biological index for the study of the frozen gait.
Methods: 93 patients with PD were selected and divided into PD+FOG group and PD-FOG group according to FOGQ. The clinical data of the patients were collected and the FOGQ scores were collected. At the same time, 64 healthy people in the same time community were selected as the control group. The blood uric acid and creatinine were measured in the morning on the empty stomach. The blood uric acid in the two groups with no frozen gait and the normal control group was compared.
Results: the serum uric acid in PD+FOG group was 258.58 + 58.15 mu mol/L, group PD-FOG was 285.58 + 64.65 mol/L, and the blood uric acid in group 327.77 + 60.23 mol/L.PD+FOG was significantly lower than that of group PD-FOG (P=0.034,0.05) and healthy control group (P=0.000,0.01) group.PD-FOG lower than that of healthy group (P=0.000,0.01).PD+FOG group, PD-FOG group and healthy control group. The scavenging rate of creatinine was 81.77 + 29.58,82.04 + 20.66,82.85 + 21.39ml/min respectively. There was no significant difference between the three groups (P0.05). There was no linear correlation between the serum uric acid level and the analysis of FOGQ related factors.
Conclusion: the level of uric acid in the frozen gait group of PD patients is significantly lower than that of the non frozen gait group and the normal healthy population. It is suggested that the level of uric acid is related to the frozen gait, but it can not be used as an indicator to judge the severity of the frozen gait.
【學(xué)位授予單位】：蘇州大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R742.5
【共引文獻(xiàn)】
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