【摘要】：研究目的:1.分析PD患者睡眠障礙的臨床特點。2.分析不同類型、不同嚴重程度的PD患者睡眠障礙的特點。3.探討PD患者睡眠障礙與其他臨床特征的相關(guān)性。研究方法:連續(xù)收集2016年1月至2017年1月就診于我院并診斷為原發(fā)性PD患者81例,同期健康體檢者80例作為對照。詢問受試者的一般信息,包括姓名、性別、年齡、文化程度等。對于PD患者:采用修訂后Hoehn-Yahr分期(H-Y分期)、統(tǒng)一帕金森病評定量表第三部分(UPDRS-III)評定PD患者的疾病嚴重程度及類型,H-Y分期:1~2期為輕度,2.5~3期為中度,4~5期為重度;根據(jù)PD患者癥狀的表現(xiàn)形式分為震顫型、強直型、混合型。對于受試者睡眠方面評估:采用帕金森病睡眠量表(PDSS)評估夜間睡眠情況、Epworth睡眠量表(ESS)評價日間嗜睡情況、快眼動期睡眠行為障礙(RBD)篩查問卷評估RBD的存在情況。其他非運動癥狀:采用自主神經(jīng)癥狀量表(SCOPA-AUT)評價自主神經(jīng)功能;漢密爾頓焦慮量表(HAMA)、漢密爾頓抑郁量表(HAMD)評價焦慮、抑郁狀態(tài);蒙特利爾認知評估量表(Mo CA)、簡易精神狀態(tài)檢查量表(MMSE)評價認知功能;日常生活活動能力量表(ADL)來評估日常生活能力。研究結(jié)果:1.PD患者中男性49例(60.5%),女性32例(39.5%);年齡25~89歲,平均(61.85±11.47)歲;病程0.5~10年,平均(2.33±2.51)年;腦力勞動者37例(45.7%),體力勞動者44例(54.3%);H-Y分期0~5期,平均為(1.80±1.05)期;UPDRS-Ⅲ分值1~82,平均為(27.43±16.585)。PD患者:早期61例(75.3%),中期16例(19.8%),晚期4例(4.9%);強直型20例(24.7%),震顫型11例(13.6%),混合型50例(61.7%)。2.PD組與對照組相比,SCOPA-AUT、HAMA、HAMD總分差異有統(tǒng)計學(xué)意義。PD組焦慮發(fā)生率12.3%,顯著高于對照組,差異有統(tǒng)計學(xué)意義(c2=14.393,P0.001)。PD組抑郁發(fā)生率為7.4%,顯著高于對照組,差異有統(tǒng)計學(xué)意義。PD組與對照組在PDSS-2~15、PDSS-T、ESS、RBDSQ總分值上差異有統(tǒng)計學(xué)意義,PDSS-1差異無統(tǒng)計學(xué)意義。以PDSS各項評分≤5分為各睡眠癥狀嚴重的標(biāo)準,PD組在PDSS-1、PDSS-3~13、PDSS-15、ESS、RBDSQ與對照組,兩組間比較差異有統(tǒng)計學(xué)意義(P0.05);PDSS-2、PDSS-14與對照組比較,差異無統(tǒng)計學(xué)意義。PD組睡眠障礙的發(fā)生率為58.0%,高于對照組36.3%,差異有統(tǒng)計學(xué)意義(P0.05)。PD組日間嗜睡發(fā)生率17.3%,顯著高于對照組2.5%,差異有統(tǒng)計學(xué)意義。RBDSQ6可認為存在RBD,PD組RBD的發(fā)生率9.9%,與對照組1.3%相比差異有統(tǒng)計學(xué)意義。3.早期、中期、晚期PD患者三組之間PDSS總分及PDSS-1~15、ESS、RBDSQ分值差異無統(tǒng)計學(xué)意義。三組之間由于不能行動而導(dǎo)致的尿失禁(PDSS-9)的發(fā)生率差異有統(tǒng)計學(xué)意義,晚期PD患者顯著高于早、中期。4.強直型、震顫型、混合型PD患者,三組之間PDSS-1~15、PDSS-T、ESS、RBDSQ總分之間差異無顯著性。三組之間的睡眠障礙癥狀的發(fā)生率在PDSS-1~8、PDSS-10~11、PDSS-13、PDSS-15、ESS之間差異有統(tǒng)計學(xué)意義。5.PDSS與NMS(r=-0.341,P=0.002)、SCOPA-AUT(r=-0.340,P=0.002)、HAMA(r=-0.549,P0.001)、HAMD(r=-0.423,P0.001)呈負相關(guān);與年齡(r=-0.218,P=0.05)、性別(r=-0.209,P=0.061)、職業(yè)(r=0.037,P=0.744)、病程(r=-0.087,P=0.438)、程度(r=-0.141,P=0.209)、分型(r=-0.055,P=0.626)、H-Y分期(r=-0.151,P=0.181)、UPDRS-Ⅲ(r=-0.181,P=0.107)、MMSE(r=-0.083,P=0.463)、Mo CA(r=-0.091,P=0.418)、ADL(r=-0.198,P=0.076)不具有相關(guān)性。研究結(jié)論:1.PD患者睡眠障礙發(fā)生率高,表現(xiàn)形式以夜間總體睡眠質(zhì)量差、入睡困難、保持睡眠困難、夜間排尿、夜間夢境困擾為主,且存在白天過度嗜睡、RBD。2.不同嚴重程度、不同臨床亞型的PD患者睡眠障礙的表現(xiàn)形式不同。晚期患者較中、早期患者相比更容易出現(xiàn)不能行動而導(dǎo)致的尿失禁;混合型PD患者較震顫型、強直型PD患者睡眠障礙的發(fā)病率高,三者之間睡眠障礙的表現(xiàn)形式顯著不同。3.焦慮、抑郁、自主神經(jīng)功能障礙是PD患者睡眠障礙的影響因素。
[Abstract]:Objective: 1. To analyze the clinical characteristics of sleep disorders in PD patients. 2. To analyze the characteristics of sleep disorders in different types and severity of PD patients. 3. To explore the correlation between sleep disorders and other clinical features in PD patients. For PD patients, the revised Hoehn-Yahr staging (H-Y staging) and the Unified Parkinson's Disease Rating Scale (UPDRS-III) were used to assess the severity and type of the disease. H-Y staging: 1-2 was mild, and 2.5-3 was mild. According to the manifestations of symptoms in PD patients, they were divided into tremor type, ankylosing type and mixed type. Other non-motor symptoms: autonomic nervous function was assessed with SCOPA-AUT; anxiety and depression were assessed with Hamilton Anxiety Scale (HAMA) and Hamilton Depression Scale (HAMD); cognitive function was assessed with Montreal Cognitive Assessment Scale (Mo CA), Simple Mental State Examination Scale (MMSE); daily living activities (ADL). Results: 1. Among the patients with PD, 49 (60.5%) were males and 32 (39.5%) were females; the age ranged from 25 to 89 years, with an average of (61.85 + 11.47) years; the course of disease ranged from 0.5 to 10 years, with an average of (2.33 + 2.51) years; 37 (45.7%) were mental workers, 44 (54.3%) were manual workers; the H-Y stage ranged from 0 to 5, with an average of (1.80 + 1.05); UPDRS-III score. PD patients: 61 cases (75.3%), 16 cases (19.8%) in the early stage, 4 cases (4.9%) in the late stage, 20 cases (24.7%), 11 cases (13.6%) in the ankylosing type, and 50 cases (61.7%) in the mixed type. 2. Compared with the control group, the total scores of SCOPA-AUT, HAMA and HAMD in the PD group were significantly different. The incidence of anxiety in the SCOPA-AUT, HAMA and HAMD group was 12.3%, significantly higher than that in the control group. The incidence of depression in PD group was 7.4%, which was significantly higher than that in the control group. The total scores of PDSS-2-15, PDSS-T, ESS and RBDSQ in PD group and the control group were significantly different. There was no significant difference in PDSS-1. The incidence of sleep disorders in PD group was 58.0%, higher than that in control group (36.3%, P 0.05). The incidence of daytime sleepiness in PD group was 17.3%, significantly higher than that in control group (2.5%). The incidence of RBD was 9.9% in the PD group and 1.3% in the control group. 3. There was no significant difference in the total score of PDSS and PDSS-1-15, ESS and RBDSQ among the three groups in the early, middle and late stages of PD. There was no significant difference in the total scores of PDSS-1-15, PDSS-T, ESS and RBDSQ among the three groups. The incidence of sleep disorders among the three groups was significantly higher than that among the early, middle and late PD patients. 41,P=0.002),SCOPA-AUT(r=-0.340,P=0.002),HAMA(r=-0.549,P0.001),HAMD(r=-0.423,P0.001)鍛堣礋鐩稿叧;涓庡勾榫，

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