【摘要】：研究背景帕金森病(Parkinson's disease,PD)是一種常見于中老年的慢性進(jìn)行性神經(jīng)系統(tǒng)變性疾病,是中老年人致殘的主要原因之一[1,2]。其主要臨床表現(xiàn)是由于紋狀體多巴胺神經(jīng)遞質(zhì)的減少而引起肌強(qiáng)直、行動(dòng)遲緩及震顫等運(yùn)動(dòng)癥狀及嗅覺功能減退、便秘、抑郁焦慮及認(rèn)知障礙等非運(yùn)動(dòng)癥狀[3]。人口流行病學(xué)調(diào)查顯示,大約有0.3%的世界人口正在經(jīng)受帕金森病的折磨,其中在60歲及以上的人群中大約占1%,在85歲以上的人口中,患病幾率增加至4-5%。經(jīng)過10-20年的病程,大約有40%-75%的患者因帕金森病去世,約50%失去生活自理能力,需專人看護(hù)由于具有高發(fā)病率及致殘性,因此帕金森病成為繼阿爾茨海默病(Alzheimer's disease.AD)后第二位的神經(jīng)變性疾病。PD患者的運(yùn)動(dòng)癥狀首發(fā)部位是多樣化的,有的患者以上肢起病,有的患者以下肢或上下肢起病,有的以左側(cè)起病,或右側(cè),或雙側(cè)同時(shí)起病,其與pD的相關(guān)危險(xiǎn)因素是否存在相關(guān)性未可知。已有研究報(bào)道,飲酒、吸煙、飲茶、腦力勞動(dòng)、殺蟲劑接觸史與帕金森病的發(fā)病有關(guān)[6],而帕金森病的發(fā)病與文化程度、高血壓病史、2型糖尿病、陽性家族史等無顯著相關(guān)性[7]。未有報(bào)道PD運(yùn)動(dòng)癥狀首發(fā)部位的多樣性與相關(guān)因素的相關(guān)性的研究。我們主要探討年齡、性別、文化程度等相關(guān)因素與PD患者首發(fā)運(yùn)動(dòng)癥狀起病部位是否存在相關(guān)性,并就結(jié)果討論其對(duì)PD的意義。研究目的研究帕金森病患者運(yùn)動(dòng)癥狀首發(fā)部位與相關(guān)因素的相關(guān)性分析。研究方法對(duì)在2013年1月份至2016年12月份之間于山東省立醫(yī)院神經(jīng)內(nèi)科病房住院的85例帕金森病患者的臨床資料進(jìn)行回顧性分析,采用單項(xiàng)及多項(xiàng)Logistic回歸分析,篩選與上肢起病存在相關(guān)性的危險(xiǎn)因素。研究結(jié)果1.我們本次研究共納入85例符合入組標(biāo)準(zhǔn)的帕金森病患者,其中以上肢起病的有54人(63.5%),不以上肢起病的有31人(36.5%),其中男性42人(49.4%),女性43人(50.6);年齡分三個(gè)層次:小于等于44歲(青年)、45歲至59歲(中年),大于等于60歲(老年),納入的病例數(shù)分別為10(11.8%),33(38.8%),42(49.4%);文化程度也分三類:小學(xué)及以下、初中至高中、高中以上,分別有46(54.1%)、29(34.1%)、10(11.8%)個(gè)患者,職業(yè)主要分三類:農(nóng)民、工人、離退人員,納入的病例數(shù)分別為43(50.6%)、13(15.3%)、29(34.1%);特殊嗜好分四類:無特殊嗜好、吸煙、飲酒、吸煙同時(shí)飲酒,各自的病例數(shù)為60(70.6%)、6(7.1%)、9(10.6%)、10(11.8%)。罹患糖尿病與高血壓的患者分別有 9(10.6%)、28(32.9%)人。2、logistic單因素相關(guān)性分析結(jié)果顯示:在性別、起病年齡、文化程度、職業(yè)、特殊嗜好、高血壓病史及糖尿病病史7類因素中,對(duì)以上肢作為帕金森病運(yùn)動(dòng)癥狀首發(fā)部位的影響各自的P值分別為:0.449、0.003、0.713、0.226、0.022、0.184、0.128(p0.05有統(tǒng)計(jì)學(xué)意義),由此可見,起病年齡及特殊嗜好對(duì)帕金森病患者以上肢作為首發(fā)部位有影響。3.我們又采用多因素的logistic回歸分析,結(jié)果顯示起病年齡與上肢發(fā)病存在明顯的相關(guān)性,其中小于等于44歲(青年)、45歲至59歲(中年)危險(xiǎn)因素的p值分別為0.020、0.011,OR值分別為0.160、0.249,B值分別為-1.833,-1.892。而特殊嗜好與上肢起病無有意義的相關(guān)性,p值均0.05。此外,危險(xiǎn)因素起病年齡中B值均為負(fù)值,說明起病年齡越小,越傾向于以上肢起病。研究結(jié)論1、性別、文化程度、職業(yè)、特殊嗜好、高血壓病史、糖尿病病史六個(gè)因素與帕金森病的起病部位不存在有意義的相關(guān)性。2、起病年齡與帕金森病患者的運(yùn)動(dòng)癥狀首發(fā)部位存在明顯的相關(guān)性,且起病年齡越小,越傾向于以上肢起病,起病年齡每增加一個(gè)年齡段,其以上肢起病的風(fēng)險(xiǎn)就減少0.1-0.2倍左右。
[Abstract]:Parkinson's disease (PD), a chronic progressive neurodegenerative disease, is one of the main causes of the disability of the middle-aged and the elderly[1,2]. The main clinical manifestation of the invention is that, due to the reduction of the dopamine neurotransmitter in the striatum, the symptoms of the motor, such as muscle rigidity, slow movement and tremor, and the non-motion symptoms such as the loss of olfaction, constipation, depression and anxiety, and the cognitive disorder[3]. An epidemiological survey shows that about 0.3 per cent of the world's population is suffering from parkinson's disease, of which about 1 per cent of the population aged 60 and above is in the range of 4-5 per cent of the population over the age of 85. After 10-20 years of disease, about 40% to 75% of patients died from Parkinson's disease, about 50% of them lost their self-care ability, and a special person was assigned to care for their high morbidity and disability, and therefore, Parkinson's disease became the second-place neurodegenerative disease following Alzheimer's disease. The first part of the movement symptoms of PD patients is diverse, and some of the patients are sick with upper limb. Some of the patients are sick with lower limbs or upper and lower limbs, some of them are on the left, or the right side or both sides, and the relevant risk factors of the pD are not known. The history of exposure to drinking, smoking, tea, brain and insecticide was related to the pathogenesis of parkinson's disease[6], but the incidence and culture of parkinson's disease, the history of hypertension, type 2 diabetes, and the positive family history of parkinson's disease had no significant correlation[7]. There was no study on the relationship between the diversity of the first part of PD motion and the related factors. We mainly discuss the correlation between the related factors such as age, gender and culture, and the onset of the first-episode motion of PD patients, and discuss their significance to PD. Objective To study the correlation between the first part of the motion symptoms and the related factors in the patients with Parkinson's disease. The clinical data of 85 patients with Parkinson's disease (PD) from January 2013 to December 2016 between January 2013 and December 2016 were analyzed retrospectively, and the risk factors associated with the onset of upper extremity diseases were selected by single and multiple logistic regression analysis. Study Results 1. In this study,85 patients with Parkinson's disease who met the criteria for enrollment were included, including 54 (63.5%) of upper limb diseases and 31 (36.5%) of upper limb diseases, of which 42 (49.4%) were male and 43 (50.6) for women; the age was divided into three levels: The number of cases of less than or equal to 44 years (youth),45 to 59 years (middle age), greater than or equal to 60 years (old), the number of cases included is 10 (11.8%),33 (38.8%),42 (49.4%), and the degree of culture is also divided into three categories: primary and lower, middle school to high school, high school,46 (54.1%),29 (34.1%),10 (11.8%) of patients, and the occupation is mainly divided into three categories: There were 43 (50.6%),13 (15.3%),29 (34.1%) of the patients,13 (15.3%),29 (34.1%), and the special preference was divided into four categories: no specific hobbies, smoking, drinking, smoking and drinking, the number of cases was 60 (70.6%),6 (7.1%),9 (10.6%), and 10 (11.8%). There were 9 (10.6%) and 28 (32.9%) of the patients with diabetes and hypertension. The P values of the first part of the upper limb as the first part of the motion of the Parkinson's disease were: 0.449, 0.003, 0.713, 0.226, 0.022, 0.184, 0.128 (P0.05). The multivariate logistic regression analysis was used to study the correlation between the onset age and the onset of upper extremity. The p-value of the risk factors was 0.020, 0.011 and the OR value of 0.160, 0.249 and the value of B were-1.833 and-1.892, respectively. There was no significant correlation between the special preference and the onset of the upper limb, and the p-value was 0.05. In addition, the value of B in the age of the risk factors was negative, indicating that the younger the onset of the disease, the more prone to the onset of the upper limb. (1) There was no significant correlation between the sex, the degree of culture, the occupation, the special hobby, the history of hypertension, the history of diabetes, and the position of the onset of Parkinson's disease.2. There was a significant correlation between the onset age and the first part of the disease in the patients with Parkinson's disease. And the smaller the onset age, the more prone to the onset of the upper limb, the onset of the disease is increased by one age group, and the risk of the onset of the upper limb is reduced by about 0.1 to about 0.2 times.
【學(xué)位授予單位】：山東大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R742.5

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