【摘要】：目的：1）研究帕金森�。≒arkinson’s disease, PD）患者自主神經(jīng)功能障礙的特點；2）探討皮膚交感反應(yīng)（sympathetic skin response, SSR）及自主神經(jīng)功能評定量表（the Scale for Outcomes in PD for AutonomicSymptoms, SCOPA-OUT）對PD患者自主神經(jīng)障礙檢測的敏感性。 方法： 選取2011年10月-2013年10月就診于河北醫(yī)科大學(xué)第一醫(yī)院的71例原發(fā)性PD患者。應(yīng)用PD患者一般情況信息表、修訂后Hoehn-Yahr分期（the Modified Hoehn and Yahr Staging）、統(tǒng)一帕金森病評定量表（Unified Parkinson’s Disease Rating Scale, UPDRS）分別調(diào)查PD患者的基本信息（包括患者性別、年齡、文化程度等）及患者病程、疾病的發(fā)生發(fā)展和嚴(yán)重程度；應(yīng)用漢密爾頓焦慮量表14項版本（HAMA14）、漢密爾頓焦慮抑郁量表24項版本（HAMD24）評估患者情緒狀況；應(yīng)用簡易精神狀態(tài)檢查量表（MMSE）、蒙特利爾認(rèn)知評估量表（MoCA）評估患者認(rèn)知情況；應(yīng)用匹茲堡睡眠質(zhì)量指數(shù)（PSQI）評估患者睡眠質(zhì)量情況。應(yīng)用自主神經(jīng)癥狀量表（the Scale for Outcomes in PD for AutonomicSymptoms, SCOPA-OUT）評估患者的自主神經(jīng)功能障礙，應(yīng)用皮膚交感反應(yīng)（sympathetic skin response, SSR）對患者進行植物神經(jīng)功能檢測。 按本研究中的標(biāo)準(zhǔn)分為正常組（PD-N）、輕度認(rèn)知功能障礙組（PD-MCI）、帕金森病癡呆組（PDD）、焦慮組、抑郁組、睡眠障礙組。其中MOCA≥26、MMSE≥26分為正常組（PD-N），認(rèn)知功能障礙組包括輕度認(rèn)知功能障礙組（PD-MCI）和帕金森病癡呆組（PDD），其中MOCA26、MMSE≥26分為PD-MCI，MOCA26、MMSE26分為PDD；HAMA14≥7分為焦慮組；HAMD24≥8分為抑郁組；PQSI≥6分為睡眠障礙組；SCOPA-OUT分為0分（無癥狀）；1分（輕）；2分（中等）；3分（重）四個等級，總得分為0分為正常組、1-12分為輕度異常組、13-69分為重度異常組。分別對這幾組進行SSR檢測，采用SPSS13.0軟件對患者基本信息進行統(tǒng)計描述，應(yīng)用秩和檢驗和卡方檢驗分析各組的異同點。 結(jié)果： 1剔除5例無效問卷，剩余PD患者中男性37例，女性29例；年齡46~84歲，平均（66.5±9.5）歲；病程1~20年，平均（6.0±4.4）年；受教育程度0~18年，平均（10.9±3.7）年；UPDRS得分為10~74分，平均（41.5±15.4）分；H-Y分期1.0~5期，平均（2.3±0.7）期；HAMA14得分2~22分，平均（11.2±4.7）分；經(jīng)HAMD24得分1~22分，平均（10.2±5.2）分；MMSE得分16~30分，平均（26.1±3.5）分；MOCA得分10~30分，平均（21.4±5.2）分；PSQI得分1~19分，平均（7.5±4.7）分。 2本研究中同女性PD患者相比，男性PD患者的病情更加嚴(yán)重（UPSRS：P=0.004，H-Y：P=0.005）。 3從臨床特征看，PD患者自主神經(jīng)功能障礙中便秘癥狀最為突出（46例，占69.07％），其次發(fā)生率較高的癥狀依次為：流涎（35例，占53.03％）；多汗（29例，占43.94%）、夜尿增多（29例，占43.94%）、尿頻（27例，占40.91%）、尿急（25例，占37.88%）、吞咽困難（21例，占31.82%）、體溫調(diào)節(jié)障礙（16例，占24.24%）、尿失禁（14例，占21.21%）、體位性低血壓（12例，占18.18%）、性功能障礙（5例，占7.58%）。PD患者自主神經(jīng)功能障礙經(jīng)SCOPA-OUT檢出率為100%；經(jīng)SSR檢測出率為63.6%。提示SCOPA-OUT敏感性更高。 4經(jīng)SCOPA-OUT量表評估發(fā)現(xiàn)自主神經(jīng)功能重度異常患者與自主神經(jīng)輕度異�；颊呦啾龋罢咴谀挲g、病程、疾病嚴(yán)重程度、焦慮情緒和認(rèn)知功能障礙等方面的病情更為嚴(yán)重（P0.05)，而兩組在受教育程度、抑郁情緒和睡眠等方面的病情無差別（P0.05）。SSR異�；颊吲cSSR正常患者相比，SSR異常患者的年齡更高（P0.05)，而兩組在病程、受教育程度、疾病嚴(yán)重程度、焦慮、抑郁情緒、認(rèn)知功能障礙和睡眠等方面的病情無差別（P0.05）。 5本研究發(fā)現(xiàn)：認(rèn)知功能正常PD患者17例（25.76%），PD-MCI患者26例（39.39%），PDD患者23例（34.85%）；伴有焦慮患者56例（84.85%），伴有抑郁患者為43例（65.15%），焦慮抑郁共病患者為40例（60.61%）；伴有睡眠障礙患者為34例（51.52%）。對于伴有焦慮、抑郁情緒和認(rèn)知功能障礙的患者，SCOPA-OUT對自主神經(jīng)功能障礙的敏感性較SSR更高（P0.05）。但對PDD、PD-MCI及伴有睡眠障礙患者，SCOPA-OUT和SSR兩者之間敏感性相同（P0.05)。 結(jié)論:（1）本研究所有PD患者中，男性的病情較女性更為嚴(yán)重。（2）本研究提示PD患者普遍存在自主神經(jīng)功能障礙，其中以便秘癥狀最為突出。（3）經(jīng)SCOPA-OUT評估，自主神經(jīng)功能重度異常患者在年齡、病程、疾病嚴(yán)重程度、焦慮情緒和認(rèn)知功能障礙等方面的病情比自主神經(jīng)功能輕度異常患者更為嚴(yán)重。經(jīng)SSR檢測，SSR異常PD患者的年齡更大。（4）對于伴有焦慮、抑郁情緒和認(rèn)知功能障礙的PD患者，SCOPA-OUT較SSR更敏感。
[Abstract]:Objective:1) To study the characteristics of autonomic dysfunction in the patients with Parkinson's disease (PD), and to explore the sensitivity of the skin sympathetic response (SSR) and the autonomic nervous function rating scale (SCOPA-OUT) to the detection of autonomic dysfunction in PD patients. square Method:71 cases of primary P were selected from October 2011 to October,2013 in the first hospital of Hebei Medical University. The basic information of PD patients (including the patient's sex, age, cultural degree, etc.) and the patient's risk were investigated by using the general information table of PD patients, the revised Hoehn-Yahr staging, and the unified Parkinson's Disease Rating Scale (VRS), respectively. The course of the disease, the development and severity of the disease, the application of the Hamilton anxiety scale 14 (HAMA14), the Hamilton anxiety and depression scale (24) (HAMD24) to assess the mood of the patient, and the application of a simple mental state examination scale (MM SE), the Montreal Cognitive Assessment Scale (MoCA) for assessing the patient's cognitive condition; using the Pittsburgh Sleep Quality Index (PSQI) to assess the patient's sleep The autonomic nervous function of the patient was assessed by the Scale for Outlines in PD for Autonomy Symptoms (SCOPA-OUT), and the autonomic nerve function was applied to the patient by using the skin sympathetic response (SSR). The criteria of this study were divided into normal group (PD-N), mild cognitive impairment group (PD-MCI), Parkinson's disease dementia group (PDD), anxiety group, and depression group. The MOCA-26 and MMSE-26 were divided into normal group (PD-N), and the cognitive impairment group included mild cognitive impairment group (PD-MCI) and Parkinson's disease dementia group (PDD), among which, MOCA 26 and MMSE-26 were divided into PD-MCI, MOCA 26, and MMSE26 into PDD; HAMA14-7 was divided into anxiety group; HAMD24-8 It is divided into depression group; PQSI-6 is divided into sleep disorder group; SCOPA-OUT is divided into 0 (asymptomatic);1 point (light);2 (medium);3 (heavy) four grades, the score of 0 is divided into normal group,1-12 is divided into mild abnormal group, and 13-69 is divided into two groups: The basic information of the patients was statistically described by using the SPSS13.0 software, and the rank sum test and the chi-square test were used to analyze the basic information of the patients. the difference of the group The results were as follows:1 out of 5 invalid questionnaires,37 in the remaining PD patients and 29 in the female; the age was 46 to 84 years, the average (66.5 to 9.5) years; the course of the disease ranged from 1 to 20 years, with an average (6.0 to 4.4) years; the education level was 0 to 18 years, with an average (10.9% 3.7) years; and the RRS It is divided into 10-74 points, average (41.5-15.4) points, H-Y stage 1.0-5, average (2.3-0.7) period, HAMA14 score of 2-22 points, average (11.2-4.7) points, HAMA 24 scores of 1-22, average (10.2-5.2) points, MMSE score of 16-30, average (26.1-3.5) points, and MOCA score of 10-30 points, average (2 1.4 (5.2) points; PSQI score of 1-19 points, average ( 7.5 (4.7) score. The condition of the male PD patient was more severe in the study compared to the female PD (UPSRS: P = 0.004, H -Y: P = 0.005). From the clinical features, the symptoms of constipation in the patients with PD were the most prominent (46 cases, 69.07%), followed by high incidence of salivation (35 cases, 53.03%), hyperhidrosis (29 cases, 43.94%), and increased night urine. (29 cases, 43.94%), frequent micturition (27 cases, 40.91%), urgency (25 cases, 37.88%), dysphagia (21 cases, 31.82%), body temperature regulation disorder (16 cases, 24.24%), urinary incontinence (14 cases, 21.21%), orthostatic hypotension (12 cases,18.18). 18%), sexual function (5 cases, 7.58%). The detection rate of autonomic dysfunction in PD patients was 100% by SCOPA-OUT. The SSR detection rate was 63.6%. The sensitivity of COPA-OUT was higher. (0.05) There was no difference between the two groups in the degree of education, depression and sleep (P0.05). , severity of the disease, anxiety, depression, cognitive impairment, and sleep There were 17 cases (25.76%) of patients with normal PD,26 (39.39%) of PD-MCI,23 (34.85%) of PDD patients,56 (84.85%) of patients with anxiety and 43 (65.15%) of patients with depression. 40 (60.61%) of the patients with depression, with sleep 34 (51.52%) patients with sleep disorder (51.52%). In patients with anxiety, depression, and cognitive impairment, SCOPA-OUT was responsible for autonomic dysfunction. The sensitivity was higher than that of SSR (P0.05). But for PDD, PD-MCI and patients with sleep disorder, SCOPA-OUT and SS The sensitivity of R is the same (P0.05). Conclusion: (1) This study In PD patients, the condition of the male is more serious than that of the female. (2) This study suggests that PD patients are endemic The main neurological function disorder, in which the symptoms of constipation are the most prominent. (3) With the evaluation of SCOPA-OUT, the patients with severe abnormal autonomic function are in the aspects of age, course of disease, severity of disease, anxiety and cognitive function, etc. The condition of the disease is more serious than that of the patients with mild abnormal autonomic function. (4) for PD with anxiety, depression and cognitive impairment
【學(xué)位授予單位】：河北醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R742.5

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