【摘要】：目的：1.初步研究帕金森病(Parkinson's disease, PD)伴慢性疼痛患者的臨床特征；2.分析帕金森病慢性疼痛與認(rèn)知功能的相關(guān)性。 方法：收集2009年1月至2013年7月蘇州大學(xué)附屬第二醫(yī)院神經(jīng)內(nèi)科門診就診的343例PD患者的臨床資料,隨機(jī)選擇同期150例年齡、性別、文化程度與之相匹配的健康成人作對(duì)照組,詢問(wèn)是否伴有慢性疼痛,對(duì)兩組慢性疼痛患者進(jìn)行視覺(jué)模擬評(píng)分法(visual analogue scale, VAS)、疼痛簡(jiǎn)明記錄表(Brief pain inventory, BPI)評(píng)估,分析比較PD伴疼痛組(90例)與正常人伴疼痛組(50例)疼痛的部位、程度、治療、及其對(duì)生活質(zhì)量7項(xiàng)指標(biāo)的影響；對(duì)180例伴或不伴慢性疼痛的原發(fā)性PD患者進(jìn)行帕金森病統(tǒng)一評(píng)定量表(Unified Parkinson's Disease Rating Scale, UPDRS)、 Hoehn-Yahr (H-Y)分期、漢密頓抑郁量表(Hamilton Rating Scale for Depression, HRSD,24項(xiàng))、簡(jiǎn)明智能狀態(tài)檢查量表(Mini-Mental State Examination, MMSE)、帕金森病生活質(zhì)量問(wèn)卷(PD Quality of Life Questionnaire, PDQL)、PD非運(yùn)動(dòng)癥狀問(wèn)卷(non-motor Symptom Quest, NMSQ)等評(píng)估,行PD患者慢性疼痛的危險(xiǎn)因素分析；針對(duì)2012年6月至12月間就診的56例PD伴慢性疼痛患者,需判斷其疼痛的類型,進(jìn)行蒙特利爾認(rèn)知評(píng)估量表(Montreal Cognitive Assessment, MoCA)等評(píng)估。 結(jié)果：1.PD組疼痛的發(fā)生率為47.8%,正常對(duì)照組疼痛的發(fā)生率33.3%,差異有統(tǒng)計(jì)學(xué)意義(P=0.003)；PD患者疼痛程度最重的部位主要集中在四肢,而對(duì)照組疼痛的部位集中在頭頸、腰痛；對(duì)PD組與對(duì)照組的BPI7項(xiàng)指標(biāo)進(jìn)行比較,PD伴慢性疼痛患者在日常生活、情緒、正常工作、行走能力、睡眠、生活樂(lè)趣方面得分均高于正常對(duì)照組,差異有統(tǒng)計(jì)學(xué)意義(P=0.001,0.001,0.004,0.01,0.003,0.00);2.PD伴慢性疼痛組在UPDRS各項(xiàng)評(píng)分、H-Y分期、HRSD、PDQL、左旋多巴日等效劑量、與PD不伴慢性疼痛組相比,差異均具有統(tǒng)計(jì)學(xué)意義；Logistic回歸分析示只有HRSD得分具有統(tǒng)計(jì)學(xué)意義(OR=1.16P=0.000):3.PD伴慢性疼痛患者的延遲記憶得分(1.9±1.3)低于不伴疼痛者(2.5±1.3),差異有統(tǒng)計(jì)學(xué)意義(P=0.02)；疼痛出現(xiàn)在運(yùn)動(dòng)癥狀之前患者的延遲記憶得分(1.2±1.2)明顯低于疼痛出現(xiàn)于運(yùn)動(dòng)癥狀以后的患者(2.2±1.3),差異有統(tǒng)計(jì)學(xué)意義(P=0.015)。 結(jié)論：1.PD患者疼痛的發(fā)生率明顯高于正常人,疼痛在PD患者中很普遍,但PD疼痛缺乏有效的治療,且其生活質(zhì)量較差；2.PD患者與正常人疼痛的機(jī)制可能不同,PD疼痛的發(fā)生與其運(yùn)動(dòng)癥狀之間可能存在相同的機(jī)制；3.抑郁可能是導(dǎo)致PD合并疼痛的獨(dú)立危險(xiǎn)因素；4.骨骼肌疼痛是PD患者最為常見(jiàn)的疼痛類型；PD伴慢性疼痛患者的認(rèn)知功能損害主要表現(xiàn)為延遲記憶障礙。
[Abstract]:Objective:1. To study the clinical features of Parkinson's disease (PD) with chronic pain. The relationship between chronic pain and cognitive function of Parkinson's disease was analyzed. Methods: The clinical data of 343 patients with PD from January 2009 to July 2013 were collected and 150 healthy adults matched with age, sex and culture were randomly selected for the control group. The pain, the visual analogue scale (VAS) and the brief history record (BPI) of the two groups of patients with chronic pain were evaluated and compared with the pain group (50 cases) in the PD with the pain group (50 cases). Patients with primary PD with or without chronic pain were treated with the unified Parkinson's Disease Rating Scale (RRS), Hoehn-Yahr (H-Y) stage, and the Hamilton Rating Scale for Expression, HRSD,24 items. ). The risk factors of chronic pain in PD patients were assessed by the evaluation of the Mini-Mental State Examination (MMSE), the PD Quality of Life Questionnaire (PDQL), the PD Non-motor Symptom Quest (NMSQ), and the like. Analysis of 56 patients with PD with chronic pain from June to December 2012, the type of pain should be judged, and the Montreal Cognitive Assessment (MoCA) evaluation should be conducted. Results:1. The incidence of pain in the PD group was 47.8%, the incidence of pain in the normal control group was 33.3%, the difference was statistically significant (P = 0.003), the most severe pain in the PD patients was mainly in the limbs, and the pain in the control group was concentrated in the head and neck. The scores of PD with chronic pain in daily life, mood, normal work, walking ability, sleep and life were higher than that of normal control group (P = 0.001, 0.001, 0.004, 0.01, 0.003, 0.00). The scores, H-Y stages, HRSD, PDQL, and levodopa-day equivalent doses were statistically significant as compared to the PD non-chronic pain group; the logistic regression analysis showed that only the HRSD score was statistically significant (OR = 1.16 P = 0.0 00):3. The delayed memory score (1.9% 1.3) in patients with PD with chronic pain was lower than those without pain (2.5% 1.3), and the difference was statistically significant (P = 0. 02); the pain in the patient's delayed memory score (1.2% 1.2) was significantly lower than that of the patient (2.2% 1.3) after the exercise symptoms, with a statistically significant difference (P = 0.0 15) Conclusion:1. The incidence of pain in PD patients is higher than that of normal people, and the pain is common in PD patients, but PD pain lacks effective treatment, and the quality of life of PD patients is poor;2. The patients with PD and the normal person's pain The system may be different, and the occurrence of PD pain may be the same as the symptoms of its motion a mechanism;3. depression may be an independent risk that leads to the combined pain of the pd Risk factors;4. Skeletal muscle pain is the most common type of pain in PD patients; the cognitive function damage in PD patients with chronic pain is mainly delayed
【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

【參考文獻(xiàn)】

相關(guān)期刊論文 前5條

1 劉祚周;海馬結(jié)構(gòu)在學(xué)習(xí)記憶和痛覺(jué)調(diào)制中的功能——電生理及神經(jīng)化學(xué)研究[J];第三軍醫(yī)大學(xué)學(xué)報(bào);2003年03期

2 劉潔瓊;張新卿;高勇安;湯哲;陳彪;劉東惠;秦曉明;;輕度認(rèn)知功能障礙患者認(rèn)知功能與內(nèi)顳葉各結(jié)構(gòu)體積的關(guān)系[J];臨床神經(jīng)病學(xué)雜志;2009年01期

3 劉聰慧;俞國(guó)良;;杏仁核在認(rèn)知過(guò)程中的作用[J];生理科學(xué)進(jìn)展;2009年04期

4 季俊霞;江鐘立;賀丹軍;尤永平;萬(wàn)琪;;基底核損傷與額葉損傷對(duì)注意力和短時(shí)記憶的影響[J];中國(guó)康復(fù)醫(yī)學(xué)雜志;2008年04期

5 張紫娟;彭蓉;安星凱;;帕金森病與疼痛[J];中國(guó)疼痛醫(yī)學(xué)雜志;2008年02期

，

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