早期帕金森病患者快速眼动睡眠期行为障碍研究

摘要

目的 探讨早期帕金森病患者快速眼动睡眠期行为障碍发生情况,以及帕金森病运动症状、非运动症状和快速眼动睡眠期行为障碍特点.方法 共60例原发性帕金森病患者,采用统一帕金森病评价量表第二和第三部分(UPDRSⅡ和UPDRSⅢ)以及Hoehn-Yahr分期评价帕金森病非运动症状和运动症状,蒙特利尔认知评价量表评价认知功能,汉密尔顿焦虑量表和汉密尔顿抑郁量表评价焦虑和抑郁症状;中文版快速眼动睡眠期行为障碍筛查量表判断是否伴快速眼动睡眠期行为障碍,Epworth嗜睡量表(ESS)评价白天过度嗜睡程度;多导睡眠图监测睡眠障碍特征,包括下颌位相性肌电活动密度和快速眼动睡眠期肌肉失弛缓.结果 60例帕金森病患者中42例(70％)伴快速眼动睡眠期行为障碍(PD+ RBD组),多导睡眠图监测其异常行为主要表现为上肢伸展抓握、肢体震颤抽搐、发笑、喊叫和怒骂等非暴力动作,仅2例出现暴力击打、蹬踢等异常行为.PD+ RBD组患者年龄(P=0.024)、病程＞8年比例(P=0.000)、UPDRSⅡ(P=0.005)和UPDRSⅢ(P=0.001)评分、Hoehn-Yahr分期2级比例(P=0.007)、焦虑障碍(P=0.044)和抑郁障碍(P=0.001)比例,以及下颌位相性肌电活动密度(P=0.000)和快速眼动睡眠期肌肉失弛缓比例(P=0.000)均高于对照组,其中,PD+ RBD组有16例(38.10％)快速眼动睡眠期行为障碍症状早于帕金森样症状5.20(3.91,6.51)年.结论 年龄大、病程长、运动症状和非运动症状严重的帕金森病患者易伴发快速眼动睡眠期行为障碍,快速眼动睡眠期行为障碍可能是帕金森病的早期表现.多导睡眠图监测对早期帕金森病伴快速眼动睡眠期行为障碍的诊断有重要参考价值.%Objective To investigate the incidence,occurrence time and electrophysiological characteristics of rapid eye movement behavior disorder (RBD) in patients with early Parkinson's disease (PD),and the characteristics of motor symptoms and non-motor symtoms (NMS).Methods Sixty PD patients were divided into PD + RBD group (N =42) and control group (N =18) according to whether they were complicated with RBD or not.Unified Parkinson's Disease Rating Scale (UPDRS) Ⅱ and Ⅲ,HoehnYahr Stage,Montreal Cognitive Assessment (MoCA),Hamilton Anxiety Rating Scale (HAMA),Hamilton Depression Rating Scale (HAMD),RBD Screening Questionnaire (RBDSQ),Epworth Sleepiness Scale (ESS) and polysomnography (PSG) were used in 60 patients.Results Among 60 patients,42 (70％) were accompanied by RBD.PSG showed that PD + RBD patients mainly presented upper limb stretching and gripping,body twitching,laughing,shouting,cursing and other non-violent actions,except 2 cases presented violent actions,such as hitting,kicking,etc.In PD + RBD group,the age was older (P =0.024),duration was longer (P =0.000),and UPDRS Ⅱ (P =0.005),UPDRS Ⅲ (P =0.001),the scale values of Hoehn-Yahr Sotage 2 (P =0.007),anxiety (P =0.044) and depression (P =0.001) ratio were all higher than control group.There were significant differences in density of mandible myoelectric activity (P =0.000) and ratio of rapid eye movement (REM) without atonia (P =0.000) between 2 groups.In PD + RBD group,16 patients (38.10％) had symptoms of RBD,earlier than PD occurred 5.20 (3.91,6.51) years.Conclusions PD patients with older age,longer duration,more severe motor symptoms and non-motor symptoms were more likely to be accompanied by RBD.The severity of RBD in PD patients accompanied with RBD is higher than that in PD without RBD.RBD may be the early manifestation of PD.PSG has important value in the diagnosis of PD with RBD.