帕金森病患者的非运动症状对其生活质量的影响

摘要

目的 探讨帕金森病(PD)患者及不同亚群生活质量(QOL)的影响因素,分析非运动症状(NMS)的具体影响.方法 用统一PD评定量表第Ⅲ、Ⅴ部分(UPDRS-Ⅲ、H-Y分级)评定185名原发性PD患者的运动症状,用PDNMS筛查问卷(NMSQ)、汉密尔顿抑郁量表(HAMD)、汉密尔顿焦虑量表(HAMA)、PD睡眠量表(PDSS)和蒙特利尔认知测验(MOCA)评定NMS,用36条简化医疗结局调查问卷(SF-36)评价QOL.采用逐步多元线性回归分析探讨PD患者QOL的影响因素和NMS的具体作用.结果 PD患者SF-36各维度分值均较健康同龄老人下降.相关分析显示,SF-36总分与H-Y分级、UPDRSⅢ、HAMA、HAMD及NMSQ分值成负相关,与PDSS评分成正相关,与HAMD的6个因子(除日夜变化)和NMSQ的9个症状群(除性功能)均显著负相关.回归分析显示,UPDRSⅢ和强直分能解释SF-36总分变化的21.6%,加入各NMS量表分值后,NMSQ能单独解释SF-36总分变化的21.5%;引入HAMD和NMSQ的细项后,绝望感、泌尿道症状、认知损害、体质量减轻、和阻滞症状能解释SF-36总分变化的35.8%;≤65岁、66岁～75岁和＞75岁患者的QOL影响因素不同.结论 NMS中的绝望感、泌尿道症状、认知、体质量减轻、阻滞症状以及运动障碍中的强直型对QOL的影响较大,且导致不同年龄段患者QOL下降的因素不同.故需重视上述NMS的诊治,以改善PD患者QOL.%Objective To investigate factors associated with the quality of life ( QOL ) in patients with PD, especially the relationship between QOL and non-motor symptoms ( NMS ). Methods 185 PD patients were analyzed with UPDRS-IH and H-Y for assessing their motor symptoms, meanwhile, the PDNMS Questionnaire ( NMSQ ), Hamilton Depression Scale ( HAMD ), Hamilton Anxiety Scale ( HAMA ), Parkinson Disease Sleep Scale ( PDSS ) and Montreal cognitive assessment ( MOCA ) were used for their NMS. The QOL was assessed with Medical Outcomes Study 36-Item Short-Form Health Survey ( SF-36 ). Multiple linear regression analyses were used todetermine which variables were strongly associated with QOL. Results Patients with PD had lower scores on all dimensions of SF-36, comparing with those of the healthy old ones. The total score of SF-36 had negative associations with scores of H-Y stages, UPDRSIH , HAMA, HAMD and NMSQ, and a positive one with PDSS. Multiple stepwise regression analysis showed that scores of UPDRSIH and rigidity could explain 21. 6% of the variance of SF-36 total score. When non-motor scales were included in the model, NMSQ alone could explain 21. 5% . After we instead the HAMD and NMSQ with their subdomains, feelings of despair, urinary symptoms, cognitive impairment, weight loss and blocking accounted for 35. 8% of the variance. For patients below 65 years old, 66 ~75 years old and older than 75years old, predictors were different. Conclusion The NMS such as feelings of despair, urinary symptoms, cognitive impairment, weight loss and blocking are the more important predictors of deterioration in QOL in PD patients. Given the patients traits, treatments aiming to these aspects should be individualized.