帕金森病冻结步态的临床特点及相关影响因素

摘要

目的 探讨帕金森病(PD)冻结步态(FOG)的临床特点和影响因素.方法 随机收集自2016年9月至2018年5月在徐州医科大学附属医院神经内科就诊的106例PD患者的临床及相关量表资料,根据FOG量表(FOG-Q)将其分为PD不伴FOG组(PD对照组,59例)与PD伴FOG组( PD+FOG组,47例).对两组资料进行对比分析.结果 本研究对象中PD伴FOG的发生率为44.3%. PD+FOG组和PD对照组的性别、年龄、MMSE、蒙特利尔认知评估量表(MoCA)、汉密尔顿焦虑量表、爱泼沃斯嗜睡量表等差异均无统计学意义(均P＞0.05). PD+FOG组的病程、汉密尔顿抑郁量表、39项PD调查表、快速动眼期睡眠行为障碍筛查量表、Hoehn-Yahr(H-Y)分期、统一PD评定量表中运动检查部分( UPDRSⅢ)等均高于PD对照组(均P＜0.05).在MMSE子项目中,PD+FOG组的记忆力、回忆力得分低于PD对照组(均P＜0.05).在MoCA子项目中,PD+FOG组的视空间与执行能力、命名和语言得分低于PD对照组(均P＜0.05).单因素及 Logistic 回归分析结果显示,病程和H-Y分级均为PD患者发生FOG的影响因素(均P＜0.05).结论 FOG为PD患者中晚期常见的异常步态. PD伴FOG的患者在抑郁、生活质量、睡眠质量较PD不伴FOG程度重,认知受损则以记忆、回忆、命名、语言及视空间与执行能力方面突出.病程的延长和高H-Y分期为PD患者伴发FOG的影响因素.%Objective To explore the clinical features and affect factors of Parkinson’s disease ( PD) with freezing of gait (FOG).Methods The clinical and related data of 106 patients with PD who were treated in the neurology department of the Affiliated Hospital of Xuzhou Medical University from September 2016 to May 2018 were collected.According to the FOG questionnaire ( FOG-Q), the subjects were divided into PD without FOG group (PD-FOG group, 59 cases) and PD with FOG group ( PD+FOG group, 47 cases).The clinical data of the two groups were compared and analyzed.Results The incidence of PD with FOG in this study was 44.3%.There were no significant differences in gender , age, MMSE, Montreal cognitive assessment scale ( MoCA), Hamilton anxiety scale, Powosi sleepiness scale between PD +FOG group and PD-FOG group (all P＞0.05).The scores of Hamilton depression scale, PD questionnaires-39, rapid eye movement sleep behavior disorder screening scale , Hoehn-Yahr (H-Y) stage, unified PD rating scale-Ⅲ(UPDRSⅢ) in the PD+FOG group were higher than those in the PD-FOG group (all P＜0.05).In the MMSE subproject, the scores of memory and recall items in the PD +FOG group were statistically lower than those in the PD-FOG group (all P＜0.05).In the MoCA subproject, The PD+FOG group had lower visual space and execution ability , naming, and language scores than the PD-FOG group (all P＜0.05). Univariate and Logistic regression analysis showed that the course of disease and H -Y grading were risk factors of the occurrence of FOG in PD patients (all P＜0.05).Conclusions FOG is a common abnormal gait in the middle and late stage of PD patients.PD patients with FOG are more likely to suffer from depression , lower quality of life and sleep than those without FOG.Cognitive impairment is more prominent in memory , memory, naming, language, visual space and executive ability.The duration of disease and high H-Y staging are risk factors for PD patients with FOG, which might aggravate the progression of the disease.