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帕金森病伴慢性疼痛的临床调查分析
引用本文:陆丽霞,周明珠,吴佳英,刘振国.帕金森病伴慢性疼痛的临床调查分析[J].中华神经科杂志,2009,42(8).
作者姓名:陆丽霞  周明珠  吴佳英  刘振国
作者单位:上海交通大学医学院附属新华医院神经科,200092
基金项目:教育部留学回国人员科研启动基金,上海市教育委员会资助项目,上海市浦江人才计划,上海市科学技术委员会上海-飞利浦研究与发展基金合作基金 
摘    要:目的 初步研究帕金森病(PD)患者伴慢性疼痛的发生与分布情况、与疾病发展的关系以及对生活质量的影响.方法 对113例原发性PD患者进行视觉模拟评分法(VAS)、简易疼痛量表(BPI)、统一PD评分量表(UPDRS)、Hoehn-Yahr(H-Y)分期、汉密尔顿焦虑量表(HAMA)、汉密尔顿抑郁量表(HRSD)、匹兹堡睡眠质量指数(PSQI)等评估.将患者分为无疼痛组、PD相关慢性疼痛组及非PD相关慢性疼痛组,其中PD相关慢性疼痛组再分为直接相关组和间接相关组.对各组进行分析比较.结果 PD相关慢性疼痛的发生率为42.5%(48/113).与无疼痛组相比,PD相关慢性疼痛组患者的起病早、病程长,且UPDRS Ⅲ评分、H-Y分期、HRSD、HAMA分值以及左旋多巴剂量均高于无疼痛组,差异均具有统计学意义;PD相关慢性疼痛组患者与非PD相关慢性疼痛组相比,其起病年龄(57.4±9.6与65.9±8.7,t=-2.596,P=0.012)、HRSD(12.9±7.9与8.7±3.7,t=2.605,P=0.014)以及疼痛强度VAS(61.6±25.9与38.0±30.1,U=-2.290,P=0.022)差异具有统计学意义.对PD直接疼痛及间接疼痛相关组的BPI 7项指标进行比较,除行走与交流能力外,其余5项指标的分值在直接相关组更高,两者差异具有统计学意义.结论 疼痛在PD患者中很普遍,其中绝大多数为PD相关慢性疼痛,患者起病早且生活质量较差.

关 键 词:帕金森病  疼痛  生活质量  疼痛测定

Clinical study on chronic pain of Parkinson' s disease
LU Li-xia,ZHOU Ming-zhu,WU Jia-ying,LIU Zhen-guo.Clinical study on chronic pain of Parkinson' s disease[J].Chinese Journal of Neurology,2009,42(8).
Authors:LU Li-xia  ZHOU Ming-zhu  WU Jia-ying  LIU Zhen-guo
Abstract:Objective To assess the prevalance and distribution of pain in Parkinson' s disease (PD) patients, and to describe the relationship between pain and development of disease and its impact on the quality of life. Methods 113 PD patients were assessed with Visual Analog Scale (VAS), Brief Pain Inventory (BPI), Unified Parkinson' s Disease Rating Scale (UPDRS), Hoehn-Yahr Scale (H-Y), Hamilton Anxiety and Depression Scale (HRSD, HAMA) and Pittsburgh Sleep Quality Index (PSQI). Patients were divided into no pain group, PD-pain group and non-PD-pain group. PD-pain group was divided into PD-pain direct group and PD-pain indirect group. And statistical analysis was performed for each group. Results The incidence of PD-pain was 42. 5% (48/113). And compared with no pain group, PD-pain group had earlier age at onset of disease, longer duration, higher HAMA, HRSD, UPDRS and H-Y score, higher daily L-dopa dose, with statistical significance. Compared with non-PD pain group, the differences in the onset of age (57.4±9.6 vs 65.9±8.7, t= -2.596, P =0.012), HRSD(12. 9±7.9 vs 8.7±3.7, t =2.605, P=0.014) and VAS (61.6±25.9 vs 38.0 ± 30. 1, U = -2.290, P =0.022) were also statistically significant. BPI was different between PD-pain direct group and PD-pain indirect group except normal work and relations with other people. Conclusion Pain is frequent in Parkinsonian population. Most pain was chronic and related to PD (PD-pain). These patients always have earlier onset age and poorer quality of life.
Keywords:Parkinson disease  Pain  Quality of life  Pain measurement
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