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伴有快动眼睡眠行为障碍帕金森患者的震颤特征及多巴反应性
引用本文:乔迪,伊新艳,张璇.伴有快动眼睡眠行为障碍帕金森患者的震颤特征及多巴反应性[J].中国神经精神疾病杂志,2017(9):520-525.
作者姓名:乔迪  伊新艳  张璇
作者单位:1. 济南大学山东省医学科学院医学与生命科学学院 济南 250022;山东省医学科学院附属济宁市第一人民医院神经内科;2. 济宁医学院附属医院神经内科;3. 山东省医学科学院附属济宁市第一人民医院神经内科
摘    要:目的研究伴与不伴快动眼睡眠行为障碍(rapid eye movement sleep behavior disorder,RBD)的帕金森病(Parkinson disease,PD)患者的震颤特征及多巴反应性。方法根据2014年国际睡眠障碍分类第三版RBD的临床最低诊断标准,本研究采用RBD筛查问卷(RBD screening questionnaire,RBDSQ)量表来诊断临床很可能RBD(clinically probable RBD,cpRBD),将PD患者分为伴有cpRBD的PD(PD+cpRBD)与不伴有cpRBD的PD(PD-cpRBD)两组。对入组患者进行一般资料的收集,采用修订的H-Y分级、统一帕金森评分量表3.0版运动检查部分(UPDRS-Ⅲ)、MDS-UPDRS震颤量表对患者的运动功能进行评估,并且分别对两组患者首发侧肢体姿势性震颤、动作性震颤及静止性震颤的幅度进行评分,比较两组患者一般资料及震颤特征的差异性。对所有患者行急性左旋多巴冲击试验,将两组患者UPDRS-Ⅲ及MDS-UPDRS震颤量表评分最大改善率进行比较。结果共纳入42例伴有震颤的PD患者,PD+cpRBD组19例,PD-cpRBD组共23例,两组患者在性别、年龄、发病年龄、病程、关期UPDRS-Ⅲ评分及H-Y分级方面均无明显差异(P0.05)。与PD-cpRBD组相比,PD+cpRBD组关期震颤评分明显增高(t=2.379,P=0.022),震颤症状由首发侧肢体进展至对侧肢体的时间短(u=-2.133,P=0.033),首发侧肢体静止性震颤幅度大(u=-2.956,P=0.003),动作性震颤幅度大(u=-2.657,P=0.008)。口服左旋多巴/苄丝肼(200/50 mg)后,PD-cpRBD组的UPDRS-Ⅲ及震颤评分最大改善率均明显高于PD+cpRBD组(UPDRS-Ⅲ最大改善率u=-3.134,P=0.002;震颤评分最大改善率t=-3.189,P=0.003)。结论本研究表明,伴有cpRBD的PD患者震颤程度相对较重,以静止性震颤和动作性震颤为主,由首发侧肢体进展至对侧肢体的时间相对较短,对左旋多巴的反应性较差。

关 键 词:帕金森病  快动眼睡眠行为障碍  震颤

Clinical features of Parkinson tremor with rapid eye movement sleep behavior disorder
QIAO Di,YI Xinyan,ZHANG Xuan.Clinical features of Parkinson tremor with rapid eye movement sleep behavior disorder[J].Chinese Journal of Nervous and Mental Diseases,2017(9):520-525.
Authors:QIAO Di  YI Xinyan  ZHANG Xuan
Abstract:Objective To investigate clinical features of tremors in PD patients with rapid eye movement sleep behavior disorder (RBD) and their response to medication. Methods PD patients were divided into PD with clinically possible (cp) RBD (PD+cpRBD) and PD without cpRBD (PD-cpRBD) according to RBDSQ scale. Hoehn & Yahr (H-Y) grade ,UPDRS-Ⅲ scale and MDS-UPDRS tremor scale were used to evaluate the motor function of the patients and amplitude of rest, kinetic and postural tremors of the first affected limbs. The re-sults were compared between these two groups including the features of the general information and tremor as well as the maximal improvement rate of UPDRS-Ⅲ and MDS-UPDRS tremor scores to acute levodopa chal-lenge test. Results A total of 42 PD patients with tremors were enrolled in this study, including 19 patients in PD+cpRBD group and 23 patients in PD-cpRBD group. There was no significant difference in sex, age, age of onset, duration of disease, UPDRS-Ⅲ score and H-Y grade between two groups (P>0.05). The tremor scores of the "off" state were significantly higher in PD+cpRBD group than in PD-cpRBD group (t=2.379,P=0.022). Compared with PD-cpRBD group, the progression of tremor from one side to other side was faster(u=-2.133,P=0.033)and the amplitude scores of rest and kinetic tremors were higher in PD+cpRBD group (rest tremor :u=-2.956,P=0.003;kinetic tremor:u=-2.657,P=0.008). The maximal improvement rate of UPDRS-Ⅲ and tremor score was significantly higher in PD-cpRBD group than in PD+cpRBD group after taking levodopa/ benserazide (200/50 mg) (UPDRS-Ⅲ:u=-3.134,P=0.002;tremor score: t=-3.189,P=0.003). Conclusion The present study has demonstrated severe tremors especially rest and kinetic tremors and poor response to levodopa in PD patients with cpRBD.
Keywords:Parkinson's disease  rapid eye movement sleep behavior disorder  tremor
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