女性帕金森病患者经期影响的相关因素分析

目的调查育龄期女性帕金森病(PD)患者受经期影响的患病率及临床特征。方法采用调查问卷、病例对照研究,连续选取自2015年6月~2016年1月我院门诊及天坛医院PD专病门诊发病年龄在50岁以下女性PD患者,记录受经期影响的病例数,分为经期相关组和与经期无关组,分析两组临床的异质性。同时收集两组发病年龄、文化程度、初始症状、病程、有无毒物接触史、家族史、统一PD评定量表第Ⅲ部分(UPDRS-Ⅲ)评分、改良Hoehn-Yahr(H-Y)分级、贝克焦虑量表(BAI)等资料。结果共收集175例女性PD患者,经期受影响者42例,患病率为24%;将经期相关组与经期无关组分别在非经期及经期期间进行比较,非经期期间,两组在发病年龄、BAI方面差异有统计学意义(均P0.05),而在病程、文化程度、有无毒物接触史、家族史、UPDRS-Ⅲ、改良H-Y分级等方面则差异无统计学意义(均P0.05),但在经期期间,两组在发病年龄、UPDRS-Ⅲ、改良H-Y分级、BAI等方面均存在明显统计学意义(均P0.000)。结论女性育龄期PD患者易受经期影响,临床症状恶化,表现为运动症状加重,更易合并焦虑,提示该类患者日常生活能力及生活质量更差,应提醒临床医生的识别。     

女性生殖因素对帕金森病认知及运动功能的影响

目的比较女性帕金森病(PD)患者与健康对照组的生殖特征,分析女性生殖因素对PD认知及运动功能的影响。方法采用前瞻性、病例对照研究,比较113例女性PD组及113例年龄、教育匹配的健康对照组的生殖特征。评估PD患者的认知及运动功能。认知功能包括词语学习、延迟回忆、符号数字、言语流畅、积木测验,运动功能采用统一的PD评分量表(UPDRS)Ⅲ运动部分评分。单因素方差分析手术绝经组与早发自然绝经组、晚发自然绝经组的认知功能及UPDRSⅢ运动评分的差异,对PD生殖因素与认知功能及UPDRS运动评分进行相关分析。结果与健康对照组比较,PD组的绝经年龄小、生育年限短、手术绝经者多(P0.05)。PD患者不同绝经组的认知及运动评分有显著差异(P0.05),与PD晚发自然绝经组比较,手术绝经组、早发自然绝经组的认知功能评分低、UPDRS运动评分高(P0.05)。PD患者的绝经年龄、生育年限与其认知功能呈显著性正相关;绝经年龄与UPDRS运动评分呈显著性负相关(P0.05)。结论女性生殖因素可能与PD发病有关,维持生殖水平的内源性雌激素可能对PD的认知及运动功能均有保护作用。     

吉林市区生活方式环境因素与帕金森病发病的相关因素分析

目的探讨不同临床分型帕金森病(PD)患者的影响因素。方法采用病例对照研究的方法,选取2017-12—2019-12北华大学附属医院、吉林医药学院附属医院、吉林市中心医院确诊的PD患者177例,按照起病类型分为静止性震颤型及运动迟缓型,2组均记录详细年龄、性别、吸烟史、饮酒史、高血压史、糖尿病史、高尿酸血症史、高同型半胱氨酸血症史并进行比较。结果震颤型99例,运动迟缓型76例。震颤型、运动迟缓型帕金森病患者年龄比较,差异无统计学意义(P0.05)。不同吸烟史、饮酒史PD患者临床分型比较,差异无统计学意义(P0.05)。高血压史、糖尿病史与PD患者临床分型比较,差异无统计学意义(P0.05)。高尿酸血症史、高同型半胱氨酸血症史与PD患者临床分型比较,差异无统计学意义(P0.05)。结论帕金森病患者以运动迟缓型发病较多,各相关因素与帕金森病不同临床类型无明显相关性。     

女性紧张性头痛及经期偏头痛影响因素的比较

目的比较女性紧张性头痛(TTH)及经期偏头痛(MM)的影响因素。方法收集104例女性TTH患者(TTH组)及91例MM患者(MM组)的临床资料。采用视觉模拟评分法(VAS)和头痛影响测评量表-6(HIT-6)对其头痛程度、生活质量进行评估,并采用汉密尔顿焦虑(HAMA)、抑郁量表(HAMD)对患者情绪障碍进行测定。结果 TTH组与经期相关19例,累积发病率18.3%;MM组与经期相关59例,累积发病率64.8%。与TTH组比较,MM组发病年龄显著降低,病程、家族史,焦虑、抑郁、重度疼痛、HIT-6(Ⅳ级)、共病的比率,以及HAMA、HAMD评分均显著升高(P0.05~0.01),而文化程度、吸烟、饮酒、职业差异无统计学意义(均P0.05)。无先兆的月经相关性偏头痛(MRM)、无先兆的单纯月经性偏头痛(PMM)及非月经性无先兆偏头痛患者发病年龄、家族史、VAS及HIT-6评分差异有统计学意义(P0.05~0.01)。结论与女性TTH比较,MM发病年龄更轻、病程更长,也更易合并焦虑、抑郁。在不同类型MM中,PMM发病年龄更早,有家族史的比率更高;而MRM的重度疼痛率及HIT-6评分最高。     

不同性别帕金森病患者血尿酸水平的相关性研究

目的研究不同性别帕金森病(PD)患者血尿酸水平的相关影响因素。方法收集72例男性PD患者及56例女性PD患者的临床资料。采取高效液相色谱法检测患者血尿酸水平,分析血尿酸水平与临床资料的相关性。结果相关性分析显示,女性PD患者血尿酸水平与患者年龄、起病年龄呈正相关(r=0.283,P=0.034;r=0.295,P=0.027),与病程、Hoehn-Yahr(H-Y)分级、统一帕金森病评分量表(UPDRS)评分,以及汉密尔顿抑郁量表(HAMD)、汉密尔顿焦虑量表(HAMA)、MMSE、非运动症状问卷(NMS-Quest)评分间无明显相关性(均P0.05);男性PD患者血尿酸水平与UPDRSⅣ评分、HAMD呈负相关(r=-0.249,P=0.035;r=-0.279,P=0.017),与年龄、起病年龄、病程、H-Y分级、UPDRSⅡ、UPDRSⅢ、UPDRS总分,以及HAMA、MMSE、NMS-Quest评分无明显相关性(均P0.05)。男性和女性患者血尿酸水平与左旋多巴等效剂量(LED)及左旋多巴剂量均呈负相关(均P0.05),与多巴胺受体激动剂剂量无关(均P0.05)。结论女性PD患者年龄越大、起病越晚,血尿酸水平越高;男性PD患者治疗并发症越多、抑郁越重,血尿酸水平越低。PD患者血尿酸水平与患者左旋多巴服用剂量呈反比。     

早期帕金森病非运动症状对患者生活质量的影响

目的探讨早期帕金森病(PD)患者非运动症状(NMS)的发病情况及其对患者生活质量的影响。方法选择我院门诊及住院160例早期PD患者为观察组;选取同期门诊就诊的非PD患者100例为对照组。采用帕金森病非运动症状筛查量表对2组的NMS发病情况进行调查;采用帕金森病生活质量问卷(PDQ-39)评估患者生活质量;分析PD患者的NMS的发病情况及其对帕金森病患者生活质量的影响。结果观察组NMS平均(8.1±4.2)分,显著高于对照组(4.9±3.1)分(P0.01);焦虑、抑郁、大便排空不完全感、注意力障碍、失眠、记忆力下降对日常生活有显著的负面影响(P0.05)。结论神经精神症状、自主神经功能障碍、睡眠障碍是PD患者最常见的非运动症状,对帕金森病患者生活质量有显著的负面影响,早期评估和干预非运动症状对提高患者生活质量有重要意义。     

帕金森病相关性疼痛的相关因素及其对生活质量的影响

目的探讨帕金森病(PD)相关性疼痛的相关因素及其对生活质量的影响。方法根据是否伴有疼痛将120例PD患者分为疼痛组(49例)和非疼痛组(71例)。采用PD统一评分量表(UPDRS)和Hoehn-Yahr(H-Y)分级评估患者的严重程度,采用PD生活质量量表-39(PDQ-39)测评其生活质量,用数字评分法(NRS)评估疼痛组患者疼痛程度。采用汉密尔顿抑郁量表(HAMD)、汉密尔顿焦虑量表(HAMA)和MMSE评价患者的焦虑、抑郁及认知情况。结果与无疼痛组比较,疼痛组H-Y分期及UPDRSⅠ、UPDRSⅢ服药后(med-on)、UPDRSⅢ服药前(med-off)、PDQ-39、HAMA、HAMD评分均显著升高(P0.05～0.01)。Spearman相关分析显示,NRS评分与H-Y分级及UPDRSⅠ、UPDRSⅢmed-off、UPDRSⅢmed-on、PDQ-39、HAMA、HAMD评分呈正相关(P0.05～0.01),与年龄、发病年龄、病程、受教育年限及UPDRSⅡ、MMSE评分无相关性(均P0.05)。线性回归分析显示,UPDRSⅡ、HAMA、NRS评分对PDQ-39有显著性影响(均P0.01)。结论 PD相关性疼痛可能与精神活动、运动症状、焦虑抑郁相关。PD相关性疼痛是影响PD患者生活质量的独立预测因子。     

初诊帕金森病患者睡眠质量的性别差异及临床特征分析

目的探讨初诊未服药帕金森病(PD)患者睡眠质量的性别差异及临床特征。方法选取初诊未服药的PD患者259例(其中男性127例,女性132例),收集患者基本临床资料并用PD睡眠量表(PDSS)评估睡眠情况,比较不同性别患者的睡眠情况以及不同运动亚型PD患者睡眠情况的性别差异,并将两组的PDSS评分分别与基本临床资料作相关性分析。结果女性患者PDSS中总体夜间睡眠质量、入睡困难、睡眠维持障碍、夜间遭受梦境困扰、夜间睡眠时出现上肢或下肢的肌肉痛性痉挛、清晨早醒并伴有上肢或下肢疼痛评分及PDSS总分显著低于男性患者(均P0.05)。在震颤为主型PD患者(TD-PD组)中,不同性别患者的教育程度、汉密尔顿焦虑量表(HAMA)、汉密尔顿抑郁量表(HAMD)及PDSS评分差异有统计学意义(均P0.05);在姿势异常步态障碍型PD患者(PIGD-TD组)中,不同性别患者的病程、教育程度、校正蒙特利尔认知评估量表(MoCA)、HAMA评分有显著差异(均P0.05)。TD-PD组男性PDSS中总体夜间睡眠质量、入睡困难、夜尿和清晨早醒并伴有上肢或下肢疼痛评分及总分显著高于女性(均P0.05)。PIGD-PD组男性PDSS中夜间遭受梦境困扰、清晨早醒并伴有上肢或下肢疼痛评分显著高于女性患者(均P0.05)。Spearman相关性分析显示,男性PD患者PDSS评分与年龄、发病年龄、HAMD评分、HAMA评分、PD非运动症状评定量表(PDNMS)评分、改良Hoehn-Yahr(H-Y)分期、统一PD评定量表(UPDRS)第三部分评分呈负相关(均P0.05),与MMSE呈正相关(P0.05);女性PD患者的PDSS评分与HAMD评分、HAMA评分、PDNMS评分、H-Y分期、UPDRS第二部分评分呈负相关(均P0.05)。结论初诊未服药PD患者中女性的睡眠质量较男性更差。     

女性生育特点对帕金森病的影响

目的研究女性帕金森病与其生育期特点的联系。方法132例已婚帕金森病患者与年龄匹配,>45岁且无神经系统疾病、冠心病和高血压的139例健康妇女进行对照比较,两组简易精神状态检测量表评分均≥27分。通过询问帕金森病患者和对照者的月经初潮年龄、绝经年龄及其类型(自然或手术)、累计妊娠时间和绝经前后是否应用雌激素(≥6个月),行t检验验证两组受试者的初潮年龄、绝经年龄、妊娠时间、生育期是否具有均衡性;并通过非条件Logistic回归分析计算95%CI的校正优势比(OR);由χ2检验检出女性帕金森病患者与血浆雌激素水平、初潮年龄以及绝经类型间的关系。结果(1)帕金森病组患者的年龄为41～84岁,平均(64.58±9.42)岁,正常对照组为49～84岁,平均(63.09±8.20)岁,组间差异无显著性意义(t=0.163,P>0.05),两组受试者年龄均衡可比。(2)帕金森病组患者生育期明显短于对照组(OR=0.758,P<0.01),且累计妊娠时间更长(OR=1.079,P<0.01),服用雌激素者罹患帕金森病的风险明显减少(OR=0.201,P<0.01),而帕金森病与月经初潮年龄(OR=0.851,P>0.05)及绝经类型(OR=1.343,P>0.05)无明显相关性。结论帕金森病与血浆雌激素水平的降低有一定相关性,生育期短、累计妊娠时间长的妇女患帕金森病的风险增加。雌激素替代疗法可以降低绝经后妇女罹患帕金森病的风险。     

帕金森病非运动症状在评价帕金森病严重程度中的作用

目的探讨帕金森病(PD)非运动症状(NMS)的发病情况及其在评估帕金森病严重程度中的作用。方法选择我院2010-10—2014-06门诊及住院210例PD患者为观察组;选取同期门诊就诊的非PD患者180例为对照组。采用帕金森病非运动症状筛查量表对2组的NMS发病情况进行调查,分析PD患者的NMS临床特征及其在评估帕金森病严重程度中的作用。结果观察组NMS发生总数为1~23项,平均(11.7±5.3)项,显著高于对照组(P0.01);各项NMS发生率比较,观察组显著高于对照组(P0.01)。分析显示,PD患者NMS发生项数与病程和病情严重程度具有相关性(P0.05)。结论自主神经功能障碍、睡眠障碍、焦虑、抑郁是PD患者最常见的非运动症状,NMS发生总数与PD患者病程及病情严重程度相关,可以作为评价PD严重程度和进展的一项指标。     

Reproductive life characteristics in females affected with Parkinson's disease and in healthy control subjects – a comparative study on Polish population

BackgroundSex and blood level of sex hormones play a key role not only in the susceptibility to develop Parkinson's disease (PD) but also influence the natural course of the disease. The aim of this study was to compare reproductive lifespan events in females affected with PD and in “non-parkinsonian” age matched subjects and to evaluate whether the whole life endogenous oestrogen level is associated with variables describing the course of the disease.Materials and methodsReproductive lifespan, age at menarche, age at menopause, gynaecological interventions and parity were compared in 76 women with idiopathic PD and in the age-adjusted control group of 74 subjects. Affected women underwent neurological and psychological assessment. Data were analysed using Mann–Whitney U Test and Spearman Rank Correlation Test.ResultsWomen affected with PD had a shorter reproductive lifespan and experienced final menstruation earlier than the control group. Early menopause was reported by 24% of the patients and only by 16% of the control subjects. Parkinsonian women reported more commonly the history of surgical menopause. Duration of reproductive lifespan, age at menopause and the type of menopause influenced both motor and cognitive functioning of patients.ConclusionsThere may be a relationship between the lifetime average endogenous oestrogen level and the susceptibility to develop PD. Longer reproductive lifespan resulting in higher “whole life” female sex steroids concentrations may exert a protective effect on central nervous system, resulting in milder course of the disease.     

Age at menopause predicts age at onset of Parkinson's disease.

We investigated the association between age at onset of Parkinson's disease (PD) and fertile life characteristics in 145 women. Linear regression analyses showed a significant correlation between age at PD onset and age at menopause (P = 0.003), between age at PD onset and fertile life duration (P = 0.008), and a nonsignificant correlation between PD onset and cumulative duration of pregnancies (P = 0.23). These results support the possible role of estrogens in PD.     

A comparison of gynecological variables and service use among older women with and without schizophrenia

Gynecological variables and service use were examined in a sample of 65 older women outpatients who had schizophrenia and in a control group of 51 women who were not known to have a psychiatric diagnosis. The groups were similar in their age at menarche and at menopause, use of oral contraceptives, and number of pregnancies and births. The groups differed in their receipt of several gynecological services; women with schizophrenia were less likely to have received mammograms or pelvic examinations and Pap tests or to have ever been prescribed hormone replacement therapy. These results suggest that women with schizophrenia receive fewer gynecological services than other women. Interventions at the patient, provider, and system levels may be needed to address this disparity in service use.     

健身气功锻炼对帕金森病患者的疗效观察

目的探讨健身气功锻炼对帕金森病(PD)患者的临床疗效。方法将41例PD患者随机分为健身气功组23例,对照组18例。2组均给予神经内科基础药物治疗,健身气功组患者在对照组治疗的基础上进行10周健身气功干预,每周5次,每次60min。对两组患者干预前、中、后分别进行起立-走计时(TUG)、单脚闭目站立测试,采用统一帕金森病评定量表-Ⅲ(UPDRS-Ⅲ)、Hoehn-Yahr(H-Y)评分、贝克焦虑量表(BAI)评价运动功能及情绪变化。结果锻炼10周后,健身气功组H-Y分级、UPDRS-Ⅲ评分、BAI评分较治疗前呈降低趋势(P0.05,P0.01),而对照组治疗前后变化无统计学差异(P0.05)。健身气功组TUG计时测试时间在第5周、第10周均较治疗前下降(P0.05),两侧单脚闭目站立测试时间在第5周、第10周均较治疗前延长(P0.05)。结论健身气功锻炼可改善轻中度PD患者运动功能,尤其是患者的平衡能力,对患者的焦虑情绪亦能起到一定程度缓解作用,值得临床推广。     

Hysterectomy, menopause, and estrogen use preceding Parkinson's disease: an exploratory case-control study.

We studied the association of Parkinson's disease (PD) with type of menopause (natural or surgical), age at menopause, and postmenopausal estrogen replacement therapy using a case-control design. We used the medical records-linkage system of the Rochester Epidemiology Project to identify 72 women who developed PD in Olmsted County, MN, during the twenty years 1976-1995. Each incident case was matched by age (+/- 1 year) to a general population control subject. We collected exposure data through review of the complete medical records of cases and control subjects in the system. PD cases had undergone hysterectomy (with or without unilateral oophorectomy) significantly more often than control subjects (odds ratio [OR] = 3.36; 95% confidence interval [CI] = 1.05-10.77). In addition, PD cases had experienced early menopause (< or = 46 years) more commonly than control subjects (OR = 2.18; 95% CI = 0.88-5.39). Finally, PD cases had used estrogens orally or parenterally for at least 6 months after menopause less frequently (8%) than control subjects (14%; OR = 0.47; 95% CI = 0.12-1.85). However, the findings for early menopause and estrogen replacement therapy were not statistically significant. Despite the limited sample size of this exploratory study, we hypothesize that there is an increased risk of PD in conditions causing an early reduction in endogenous estrogen. This hypothesis needs to be confirmed in a larger study.     

Reproductive life milestones in women with Parkinson's disease

Reproductive life milestones were studied in 150 unselected women with idiopathic Parkinson's disease (PD) and in 300 postmenopausal healthy women (PM). Duration of reproductive life was found to be similar in the two groups. The women with PD reported significantly more premenstrual symptoms, fewer deliveries and abortions, and less use of contraception. Time and mode of menopause onset were similar in PD and PM, but the PD women reported significantly more hot flushes, less insomnia, depression, urinary incontinence and dyspareunia, and less recourse to hormone replacement therapy than the PM women. Women diagnosed with PD before the menopause reported more premenstrual symptoms and contraceptive use compared with those with postmenopausal PD onset, as well as a premenstrual worsening of PD symptoms in more than 50% of cases. Our data indicate poor adaptation of neuronal pathways to the hormonal fluctuations of reproductive life in women with PD, supporting the existence of a qualitative relationship between PD and reproductive events.     

Sexual well being in parkinsonian patients after deep brain stimulation of the subthalamic nucleus

OBJECTIVES: To evaluate changes in sexual well being in a group of patients with Parkinson's disease following deep brain stimulation (DBS) of the subthalamic nucleus (STN). METHODS: 31 consecutive patients with Parkinson's disease (21 men and 10 women), bilaterally implanted for DBS of STN, were evaluated one month before and 9-12 months after surgery. Sexual functioning was assessed using a reduced form of the Gollombok Rust inventory of sexual satisfaction (GRISS). Depression (Beck depression inventory) and anxiety (STAI-X1/X2) were also evaluated. Relations between sexual functioning and modifications in the severity of disease (Hoehn and Yahr stage), reduction in levodopa equivalent daily dosage (LEDD), age, and duration of disease were analysed. RESULTS: While no modifications were found in female patients, male patients reported slightly but significantly more satisfaction with their sexual life after DBS of STN. When only male patients under 60 years old were considered, a greater improvement in sexual functioning was found, though still small. Modifications in depressive symptoms and anxiety, as well as duration of the disease, reduction in LEDD, and improvement in the severity of disease, showed no relation with changes in sexual functioning after DBS of STN. CONCLUSIONS: DBS of STN appears to affect sexual functioning in a small but positive way. Male patients with Parkinson's disease, especially when under 60, appeared more satisfied with their sexual well being over a short term follow up period.     

Menopause and menarche in patients with primary blepharospasm: an exploratory case-control study

We studied the relationships between blepharospasm (BSP) and menopause/menarche in female patients with primary BSP (n = 83) and age-matched healthy (n = 83) and disease controls (n = 83). BSP patients and matched controls had comparable age at menopause, and there was no correlation between age at menopause and age at BSP onset. Thus, menopause probably exerts no significant influence on the age-dependent development of BSP. BSP cases tended to have a later menarche than either group of controls. The association was independent of age, disease duration and education level. Because the higher the age at menarche, the higher the age at BSP onset, later menarche was unlikely to be a risk factor for BSP. Rather, the two conditions may share pathophysiologic mechanisms, for example minor abnormality of neurotransmitter systems controlling both the motor system and the maturation of the hypothalamic-pituitary-gonadal axis responsible for the onset of puberty.     

Reproductive factors and clinical features of Parkinson's disease

BackgroundLiterature suggests that sex steroid hormones may modify the risk for Parkinson's disease (PD). We investigated the potential effect of reproductive factors on the clinical features of idiopathic PD (IPD) patients.MethodsAll IPD female patients admitted to and evaluated at our Institute over a 12-month period were included in the present cross-sectional study. We investigated the effect of the following parameters by multivariate linear regression analysis: age at menarche, age at menopause, length of fertile life, duration of exposure to endogenous estrogens and cumulative length of pregnancies, use of contraceptives and hormonal replacement therapy.ResultsIn total, 579 patients were evaluated and 497 reported menopause before PD onset. In this population, age at PD onset was positively associated with age at menarche and at menopause, length of fertile life and duration of estrogen exposure. Moreover, UPDRS motor score was inversely associated with age at menopause, length of fertile life and duration of estrogen exposure. Increasing age at menarche was also associated with predominant resting tremor at PD onset. In models refitted on patients with early PD (disease duration <5 years; N = 226) all the associations found were confirmed. The relationship between surrogates of estrogen exposure and UPDRS motor score actually became more significant.ConclusionsOur observations support the concept that hormonal exposure of the nigro-striatal network during life may influence its susceptibility to degenerative stimuli in later life, but the association does not seem to be unique? unidirectional. In particular, increased severity of PD signs correlates with shorter duration of estrogen exposure. The underlying mechanisms need to be clarified.     

Case-control study of estrogen receptor gene polymorphisms in Parkinson's disease.

We investigated the association of Parkinson's disease (PD) with two estrogen receptor gene polymorphisms. In a sample of 319 unrelated PD cases and 196 control subjects including both men and women, we observed no association of PD with the estrogen receptor genotypes derived from XbaI and PvuII digests. Analyses restricted to women or to cases and controls of European origin yielded similar findings. Further analyses stratified by age at examination or by family history did not show associations. While exogenous and endogenous estrogen may modify the risk of PD in women, the two estrogen receptor gene polymorphisms considered here do not seem to contribute to PD susceptibility.