帕金森病患者冻结步态的危险因素及对生活质量的影响

目的：调查帕金森病(PD)患者冻结步态(FOG)的相关危险因素及对生活质量的影响.方法于2014年1月~2016年1月,对我院神经科门诊就诊的 PD 患者,以问卷的方式,调查患者的一般情况、运动症状、非运动症状和治疗情况,分析 PD 患者 FOG 的相关影响因素及其对生活质量的影响.结果共纳入107例符合条件的 PD 患者,平均发病年龄(59．07±10．46)岁,平均年龄(64．29±9.77)岁,病程2．00~8．00年,中位值4．00年.64例(59．8％)患者出现 FOG,其中男37例(57．8％).与未出现 FOG 的 PD 患者比较,FOG 患者病程长、UPDRS－Ⅱ评分高、“开”期 UPDRS－Ⅲ评分高、“开”期改良 Hoehn& Yahr 分级(H－Y 分级)高、症状波动和剂峰异动症多见、Epworth 嗜睡评分量表(ESS)评分高、快速动眼睡眠行为异常问卷(香港版)(RBDQ－HK)评分高、Beck 抑郁量表(BDI)评分高,差异均有统计学意义(P ＜0．05).调整性别和调查时年龄后,多因素 Logistic 回归分析发现病程长1．12(1．01~1．25),P ＝0．034]、H － Y 分级高4．13(1．90~8．98),P ＜0．001]、统一 PD 评分量表(UPDRS)－Ⅱ评分高1．23(1.12~1．35),P ＜0．001]、UPDRS－Ⅲ评分高1．06(1．03~1．09),P ＜0.001]、症状波动3．98(1．68~9．43),P ＝0．002]、剂峰异动症10．71(1．35~85．23),P ＝0．025]、RBDQ－HK评分高1．03(1．00~1.60),P ＝0．023]和 BDI 评分高1．08(1．03~1．14),P ＝0．004]等因素与 FOG 显著相关.同时,合并 FOG 患者 PDQ－39总分更高,除社会支持外,FOG 对其他维度均存在显著影响(P ＜0．05).结论 FOG在 PD 患者中十分常见,病程、疾病严重程度、症状波动、剂峰异动症、RBD 和抑郁状态可能是 PD 患者发生 FOG 的独立危险因素,FOG 可显著降低 PD 患者的生活质量.

Freezing of gait in Parkinson disease:the risk factors and influence on the quality of life

Objective To investigate the risk factors of freezing of gait (FOG)in Parkinson disease (PD)and the influence of FOG on quality of life in PD patients.Methods The PD patients from outpatient settings in Department of Neurology were recruited from January 2014 to January 201 6.We investigated demographic characteristics,motor symptoms,non- motor symptoms and treatments re-lated to PD by physical examination and questionnaire survey,and compared the clinical characteristics and quality of life between with and without FOG in PD patients.Results Totals of 107 patients were in-cluded .The age at onset was (59.07±10.46)years and the age was(64.29±9.77)years.PD duration was 2.00~8.00 years,and the median value was 4.00 years.There were 64 (59.8%)patients with FOG.The patients with FOG consisted of 37(57.8%)male.Compared with the patients without FOG,the PD pa-tients with FOG have longer duration,higher UPDRS - Ⅱ,UPDRS - Ⅲ,and H - Y scores,more motor fluctuations and peak - dose dyskinesia,higher Epworth Sleepiness Scale(ESS)scores,higher REM Sleep Behavior Disorder Questionnaire- Hong Kong (RBDQ- HK)scores and higher Beck De-pression Inventory (BDI)scores (P < 0.05).After adjusting by sex and age ,the multiple logistic re-gression analysis showed that FOG was correlated with longer duration 1.12(1.01~1.25),P = 0.034], higher H-Y scores 4.13(1.90~8.98),P < 0.001],higher UPDRS parts Ⅱ1.23(1.12~1.35),P <0.001]and Ⅲ1.06(1.03 ~1.09),P < 0.001],the presence of motor fluctuations 3.98(1.68~9.43), P = 0.002]and peak-dose dyskinesia 10.71 (1.35 ~85.23),P = 0.025],higher RDBQ- HK scores 1.03(1.00~1.60),P = 0.023]and higher BDI scores 1.08(1.03 ~1.14),P = 0.004)].The PD pa-tients with FOG had higher PDQ-39 total score,and had significantly worse quality of life in almost all domains of the PDQ-39.Conclusions FOG is very common in PD patients.The duration of disease,se-verity of disease,motor fluctuation,peak-dose dyskinesia,RBD and depression may be the independent predictors of the PD patients with FOG and FOG can markedly deteriorate the quality of life in PD pa-tients.