帕金森病抑郁的临床特征、影响因素及治疗

目的探讨帕金森病(PD)合并抑郁患者的临床特征、影响因素及治疗,为临床治疗PD提供进一步依据。方法统计81例PD患者帕金森病抑郁(PDD)发病率,比较PDD组与PD非抑郁(PDND)组年龄、病程、统一PD评定量表(UPDRS)评分、性别、Hoehn-Yahr分期、临床分型的差异及汉密尔顿抑郁量表(HAMD)因子分差异。比较采用抗PD药物合并抗抑郁药与单纯使用抗PD药物治疗PDD 30天后UPDRS及HAMD评分的变化。结果81例PD患者中52例并发抑郁,其中轻度抑郁31例(59.6%),中重度抑郁21例(40.4%)。震颤为主型抑郁发生率44.4%,强直为主型抑郁发生率为69.8%。UPDRS分值越高、Hoehn-Yahr分期越高、女性、强直为主型更容易合并抑郁。PDD主要表现在焦虑/躯体化、认识障碍、阻滞、睡眠障碍及绝望感方面。抗PD药物合并抗抑郁药治疗能显著降低患者的UPDRS及HAMD评分。结论PD合并抑郁比较常见,以轻度抑郁为主,UPDRS分值越高、Hoehn-Yahr分期越高、女性、强直为主型更容易合并抑郁。治疗上使用抗PD药物联用抗抑郁药优于单纯抗PD药物。

Clinical feature,influence factor and treatment of Parkinson disease with depression

Objective To investigate the clinical characteristics and influencing factors of Parkinson disease(PD) with depression(PDD),and to provide a better treatment for the disease.Methods Depressive states of 81 PD patients were evaluated with Zung Self-rating depressive scale(SDS) and Hamilton depression scale(HAMD).Meanwhile the seven factors scores of HAMD were recorded.Unified PD rating scale(UPDRS) and Hoehn-Yahr stages were used to evaluate the symptom severity of PD and the clinical type were decided:tremor type and rigidity type.According to SDS and HAMD,all patients were divided into two groups:PDD group and nondepressed PD(PDND) group.The differences of gender,age,course,UPDRS scores,Hoehn-Yahr stages and clinical type were compared between two groups.UPDRS and HAMD scores of PDD were recorded after 30 days in the patients who were administrated anti-Pakinson drugs accompanied with antidepressants or anti-Pakinson drugs alone.Results Fifty-two(64.2%) patients of 81 patients were PDD patients.Among these 52 patients,31(59.6%) patients were light depression,21(40.4%) patients were moderate and severe depression.The rate of depression in tremor type was 44.4% and that of rigidity type was 69.8%.UPDRS scores of PDD group were higher than those of PDND group.Anxiety/somatization,cognitive disturbance,blockage,sleep disorder and feeling of desire were the main characters of PDD.The patients who had higher UPDRS scores,higher Hoehn-Yahr stages were female,rigidity type had higher risk of attack of depression,and the difference was significant.UPDRS score and HAMD score of PDD patients who were given anti-Pakinson drugs accompanied with antidepressants decreased greatly than the patients who were given anti-Pakinson drugs only.Conclusion Depression is a very common psychological obstacle in PD patients,and majority is light depression.Female,rigidity type,severe PD patients have a higher risk of attack of depression.Anti-Parkinson drugs accompanied with antidepressants used to treat PDD decrease UPDRS and HAMD scores significantly and improve the clinical symptom compared to anti-Parkinson drugs only.