李蒙燕;郑浩;陈浩博;

• 1:广州市第一人民医院神经内科

摘要(Abstract)：

目的通过临床资料的收集,分析帕金森病患者(Parkinson’s disease,PD)自主神经症状(autonomic symptom,AS)出现的特点、临床异质性分类与AS的关联。方法记录121例PD患者的一般资料,使用帕金森病自主神经症状量表(the scale outcomes in PD for autonomic symptoms,SCOPA-AUT)评估患者的AS;Hoehn-Yahr(H-Y)分级进行病情严重度评级。根据PD异质性分组方法将患者分为:以H-Y分级为标准的早期、中期、晚期组,以病程为标准划分为≤2a、2⁵a及>5a3组;以发病年龄为标准的早发组(≤50岁)、晚发组(>50岁);以性别为标准的男性组、女性组;以运动障碍表现为依据的混合组、震颤组和强直组;比较各亚组间SCOPA-AUT量表评分的差异。结果全组PD患者出现至少一项AS症状的占98.30%,消化系统症状及泌尿系统障碍是出现概率最高,程度最重的AS病变。以H-Y分级为标准的PD亚型及以病程为标准的亚型组内SCOPA-AUT评分比较,各组间差异有统计学意义(P=0.00);以发病年龄、性别及以运动障碍表现为依据分型的PD亚型组内比较,SCOPA-AUT评分组差异无统计学意义(P>0.05);女性较男性在AS症状方面症状较轻。结论 PD患者普遍存在自主神经功能障碍(automomic dysfuction,AD),病情越重,病程越长,AD越重;女性可能是AS的一项保护性因素。

关键词(KeyWords)： 帕金森病;异质性;自主神经功能障碍;H-Y分级;女性

Abstract:

Keywords:

基金项目(Foundation): 广州市医药卫生科技项目,编号:20171A010247

作者(Authors): 李蒙燕;郑浩;陈浩博;

参考文献(References)：

• [1]Braak H,Bohl JR,Muller CM,et al.The staging procedure for the inclusion body pathology associated with sporadic Parkinson disease reconsidered[J].MOV Disord,2006,21(12):2 042-2 051.
• [2]Verbaan D,Marinus J,Visser M,et al.Patient-reported autonomic symptoms in Parkinson disease[J].Neurology,2007,69(4):333-341.
• [3]Valentina A,Antonio C,Valention F,et al.In patient’s with Parkin-son disease,autonomic symptomsare frenquent and associated with other non-motor symptoms[J].Clin Auton Res,2015,25(5):301-307.
• [4]Visser M,Marinus J,Stiggelbout AM,et al.Assess-ment of autonomic dysfunction in Parkinson’disease:the SCOPA-AUT[J].Mov Disorders,2004,19(11):1 306-1 312.
• [5]Winge K.Lower urinary tract dysfuction in patients with parkinsonisom[J].Handb Clin Neurol,2015,130:335-356.
• [6]Isao A,Sadako K.Assessment of voiding dysfunction in Parkinson's disease by the international prostate symptom score[J].J Neurol Neurosurg Psychiatry 2000,68(4):429-443.
• [7]Lemack GE,Dewey RB Jr,Rochrbom CG,et al.Questionnaire-based assessment of bladder dysfunction in patients with mild tomoderate Parkinson's disease[J].Urology,2000,56(2):250-254.
• [8]Donadio V,Incensi A,Piainini C,et al.Skin Nerve Misfolded a-Synuclein in Pure Autonomic Failure and Parkinson Disease[J].Ann Neurol,2016,79(2):306-316.
• [9]孔双艳,田成林.帕金森病自主神经功能障碍的回顾性分析[J].脑与神经疾病杂志,2009,17(4):288-290.
• [10]Hawkes CH,Del Tredici K,Braak H.A timeline for Parkinson’S disease[J].Parkinsonism Relat Disord,2010,16(2):79-84.
• [11]Miao CY,Xie HH,Zhan IS,et al.Blood pressure variability is more important than blood pressure level in determination of end-or-gan damage in rats[J].J Hypenens,2006,24(6):1 125-1 135.
• [12]Haapaniemi TH,Pursiainen V,Korpelainen JT,et al.Ambulatory ECG and analysis of heart rate variability in Parkinson’s disease[J].Neurol Neurosurg Psychi-atry,2001,70(3):305-310.
• [13]Sawada H,Oeda T,Yamamoto K,et al.Diagnostic accuracy of cardiac metaiodobenzylguanidine scintigraphy in Parkinson disease[J].Eur J Neurol,2009,16(2):174-182.
• [14]Daniel G,Stefanie B,Ramona,H,et al.Is reduced myocardial sympathetic innervation associated with clinical symptoms of autonomic impairment in idiopathic Parkinson's disease?[J].J Neurol,2014,261(1):45-51.
• [15]Sakakibara R,Kishi M,Ogawa E,et al.Bladder,bowel and sexual dysfunction in Parkinson’s disease[J].Parkinsons Dis,2011,2011:924 605.
• [16]Bronner G.Sexual problems in Parkinson’s disease:the multidimensional nature of the problem and of the intervention[J].J Neurol Sci,2011,310(1/2):139-143.
• [17]曹辰杰,余舒扬,左丽君,等.帕金森病患者伴发自主神经功能障碍与运动症状和非运动症状相关性的研究[J].中华临床医师杂志(电子版),2013,7(15):6 898-6 903.