【摘要】 目的探讨伴快速眼动睡眠行为障碍(RBD)帕金森病(PD)患者的临床特点,及自主神经功能变化。方法收集2016年2月至2018年2月就诊于河北医科大学第一医院神经内科的102例PD患者。根据病史及多导睡眠图(PSG)结果将患者分为PD伴RBD组和PD不伴RBD组。比较两组患者统一帕金森病评定量表第3部分(UPDRS-Ⅲ)、Hochn-Yahr(H-Y)分级、汉密尔顿焦虑量表14项(HAMA-14)和汉密尔顿抑郁量表24项(HAMD-24)、匹兹堡睡眠指数量表(PSQI)、简易智能精神状态检查量表(MMSE)、蒙特利尔认知评估量表(MoCA)、自主神经症状量表(SCOPA-AUT)、皮肤交感反应(SSR)检测的差别。结果 102例PD患者中PD伴RBD组54例,PD不伴RBD组48例。与PD不伴RBD组相比,PD伴RBD组病程明显延长,H-Y分级、UPDRS-Ⅲ、HAMA-14、HAMD-24、PSQI评分明显增高(均P<0. 05),MoCA总评分、视空间与执行功能、语言功能评分均降低(均P<0. 05)。PD伴RBD组SCOPA-AUT量表总分及消化、泌尿、心血管、体温调节系统得分较PD不伴RBD组增高(均P<0. 05),PD伴RBD组SSR异常率高于PD不伴RBD组(85. 2%比62. 5%,P<0. 05),潜伏期延长[中位数(四分位数间距):1. 35(0. 46)s比1. 27(0. 15)s,P<0. 05],波幅下降[中位数(四分位数间距):1. 34(2. 21)mV比2. 87(0. 97)mV,P<0. 05]。PD伴RBD组出现自主神经功能障碍的风险更高(OR=3. 450,95%CI:1. 332～8. 933)。结论伴RBD的PD患者病程长,运动症状和情绪、睡眠、认知功能、自主神经功能方面的非运动症状均较不伴RBD的PD患者更为明显,PD伴有RBD者出现自主神经功能障碍的风险更高。更多还原

【Abstract】 Objective To investigate the clinical characteristics and autonomic dysfunction in patients with Parkinson’s discase(PD) and rapid eye movement sleep behavior disorder(RBD).Methods The general information of 102 patients with PD in the neurology department of the first hospital of Hebei medical university from February 2016 to February 2018 were collected.Patients were divided into PD with RBD group and PD without RBD group by medical history and results of polysomnogram(PSG).The motor and non-motor symptoms,as well as autonomic dysfunction were assessed by Unified Parkinson’s disease rating scale part Ⅲ(UPDRS-Ⅲ),Hochn-Yahr(H-Y) stage,Hamilton anxiety scale(HAMA-14),Hamilton depression scale(HAMD-24),Pittsburgh sleep index scale(PSQI),mini-mental state examination(MMSE),Montreal cognitive assessment scale(MoCA),scale for outcomes in PD-autonomic(SCOPA-AUT) and skin sympathetic response(SSR),differences between the two groups were analyzed.Results There were 54 cases in the PD with RBD group and 48 cases in the PD without RBD group.Compared with PD without RBD group,the course of patients in the PD with RBD group was significantly longer,the H-Y stage,UPDRS-Ⅲ,HAMA-14,HAMD-24,PSQI scores were significantly higher,while the total MoCA score and scores of visuo-spatial and executive function,naming were significantly lower(all P <0.05).The PD with RBD group scored more than PD without RBD group in the total score of SCOPA-AUT scale and scores of digestive,urinary,cardiovascular,thermoregulatory system symptoms(all P <0.05).The abnormal rate of SSR in the PD with RBD group was higher than the PD without RBD group(85.2 % vs.62.5%,P<0.05),the latency was longer [median(interquartile distance):1.35(0.46) s vs.1.27(0.15) s;P<0.05],and the amplitude was lower [median(interquartile distance):1.34(2.21) mV vs.2.87(0.97) mV;P < 0.05 ].The risk of autonomic nervous dysfunction was significantly higher in the PD with RBD group(OR=3.450,95%CI :1.332-8.933).Conclusions The course of PD patients with RBD is longer,and the motor and non-motor symptoms,include mood,sleep,cognitive function,and autonomic function arc more serious in PD patients with RBD than PD without RBD.The risk of autonomic dysfunction in PD patients with RBD is higher.更多还原