1.上海中医药大学附属龙华医院(上海 200032)
李慧,女,硕士,主治医师,主要从事中医药防治脑病临床与研究工作
袁晓蕾,主治医师;E-mail:clq710@163.com
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李慧,袁晓蕾,叶青,等.早中期帕金森病患者睡眠障碍影响因素分析及中医证型分布特点研究[J].上海中医药杂志,2023,57(3):21-25.
LI Hui,YUAN Xiaolei,YE Qing,et al.Analysis of factors influencing sleep disorders and the distribution characteristics of traditional Chinese medicine syndromes in people with early⁃or mid⁃stage Parkinson’s disease[J].Shanghai Journal of Traditional Chinese Medicine,2023,57(3):21-25.
李慧,袁晓蕾,叶青,等.早中期帕金森病患者睡眠障碍影响因素分析及中医证型分布特点研究[J].上海中医药杂志,2023,57(3):21-25. DOI: 10.16305/j.1007-1334.2023.2208083.
LI Hui,YUAN Xiaolei,YE Qing,et al.Analysis of factors influencing sleep disorders and the distribution characteristics of traditional Chinese medicine syndromes in people with early⁃or mid⁃stage Parkinson’s disease[J].Shanghai Journal of Traditional Chinese Medicine,2023,57(3):21-25. DOI: 10.16305/j.1007-1334.2023.2208083.
目的,2,研究早中期帕金森病(PD)患者睡眠障碍的影响因素及中医证型分布特点。,方法,2,根据PD睡眠量表(PDSS)评分,将87例早中期PD患者分为PD睡眠障碍组(46例)和PD不伴睡眠障碍组(41例),分析比较两组性别、年龄、发病年龄、病程、Hoehn-Yahr分级等基线资料,以及PD综合评分量表(UPDRS)、自主神经症状量表(SCOPA-AUT)、汉密尔顿抑郁量表(HAMD)、汉密尔顿焦虑量表(HAMA)、简易智力状态检查量表(MMSE)、PD生活质量问卷(PDQ-39)评分。对所有患者行中医辨证分型,观察中医证型分布规律,比较不同中医证型早中期PD患者的睡眠情况。采用线性回归分析或Logistic回归法检验PDSS总分与各变量之间的线性趋势,探讨早中期PD患者睡眠障碍的影响因素。,结果,2,①两组基线资料比较,差异无统计学意义(,P,>,0.05);与PD不伴睡眠障碍组比较,PD伴睡眠障碍组SCOPA-AUT、HAMA、HAMD、PDQ-39及UPDRS各部分(Ⅰ精神、行为和情绪,Ⅱ日常活动,Ⅲ运动功能)评分升高(,P,<,0.05)。②本研究收集的87例早中期PD患者中,气血不足证22例、气滞血瘀证21例、痰热动风证15例、肝肾不足证29例;PD伴睡眠障碍组和PD不伴睡眠障碍组患者的中医证型分布差异有统计学意义(,P,<,0.05),PD伴睡眠障碍组的常见中医证型为肝肾不足证(43.50%),PD不伴睡眠障碍组则以气滞血瘀证(41.50%)多见。③不同中医证型早中期PD患者PDSS总分比较,差异有统计学意义(,P,<,0.05),其中肝肾不足证PDSS总分最低。④ PDSS总分与年龄、UPDRS Ⅰ、UPDRS Ⅱ、UPDRS Ⅲ、SCOPA-AUT、HAMA、HAMD、PDQ-39评分呈负相关(,r,<,0,,P,<,0.05),其中UPDRS Ⅰ、UPDRS Ⅱ、SCOPA-AUT、HAMA、HAMD、PDQ-39是危险因素(,P,<,0.05)。,结论,2,高龄早中期PD患者更容易合并睡眠障碍,运动症状和自主神经功能症状亦更为严重,容易出现焦虑、抑郁情绪,从而影响生活质量;早中期PD伴睡眠障碍患者的常见中医证型为肝肾不足证,此类患者的睡眠障碍程度最为严重。
Objective,2,To investigate the factors influencing sleep disorders and the distribution characteristics of traditional Chinese medicine (TCM) syndromes in patients with early- or mid-stage Parkinson’s disease (PD).,Methods,2,Based on the Parkinson’s Disease Sleep Scale (PDSS) score, 87 patients with early- or mid-stage PD were divided into the PD sleep disorder group (,n,=46) and the PD without sleep disorder group (,n,=41). Baseline data such as gender, age, age of onset, duration of illness, Hoeln-Yahr Stage, and scores of the Unified Parkinson Disease Rating Scale (UPDRS), Scales for Outcomes in Parkinson’s disease - Autonomic (SCOPA-AUT), Hamilton Depression Scale (HAMD), Hamilton Anxiety Scale (HAMA), Minimum Mental State Examination (MMSE) and the Parkinson’s Disease Questionnaire (PDQ-39) were analyzed and compared between the two groups. All patients with early- or mid-stage PD had TCM syndrome differentiation, the distribution pattern of TCM syndromes were analyzed, and the sleep condition in patients with different TCM syndromes were compared. Linear regression analysis or Logistic regression analysis was used to test for linear trends between the total PDSS score and each variable, and to explore the influencing factors of sleep disorders in early- or mid-stage PD patients.,Results,2,①No statistically significant baseline difference was found between the two groups (,P,>,0.05). The scores of SCOPA-AUT, HAMA, HAMD, PDQ-39 and subscales of UPDRS (I mentation, behavior and mood, Ⅱ activities of daily living, Ⅲ motor exam) were higher in the PD with sleep disorder group than those in the PD without sleep disorder group (,P,<,0.05). ②Among the 87 patients with early- or mid-stage PD collected in this study, there were 22 cases with qi and blood deficiency syndrome, 21 cases with qi stagnation and blood stasis syndrome, 15 cases with stirring wind due to phlegm-heat syndrome, and 29 cases with liver and kidney deficiency syndrome. There was a statistically significant difference in the distribution of TCM syndromes between the PD with sleep disorder group and the PD without sleep disorder group (,P,<,0.05). The most common TCM syndrome in the PD with sleep disorder group was liver and kidney deficiency syndrome (43.50%) while that in the PD without sleep disorder group was qi stagnation and blood stasis syndrome (41.50%). ③The differences in the total PDSS scores of early- or mid-stage PD patients with different TCM syndrome were statistically significant (,P,<,0.05), and the total PDSS score in patients with the liver and kidney deficiency syndrome was the lowest. ④The total PDSS score was negatively correlated with age, UPDRS Ⅰ, UPDRS Ⅱ, UPDRS Ⅲ, SCOPA-AUT, HAMA, HAMD and PDQ-39 scores (,r,<,0, ,P,<,0.05), and UPDRS Ⅰ, UPDRS Ⅱ, SCOPA-AUT, HAMA, HAMD, and PDQ-39 were risk factors (,P,<,0.05).,Conclusions,2,Older patients with early- or mid-stage PD are more likely to have sleep disorders, more severe motor and autonomic symptoms, as well as anxiety and depression, affecting their quality of life. The most common TCM syndrome of early- or mid-stage PD patients with sleep disorders is liver and kidney deficiency syndrome, and patients with this syndrome have the most serious sleep disorder.
帕金森病睡眠障碍中医证型肝肾不足证焦虑抑郁
Parkinson’s diseasesleep disorderstraditional Chinese medicine syndromeliver and kidney deficiency syndromeanxietydepression
ALBERS J A, CHAND P, ANCH A M. Multifactorial sleep disturbance in Parkinson’s disease[J]. Sleep Med, 2017, 35: 41-48.
VAN UEM J M T, MARINUS J, CANNING C, et al. Health-Related Quality of Life in patients with Parkinson’s disease—A systematic review based on the ICF model[J]. Neurosci Biobehav Rev, 2016, 61: 26-34.
HAWKES C H, DEL TREDICI K, BRAAK H. A timeline for Parkinson’s disease[J]. Parkinsonism Relat Disord, 2010, 16(2): 79-84.
陈伟,俞郦,朱炜,等. 天芪平颤方治疗帕金森病运动症状临床观察[J]. 辽宁中医药大学学报,2014, 16(7): 99-101.
赵俊杰. 帕金森病患者的临床特征及中医证候分析[D]. 西安:第四军医大学,2016.
中华医学会神经病学分会帕金森病及运动障碍学组,中国医师协会神经内科医师分会帕金森病及运动障碍专业委员会,上海交通大学医学院附属瑞金医院. 中国帕金森病的诊断标准(2016版)[J]. 中华神经科杂志,2016, 49(4): 268-271.
CHAUDHURI K R, PAL S, DIMARCO A, et al. The Parkinson’s disease sleep scale: a new instrument for assessing sleep and nocturnal disability in Parkinson’s disease[J]. J Neurol Neurosurg Psychiatry, 2002, 73(6): 629-635.
GOETZ C G, TILLEY B C, SHAFTMAN S R, et al. Movement Disorder Society-sponsored revision of the Unified Parkinson’s Disease Rating Scale (MDS-UPDRS): scale presentation and clinimetric testing results[J]. Mov Disord, 2008, 23(15): 2129-2170.
VISSER M, VAN ROODEN S M, VERBAAN D, et al. A comprehensive model of health-related quality of life in Parkinson’s disease[J]. J Neurol, 2008, 255(10): 1580-1587.
马惠姿,房进平,冯涛,等. 帕金森病患者不同程度抑郁在汉密尔顿抑郁量表的结构差异[J]. 中国康复理论与实践,2021, 27(7): 829-833.
蒋莹,房进平,冯涛,等. 帕金森病患者不同焦虑程度在汉密尔顿焦虑量表的结构差异[J]. 中国康复理论与实践,2021, 27(3): 325-328.
俞璐,李敏琤,夏明. 轻度认知损害与简易精神状态检查分项相关性分析及其中医防治研究[J]. 吉林中医药,2019, 39(6): 763-767.
CAROD-ARTAL F J, MARTINEZ-MARTIN P, VARGAS A P. Independent validation of SCOPA-psychosocial and metric properties of the PDQ-39 Brazilian version[J]. Mov Disord, 2007, 22(1): 91-98.
TOMLINSON C L, STOWE R, PATEL S, et al. Systematic review of levodopa dose equivalency reporting in Parkinson’s disease[J]. Mov Disord, 2010, 25(15): 2649-2653.
中华中医药学会老年医学会. 中医老年颤证诊断和疗效评定标准(试行)[J]. 山东中医学院学报,1992, 15(6): 55.
SEPPI K, RAY CHAUDHURI K, COELHO M, et al. Update on treatments for nonmotor symptoms of Parkinson’s disease-an evidence-based medicine review[J]. Mov Disord, 2019, 34(2): 180-198.
HATANO T, HATTORI N, KAWANABE T, et al. An exploratory study of the efficacy and safety of yokukansan for neuropsychiatric symptoms in patients with Parkinson’s disease[J]. J Neural Transm Vienna Austria, 2014, 121(3): 275-281.
吴慧芬,贝筝,叶苗苗,等. 帕金森病患者血清脑源性神经营养因子前体蛋白水平与病情严重程度及认知障碍相关性研究[J]. 创伤与急危重病医学,2021, 9(5): 365-369, 373.
冯诗锐,张青萍. 中药有效成分及方剂多靶点调控治疗帕金森病研究进展[J]. 辽宁中医药大学学报,2020, 22(8): 162-165.
解晶. 帕金森病睡眠障碍与非运动症状的相关性分析[J]. 中国医药指南,2019, 17(18): 116-117.
施德,干静,万赢,等. 早中期帕金森病患者自主神经功能障碍的临床及中医辨证分型特点[J]. 上海中医药杂志,2021, 55(6): 15-20.
司慧丽,纪别克,赵鸿雁,等. 帕金森病患者睡眠障碍特点及其影响因素分析[J]. 广东医学,2020, 41(1): 61-65.
RANA A Q, QURESHI A R M, SHAMLI OGHLI Y, et al. Decreased sleep quality in Parkinson’s patients is associated with higher anxiety and depression prevalence and severity, and correlates with pain intensity and quality[J]. Neurol Res, 2018, 40(8): 696-701.
KAY D B, TANNER J J, BOWERS D. Sleep disturbances and depression severity in patients with Parkinson’s disease[J]. Brain Behav, 2018, 8(6): e00967.
袁晓蕾,叶青,袁灿兴,等. 滋肾平颤颗粒治疗帕金森病非运动症状临床研究[J]. 中国中医药信息杂志,2017, 24(9): 25-29.
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