初诊未服药帕金森病患者的抑郁特点及危险因素 分析
作者:
作者单位:

作者简介:

通讯作者:

基金项目:

国家重点研发计划项目(2017YFC1310302)


Clinical characteristics and risk factors of depression in newly diagnosed untreated patients with Parkinson disease
Author:
Affiliation:

Fund Project:

  • 摘要
  • |
  • 图/表
  • |
  • 访问统计
  • |
  • 参考文献
  • |
  • 相似文献
  • |
  • 引证文献
  • |
  • 资源附件
  • |
  • 文章评论
    摘要:

    目的 探讨初诊未服药的帕金森病(PD)患者抑郁的临床特征及危险因素。方法 回顾 性收集 2010 年 10 月至 2019 年 12 月在南京医科大学附属脑科医院神经内科运动障碍门诊初诊未服药的 218 例 PD 患者(PD 组)和 171 名年龄、性别相匹配的健康对照者(对照组)的资料。采用统一 PD 评定量表 (UPDRS)第Ⅱ、Ⅲ、Ⅴ部分评估 PD 患者的运动症状,采用 PD 睡眠量表(PDSS)、蒙特利尔认知评估量表 (MoCA)和非运动症状问卷(NMSQ)评估 PD 患者的非运动症状。采用 24 项汉密尔顿抑郁量表(HAMD- 24)和汉密尔顿焦虑量表(HAMA)评估受试者的抑郁、焦虑程度。比较 PD 组和对照组抑郁发作的发病 率、临床资料的差异,比较帕金森病抑郁(dPD)和非帕金森病抑郁(n-dPD)患者临床症状的差异。采用 多因素 Logistic 回归分析初诊未服药 PD 患者抑郁的危险因素。结果 PD 组 HAMD-24 评分为 8.0(4.0, 13.0)分,dPD 的发病率为 12.4%(27/218),其中轻度、中度和重度抑郁患者分别为 5 例、18 例和 4 例。对 照组 HAMD-24 评分 2.0(0,2.0)分,抑郁发作的发病率为 6.4%(11/171),其中轻度、中度和重度抑郁患者 分别为 5 名、5 名和 1 名。两组抑郁程度和抑郁发病率比较,差异有统计学意义(P< 0.05)。dPD 组患 者的 HAMD-24 总分及各因子评分、HAMA 评分、NMSQ 评分高于 n-dPD 组,运动分期为早期、姿势异常 步态不稳(PIGD)亚型的患者比例高于 n-dPD 组,UPDRS-Ⅱ评分和 PDSS 评分低于 n-dPD 组(P< 0.05)。 HAMA 评分高(OR=1.167,95%CI=1.077~1.265)、NMSQ 评分高(OR=1.235,95%CI=1.052~1.449)和 PIGD 运动障碍亚型(OR=2.024,95%CI=1.053~3.891)是 PD 患者发生抑郁的危险因素(P< 0.05),PDSS 评分高 (OR=0.971,95%CI=0.945~0.997)是 PD 患者发生抑郁的保护因素(P< 0.05)。结论 初诊未服药 PD 患 者的抑郁程度以中度抑郁为主,焦虑、非运动症状多、睡眠质量差和 PIGD 型 PD 患者更易患抑郁。

    Abstract:

    Objective To investigate the clinical features and risk factors of depression in newly diagnosed untreated people with Parkinson disease (PD). Methods The data of a total of 218 newly diagnosed untreated PD patients in dyskinesia outpatient of Neurology Department of Affiliated Nanjing Brain Hospital, Nanjing Medical University from October 2010 to December 2019 and 171 age- and gendermatched healthy controls were retrospectively collected. The Unified PD Rating Scale (UPDRS) Part Ⅱ, Ⅲ and Ⅴ were used to examine the motor symptoms of PD patients. The PD Sleep Scale (PDSS), Montreal Cognitive Assessment Scale (MoCA) and Non-Motor Symptom Quest (NMSQ) were used to assess nonmotor symptoms in PD patients. The degree of depression and anxiety in PD group and control group were evaluated using the 24-item Hamilton Depression Scale (HAMD) and Hamilton Anxiety Scale (HAMA). The incidence rate and clinical data were compared between the PD and control groups. The clinical symptoms of PD patients with depression (dPD) and those without depression (n-dPD) were compared. Multivariate Logistic regression was used to analyze the risk factors of depression in newly diagnosed and untreated PD patients. Results The HAMD score of PD group was 8.0 (4.0,13.0), and the incidence of dPD was 12.4% (27/218), with 5 cases of mild depression, 18 cases of moderate depression, and 4 cases of severe depression. The HAMD score of control group was 2.0 (0,2.0), and the rate of depressive episode was 6.4% (11/171), with 5 cases of mild depression, 5 cases of moderate depression, and 1 case of severe depression. The differences in severity and incidence rate of depression between the two groups were statistically significant (P < 0.05). The total score of HAMD-24 and each factor score, HAMA score and NMSQ score in dPD group were higher than those in n-dPD group. The proportion of patients in early stage, with aberrant posture instability and gait difficulty (PIGD) subtype in dPD group was higher than that in n-dPD group. The scores of UPDRS-Part Ⅱ and PDSS in dPD group were lower than those in n-dPD group (P< 0.05). High HAMA score (OR=1.167, 95%CI=1.077-1.265), high NMSQ score (OR=1.235, 95%CI=1.052-1.449), and PIGD subtype (OR=2.024, 95%CI=1.053-3.891) were the risk factors of dPD. High PDSS score was the protective factor of dPD (OR=0.971, 95%CI=0.945-0.997) (P < 0.05). Conclusions The depression of newly diagnosed PD patients was mainly moderate depression. PD patients with anxiety, more non-motor symptoms, poor sleep quality and PIGD subtype were more likely to suffer from depression.

    参考文献
    相似文献
    引证文献
引用本文

华平,李丽,张洪燕,姚燕,于翠玉,刘卫国.初诊未服药帕金森病患者的抑郁特点及危险因素 分析[J].神经疾病与精神卫生,2022,22(10):
DOI :10.3969/j. issn.1009-6574.2022.10.005.

复制
文章指标
  • 点击次数:
  • 下载次数:
历史
  • 收稿日期:
  • 最后修改日期:
  • 录用日期:
  • 在线发布日期: 2022-11-04