帕金森病、多系统萎缩和进行性核上性麻痹患者尿流率与运动、认知功能的关联研究
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国家自然科学基金项目(82071419);广东省人民医院(广东省医学科学院)登峰计划项目(DFJH201907)


Relationship between uroflowmetry and motor function and cognitive function in patients with Parkinson disease, multiple system atrophy and progressive supranuclear palsy
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    摘要:

    目的 探讨帕金森病(PD)、多系统萎缩(MSA)和进行性核上性麻痹(PSP)患者的尿流率与 运动、认知功能的相关性。方法 选取 2018 年 12 月至 2021 年 12 月就诊于广东省人民医院神经内科的 27 例 PD 患者、17 例 MSA 患者、16 例 PSP 患者为研究对象,收集患者的人口学资料。采用蒙特利尔认知 评估量表(MoCA)和简易智力状态检查(MMSE)比较 3 组患者的认知功能;采用 Hoehn-Yahr 分级量表、 国际运动障碍协会 PD 综合评分量表第 3 部分(MDS-UPDRS Ⅲ)比较 3 组患者的运动功能;采用智能尿 流动力学检测仪评估患者的尿流率。采用 Spearman 相关分析 3 组患者认知、运动功能与尿流率的相关 性。结果 PD 组病程为 4.0(2.0,7.0)年,长于 MSA 组的 2.0(1.0,2.5)年,差异有统计学意义(H=-16.038, P< 0.01)。3 组患者 MDS-UPDRS Ⅲ、MoCA、MMSE 评分比较,差异无统计学意义(P> 0.05);PD 组的 Hoehn-Yahr分级量表评分为2.5(2.0,3.0)分,低于PSP组的3.0(2.5,3.0)分,差异有统计学意义(H=-14.683, P< 0.05)。3 组患者排尿延迟时间比较,差异有统计学意义(H=6.196,P< 0.05)。Spearman 相关分析显 示,PD 组的 MDS-UPDRS Ⅲ评分与达到最大尿流率的时间呈正相关(r=0.379,P< 0.05),MMSE 评分与最 大尿流率、平均尿流率、尿流加速度呈负相关(r=-0.419、-0.456、-0.402;P< 0.05),MoCA 评分与最大尿 流率、平均尿流率、排尿量、尿流加速度呈负相关(r=-0.427、-0.432、-0.384、-0.385;P< 0.05);MSA 组 的 MDS-UPDRS Ⅲ评分与最大尿流率、尿流加速度呈负相关(r=-0.527、-0.696;P< 0.05),与总排尿时间 呈正相关(r=0.619,P< 0.05),MMSE 评分与达到最大尿流率的时间呈正相关(r=0.499,P< 0.05);PSP 组 的MDS-UPDRS Ⅲ评分与达到最大尿流率的时间呈正相关(r=0.549,P<0.05),与尿流加速度呈负相关(r= -0.621,P< 0.05)。结论 PD、MSA、PSP 患者的尿流率无明显差异,其中排尿加速度与运动能力呈负相 关,PD 患者的最大尿流率、MSA 患者的平均尿流率与认知能力呈正相关。

    Abstract:

    Objective To investigate the correlation between uroflowmetry and motor function, cognitive function in patients with Parkinson disease (PD), multiple system atrophy (MSA) and progressive supranuclear palsy (PSP). Methods A total of 27 PD patients, 17 MSA patients, and 16 PSP patients who visited the Department of Neurology, Guangdong Provincial People's Hospital from December 2018 to December 2021 were selected. The demographic data of the patients were recorded. The overall cognitive function of the three groups was assessed and compared using the Montreal Cognitive Assessment (MoCA) and Mini-Mental State Examinationl (MMSE). The motor function of the three groups was assessed and compared using the HoehnYahr (H-Y) and Movement Disorder Society-Sponsored Revision of the Unified Parkinson's Disease Rating Scale Ⅲ (MDS-UPDRS Ⅲ). The uroflowmetry of the patients was assessed using an intelligent urodynamic tester. Spearman correlation was used to analyze the correlation between cognition, motor function and uroflowmetry in three groups. Results The course of disease in PD group was 4.0 (2.0,7.0) years, which was longer than 2.0 (1.0, 2.5) years in MSA group, and the difference was statistically significant (H=-16.038,P < 0.01). There was no statistical difference in MDS-UPDRS Ⅲ, MoCA and MMSE scores among the 3 groups (P> 0.05). The H-Y score of PD group was 2.5 (2.0, 3.0), which was lower than 3.0 (2.5, 3.0) of PSP group, and the difference was statistically significant (H=-14.683, P< 0.05). There was a statistically significant difference in urination delay time among the three groups (H=6.196, P < 0.05). Further Spearman correlation analysis showed that MDS-UPDRS Ⅲ score in PD group was positively correlated with the time to reach the maximum uroflowmetry (r=0.379, P=0.047); MMSE score was negatively correlated with the maximum uroflowmetry, mean uroflowmetry and urinary flow acceleration (r=-0.419,-0.456,-0.402; P< 0.05); MoCA score was negatively correlated with maximum uroflowmetry, mean uroflowmetry, urine output and urinary flow acceleration (r= -0.427,-0.432,-0.384,-0.385; P< 0.05). In MSA group, MDS-UPDRS Ⅲ score was negatively correlated with maximum uroflowmetry and urinary flow acceleration (r=-0.527,-0.696; P < 0.05), and positively correlated with total voiding time (r=0.619,P < 0.05); MMSE score was positively correlated with time to achieve maximum uroflowmetry (r=0.499, P < 0.05). In PSP group, MDS-UPDRS Ⅲ score was positively correlated with time to achieve maximum uroflowmetry (r=0.549,P < 0.05), and negatively correlated with urinary flow acceleration (r=-0.621, P<0.05). Conclusions There is no significant difference in uroflowmetry among PD, MSA and PSP patients. Urinary acceleration is negatively correlated with motor function, maximum uroflowmetry is positively correlated with cognitive function in PD patients, and mean uroflowmetry is positively correlated with cognitive function in MSA patients.

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谢剑玮,张飘,李彦,陈真真,何郴涛,王丽娟,张玉虎.帕金森病、多系统萎缩和进行性核上性麻痹患者尿流率与运动、认知功能的关联研究[J].神经疾病与精神卫生,2022,22(9):
DOI :10.3969/j. issn.1009-6574.2022.09.007.

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  • 在线发布日期: 2022-09-21