目的 探讨早期帕金森病(PD)进展的危险因素.方法 收集2010年4月至2011年7月在浙江大学医学院附属第一医院神经内科就诊的114例早期(Hohen-Yahr分期＜3期)PD患者的一般资料和临床特征参数,包括发病情况、运动障碍程度、疾病进展速度、日常生活能力、总体认知功能、抑郁、睡眠、疲劳等.应用K型聚类分析对PD进行亚型分析,根据聚类分析4分组后疾病进展速度UPDRS Ⅰ～Ⅲ/病程分为快速进展组和非快速进展组,比较两组患者临床特征参数的差异,UPDRS Ⅰ～Ⅲ/病程与上述临床特征参数的相关性采用Spearman秩相关,采用Logistic回归分析得出早期PD进展的危险因素.结果 聚类分析4分组后按照UPDRSⅠ～Ⅲ/病程分为快速进展组(26例)和非快速进展组(88例).组间比较显示,快速进展组较非快速进展组年龄更大,发病年龄更晚,病程更短,运动障碍包括平均UPDRSⅢ强直、运动迟缓、姿势不稳步态障碍(PIGD)积分更高,日常生活能力(UPDRSⅡ积分)受累更重、日常生活能力衰退速度(UPDRSⅡ/病程)更快,HAMD积分更高,差异有统计学意义(P＜0.05).Spearman秩相关性分析显示疾病进展速度UPDRSⅠ～Ⅲ/病程与发病年龄、病程、平均UPDRSⅢ强直、运动迟缓、PIGD积分、HAMD积分显著相关(P均＜0.05).Logistic回归分析显示发病年龄、平均UPDRSⅢ强直的比值比(0R)分别为1.109,2.490(P ＜0.05).结论 PD快速进展的危险因素可能包括运动障碍的亚型(强直、运动迟缓、姿势不稳步态障碍显著)、发病年龄晚、抑郁显著等.%Objective To investigate the risk factors for the progression of early stage Parkinson's disease (PD).Methods One hundred and fourteen early-stage PD patients Hoehn and Yahr stage ＜ 3) were classified using k means cluster analysis and then further divided into the rapid disease progression group and non-rapid disease progression group based on disease progression.The demographic data,motor variables,MMSE,HAMD,PQSI,FSS score were compared between groups.The relationships between PD progression and demographic data,motor variables,MMSE,HAMD,PQSI,FSS score were analyzed by using spearman rank correlation.Logistic regression analysis was applied to determine the risk factors for PD progression.Results Twenty-six patients were divided into the rapid disease progression group,and 88 into the non-rapid disease progression group based on disease progression.Age,age of disease onset,the mean score of UPDRS Ⅲ rigidity,bradykinesia,and postural instability/gait difficulties (PIGD),UPDRS Ⅱ,UPDRS Ⅱ/disease duration,HAMD score of patients in rapid disease progression group were significantly greater than those in the non-rapid disease progression group (P ＜0.05).Spearman rank correlation showed UPDRS Ⅰ-Ⅲ/disease duration had significant correlation with age of disease onset,disease duration,the mean score of UPDRS Ⅲi rigidity,bradykinesia,PIGD and HAMD score.Logistic regression analysis showed that odds ratio of age of disease onset and the mean score of UPDRS Ⅲ rigidity were 1.109 and 2.490 (P ＜0.05),respectively.Conclusion The risk factors for the progression of early stage Parkinson's disease may include motor subtypes (dominant rigidity,bradykinesia,and postural instability/gait difficulties),later disease onset and depression.
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