帕金森病伴脑白质病变患者临床特征及危险因素分析

doi:10.3969/j.issn.1004-583X.2024.03.004

摘要/Abstract

摘要：

目的探讨帕金森病(Parkinson disease, PD)伴脑白质病变(white matter lesions, WML)患者的临床特征和相关危险因素。方法选取2022年2月至2023年9月安徽医科大学附属宿州医院神经内科收治的PD患者127例,并收集患者临床资料。根据改良Fazekas评分量表将受试者分为正常组(n=15)、轻度异常组(n=43)、中度异常组(n=45)、重度异常组(n=24),比较4组临床资料差异,并进一步通过Spearman相关分析和多因素logistic回归分析研究PD患者WML严重程度的危险因素。结果 4组性别、高血压、糖尿病、冠心病、抑郁自评量表评分、焦虑自评量表评分、帕金森病睡眠量表评分、尿酸、甘油三酯、总胆固醇、低密度脂蛋白胆固醇水平比较,差异均无统计学意义(P>0.05);4组年龄、帕金森病统一评分量表第三部分评分、Hoehn-Yahr分期、简易精神状态检查量表评分、蒙特利尔认知评估量表评分、同型半胱氨酸(homocysteine,HCY)、高密度脂蛋白胆固醇(high density lipoprotein cholesterol,HDL-C)水平比较,差异均有统计学意义(P<0.05)。年龄、帕金森病统一评分量表第三部分评分、Hoehn-Yahr分期和HCY水平与PD患者WML的严重程度呈正相关(r=0.759、0.319、0.378、0.545, P<0.01);简易精神状态检查量表评分、蒙特利尔认知评估量表评分及HDL-C水平与PD患者WML的严重程度呈负相关(r=-0.510、-0.524、-0.319, P<0.01)。年龄、HCY是PD患者WML严重程度的危险因素(P<0.05), HDL-C是PD患者WML严重程度的保护因素(P<0.05)。结论 WML加重PD患者的运动症状和认知障碍,年龄、HCY是PD患者WML严重程度的危险因素,HDL-C是其保护因素。

关键词: 帕金森病, 脑白质病变, 临床特征, 危险因素

Abstract:

Objective To explore the clinical characteristics and related risk factors of Parkinson's disease (PD) patients with white matter lesions (WML). Methods A total of 127 PD patients admitted to the Neurology Department of Suzhou Hospital Affiliated to Anhui Medical University from February 2022 to September 2023 were selected, and their clinical data were collected. According to the modified Fazekas scale, participants were divided into normal group (n=15), mild abnormal group (n=43), moderate abnormal group (n=45), and severe abnormal group (n=24). The clinical data differences among the four groups were compared. Spearman correlation analysis and multivariate logistic regression analysis were used to study the risk factors for the severity of WML in PD patients. Results There were no significant differences in the gender, hypertension, diabetes, coronary heart disease, Self-Rating Anxiety/ Depression Scale score, Parkinson's Disease Sleep Scale score, uric acid, triglycerides, total cholesterol and low-density lipoprotein cholesterol among the four groups (P>0.05). There were significant differences in the age, Unified Parkinson Disease Rating Scale-part Ⅲ (UPDRS Ⅲ), Hoehn and Yahr (HY) staging, Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA) score, homocysteine (HCY), and high-density lipoprotein cholesterol (HDL-C) levels (P<0.05). Age, UPDRS Ⅲ scores, HY staging, and HCY level were positively correlated with the severity of WML in PD patients (r=0.759, 0.319, 0.378, and 0.545, respectively; P<0.01). The MMSE score, MoCA score, and HDL-C level were negatively correlated with the severity of WML in PD patients (r=-0.510, -0.524, and -0.319, respectively; P<0.01). Age and HCY level were risk factors for the severity of WML in PD patients (P<0.05), while HDL-C level was a protective factor (P<0.05). Conclusion WML exacerbates motor symptoms and cognitive impairment in PD patients. The age and HCY are risk factors for the severity of WML in PD patients, while HDL-C is a protective factor.

Key words: Parkinson disease, white matter lesions, clinical features, risk factors

中图分类号:

R742.5

李倩, 钟平. 帕金森病伴脑白质病变患者临床特征及危险因素分析[J]. 临床荟萃, 2024, 39(3): 222-226.

Li Qian, Zhong Ping. Clinical characteristics and risk factors of Parkinson's disease with white matter lesions[J]. Clinical Focus, 2024, 39(3): 222-226.

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链接本文: https://huicui.hebmu.edu.cn/CN/10.3969/j.issn.1004-583X.2024.03.004

https://huicui.hebmu.edu.cn/CN/Y2024/V39/I3/222

图/表 3

参考文献 28

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组别	例数	年龄 (岁)				性别[例(%)]								高血压 [例(%)]			糖尿病 [例(%)]			冠心病 [例(%)]
组别	例数	年龄 (岁)				男				女				高血压 [例(%)]			糖尿病 [例(%)]			冠心病 [例(%)]
正常组	15	50.93±3.52				8(53.3)				7(46.7)				5(33.3)			1(6.7)			1(6.7)
轻度异常组	43	67.58±6.59^*				22(51.2)				21(48.8)				18(41.9)			9(20.9)			7(16.3)
中度异常组	45	73.76±4.88^*#				22(48.9)				23(51.1)				23(51.1)			13(28.9)			15(33.3)
重度异常组	24	79.67±5.18^*#△				15(62.5)				9(37.5)				15(62.5)			6(25.0)			5(20.8)
F/χ²值		96.151				1.230								4.138			3.314			6.253
P值		<0.01				0.746								0.247			0.346			0.100
组别	H-Y分级 (级)				UPDRS-Ⅲ评分 (分)				MMSE评分 (分)				MoCA评分 (分)				SDS评分 (分)			SAS评分 (分)
正常组	1.63±0.64				20.27±15.13				26.93±3.39				25.80±3.38				43.92±13.06			43.17±11.82
轻度异常组	2.35±0.81^*				30.98±12.98^*				24.14±4.23				21.28±5.92^*				47.37±11.06			49.25±12.60
中度异常组	2.68±1.05^*				35.16±13.65^*				19.64±6.84^*#				16.33±6.50^*#				49.97±11.03			50.52±9.62
重度异常组	3.04±1.05^*#				39.71±18.61^*#				18.00±5.47^*#				14.75±6.09^*#				48.40±12.96			49.11±12.60
F/χ²值	7.964				6.039				17.593^▲				25.198^▲				1.090			1.548
P值	<0.01				0.010				<0.01				<0.01				0.356			0.205
组别	PDSS评分 (分)		UA (μmol/L)				HCY (μmol/L)				TG (mmol/L)				TC (mmol/L)		HDL-C (mmol/L)		LDL-C (mmol/L)
正常组	106.60±31.69			274.11±89.52				12.26±2.85				4.12±0.92				1.77±1.74		1.30±0.33			2.55±0.76
轻度异常组	99.72±22.91			291.51±85.14				12.90±4.15				4.56±1.09				1.10±0.54		1.22±0.25			2.68±0.94
中度异常组	89.82±25.71			270.24±67.89				15.15±3.99^*#				4.37±1.23				1.14±0.58		1.16±0.25			2.42±1.04
重度异常组	96.79±18.84			270.71±82.71				21.40±5.30^*#△				4.12±0.92				1.22±1.16		0.98±0.26^*#△			2.26±0.60
F/χ²值	2.227			0.637				24.041				1.070				2.230		6.008			1.287
P值	0.088			0.593				<0.01				0.365				0.088		0.001			0.282

组别	例数	年龄 (岁)				性别[例(%)]								高血压 [例(%)]			糖尿病 [例(%)]			冠心病 [例(%)]
组别	例数	年龄 (岁)				男				女				高血压 [例(%)]			糖尿病 [例(%)]			冠心病 [例(%)]
正常组	15	50.93±3.52				8(53.3)				7(46.7)				5(33.3)			1(6.7)			1(6.7)
轻度异常组	43	67.58±6.59^*				22(51.2)				21(48.8)				18(41.9)			9(20.9)			7(16.3)
中度异常组	45	73.76±4.88^*#				22(48.9)				23(51.1)				23(51.1)			13(28.9)			15(33.3)
重度异常组	24	79.67±5.18^*#△				15(62.5)				9(37.5)				15(62.5)			6(25.0)			5(20.8)
F/χ²值		96.151				1.230								4.138			3.314			6.253
P值		<0.01				0.746								0.247			0.346			0.100
组别	H-Y分级 (级)				UPDRS-Ⅲ评分 (分)				MMSE评分 (分)				MoCA评分 (分)				SDS评分 (分)			SAS评分 (分)
正常组	1.63±0.64				20.27±15.13				26.93±3.39				25.80±3.38				43.92±13.06			43.17±11.82
轻度异常组	2.35±0.81^*				30.98±12.98^*				24.14±4.23				21.28±5.92^*				47.37±11.06			49.25±12.60
中度异常组	2.68±1.05^*				35.16±13.65^*				19.64±6.84^*#				16.33±6.50^*#				49.97±11.03			50.52±9.62
重度异常组	3.04±1.05^*#				39.71±18.61^*#				18.00±5.47^*#				14.75±6.09^*#				48.40±12.96			49.11±12.60
F/χ²值	7.964				6.039				17.593^▲				25.198^▲				1.090			1.548
P值	<0.01				0.010				<0.01				<0.01				0.356			0.205
组别	PDSS评分 (分)		UA (μmol/L)				HCY (μmol/L)				TG (mmol/L)				TC (mmol/L)		HDL-C (mmol/L)		LDL-C (mmol/L)
正常组	106.60±31.69			274.11±89.52				12.26±2.85				4.12±0.92				1.77±1.74		1.30±0.33			2.55±0.76
轻度异常组	99.72±22.91			291.51±85.14				12.90±4.15				4.56±1.09				1.10±0.54		1.22±0.25			2.68±0.94
中度异常组	89.82±25.71			270.24±67.89				15.15±3.99^*#				4.37±1.23				1.14±0.58		1.16±0.25			2.42±1.04
重度异常组	96.79±18.84			270.71±82.71				21.40±5.30^*#△				4.12±0.92				1.22±1.16		0.98±0.26^*#△			2.26±0.60
F/χ²值	2.227			0.637				24.041				1.070				2.230		6.008			1.287
P值	0.088			0.593				<0.01				0.365				0.088		0.001			0.282

影响因素	回归系数	标准误	Wald χ²值	P值	OR值	95%CI
影响因素	回归系数	标准误	Wald χ²值	P值	OR值	下限	上限
年龄	0.229	0.470	23.873	<0.01	1.257	0.320	1.370
HCY	0.202	0.530	14.587	<0.01	1.224	0.098	0.305
HDL-C	-2.672	0.967	7.638	0.006	0.069	-4.566	0.777

影响因素	回归系数	标准误	Wald χ²值	P值	OR值	95%CI
影响因素	回归系数	标准误	Wald χ²值	P值	OR值	下限	上限
年龄	0.229	0.470	23.873	<0.01	1.257	0.320	1.370
HCY	0.202	0.530	14.587	<0.01	1.224	0.098	0.305
HDL-C	-2.672	0.967	7.638	0.006	0.069	-4.566	0.777