帕金森病剂末现象的危险因素

目的探讨帕金森病剂末现象(WO)的危险因素。方法采用剂末现象-9项问卷(WOQ-9)评价149例PD患者有无WO。根据临床WO定义将WOQ-9(+)患者分为临床WO(+)组和临床WO(-)组。详细记录患者的一般情况(性别,发病年龄)、疾病概况(评估时疾病持续时间、疾病严重程度)及药物治疗概况[发病至启动左旋多巴(LD)的时间、LD治疗时间、LD起初剂量、LD终末剂量、是否联合应用多巴胺受体激动剂]。结果与临床WO(-)组相比,临床WO(+)组发病年龄显著降低,疾病持续时间、统一帕金森病评定量表Ⅲ(UPDRSⅢ)评分、LD治疗时间、LD初始剂量及终末剂量均显著升高(均P0.01)。两组患者性别、发病至启动LD的时间、使用多巴胺受体激动剂比率差异均无统计学意义(均P0.05)。多因素Logistic回归分析显示,发病年龄、LD终末剂量、UPDRSⅢ评分为WO的独立危险因素(均P0.01)。ROC曲线分析显示,UPDRSⅢ评分、LD终末剂量可较好预测WO的发生。UPDRSⅢ评分的准确性(曲线下面积0.913)及灵敏性(85.5%)最高,起病年龄的特异最高(97.7%)。随着LD治疗时间的延长,WO发生的风险随之增加(P=0.008)。发病年龄的早晚(分为早发型50岁、晚发型≥50岁)与WO关联不大(P=0.565),而每日接受LD治疗剂量超过400 mg的PD患者WO发生风险显著增加(P0.001)。结论在临床中应警惕发病年龄较低、UPDRSⅢ分值及LD终末剂量偏高的患者发生WO,根据个体特征进行个性化治疗则是降低运动并发症的最佳选择。     

不同性别帕金森病患者血尿酸水平的相关性研究

目的研究不同性别帕金森病(PD)患者血尿酸水平的相关影响因素。方法收集72例男性PD患者及56例女性PD患者的临床资料。采取高效液相色谱法检测患者血尿酸水平,分析血尿酸水平与临床资料的相关性。结果相关性分析显示,女性PD患者血尿酸水平与患者年龄、起病年龄呈正相关(r=0.283,P=0.034;r=0.295,P=0.027),与病程、Hoehn-Yahr(H-Y)分级、统一帕金森病评分量表(UPDRS)评分,以及汉密尔顿抑郁量表(HAMD)、汉密尔顿焦虑量表(HAMA)、MMSE、非运动症状问卷(NMS-Quest)评分间无明显相关性(均P0.05);男性PD患者血尿酸水平与UPDRSⅣ评分、HAMD呈负相关(r=-0.249,P=0.035;r=-0.279,P=0.017),与年龄、起病年龄、病程、H-Y分级、UPDRSⅡ、UPDRSⅢ、UPDRS总分,以及HAMA、MMSE、NMS-Quest评分无明显相关性(均P0.05)。男性和女性患者血尿酸水平与左旋多巴等效剂量(LED)及左旋多巴剂量均呈负相关(均P0.05),与多巴胺受体激动剂剂量无关(均P0.05)。结论女性PD患者年龄越大、起病越晚,血尿酸水平越高;男性PD患者治疗并发症越多、抑郁越重,血尿酸水平越低。PD患者血尿酸水平与患者左旋多巴服用剂量呈反比。     

早发性和晚发性帕金森病合并抑郁的临床特点研究

目的探索早发性和晚发性帕金森病(PD)合并抑郁各自的临床特点及意义。方法本研究对符合纳入标准的211例PD患者进行回顾性分析,根据起病年龄分为早发组(起病年龄≤50岁)和晚发组(起病年龄50岁),比较两组患者的临床资料、Hoehn-Yahr分级、UPDRSⅢ评分、老年抑郁量表(GDS)评分、Beck抑郁量表(BDI)评分。结果早发组与晚发组患者Hoehn-Yahr分级、UPDRSⅢ评分比较均差异无统计学意义(P0.05);早发组与晚发组患者的抑郁患病率、BDI评分、GDS评分和抑郁程度分布差异无统计学意义(P0.05),但早发组抑郁发生时间要早于晚发组(P0.05)。早发组的抑郁评分与病程、Hoehn-Yahr分级和UPDRSⅢ评分相关(P0.05);晚发性组的抑郁评分与起病年龄、Hoehn-Yahr分级和UPDRSⅢ评分相关(P0.05)。结论早发性PD患者抑郁症状出现时间更早,其抑郁程度与病程、Hoehn-Yahr分级和UPDRSⅢ评分相关。晚发性PD患者抑郁程度与起病年龄、Hoehn-Yahr分级和UPDRSⅢ评分等密切相关。     

帕金森病和便秘的关系

目的探讨帕金森病(PD)与便秘的关系。方法收集164例便秘PD患者及69例无便秘PD患者的一般资料,采用PD统一评价量表(UPDRS)、Hoehn-Yahr(H-Y)分期、汉密顿抑郁量表(HAMD)评分、克里夫兰量表(CCS)对患者进行评估,根据CCS将便秘患者分为重度便秘亚组和轻度便秘亚组。对结果进行比较。结果便秘组病程显著长于,HAMD评分、左旋多巴等效剂量(LED)、UPDRSⅢ评分及H-Y分期显著高于无便秘组(P0.05~0.01)。非条件Logistic回归显示,PD病程、UPDRSⅢ评分、H-Y分期、LED与PD患者便秘呈正相关(均P0.05)。UPDRSⅢ评分及LED是PD便秘发生的独立危险因素(OR=1.070,95%CI:1.012~1.131,P0.05;OR=1.002,95%CI:1.000~1.004,P0.05)。重度便秘亚组患者PD及便秘病程明显长于,HAMD评分、LED、UPDRSⅢ评分、H-Y分期显著高于轻度便秘亚组(P0.05~0.01)。非条件Logistic回归分析显示,PD病程、便秘病程、HAMD评分、UPDRSⅢ评分、H-Y分期、LED与便秘严重程度呈正相关(OR=1.237,1.564,1.055,1.071,1.776,1.002;P0.05~0.01)。HAMD评分是重度便秘的独立危险因素(OR=1.056,95%CI:1.001~1.115,P0.05)。结论 PD患者运动症状重、服用抗PD药物剂量大是PD便秘发生的独立危险因素,抑郁是PD患者重度便秘的独立危险因素。     

帕金森病患者疲劳的临床特点及其影响因素研究

目的探讨帕金森病(PD)患者疲劳的临床特点、影响因素及其对其生活质量的影响。方法入组PD患者75例,记录患者的年龄、性别、起病年龄,受教育程度,采用疲劳严重程度量表(FSS)评估PD患者疲劳程度,并对所有患者进行统一帕金森病评分表(UPDRS),Hoehn-Yahr(H-Y)分级,汉密尔顿抑郁量表(HMDS),简易精神状态检查量表(MMSE)和匹兹堡睡眠量表(PSQI)等评定。比较疲劳与非疲劳PD患者各量表评价的差异,并对疲劳评分与其他各量表评分进行多因素相关分析。结果 75例PD患者中,有52例(69.3%)患者存在疲劳,患者的疲劳与性别、年龄、起病年龄无相关性;Spearman相关性分析示PD患者UPDRSⅠ~Ⅲ、H-Y评分、HMDS、PSQI和左旋多巴服用剂量与疲劳呈显著相关性;Logistic回归分析显示,UPDRSⅡ评分及PSQI是疲劳的独立危险因素。结论疲劳是PD患者常见的非运动症状,明显影响PD患者的生存质量,并与多个运动及非运动症状相关。     

帕金森病患者快速眼球运动睡眠行为障碍临床特征及相关因素

目的分析伴快速眼球运动睡眠行为障碍(REM sleep behavior disorder,RBD)帕金森病(Parkinson’s disease,PD)患者的临床特征,探讨RBD的相关因素。方法连续入组PD患者63例,根据REM睡眠行为异常问卷-香港版(RBDQ-HK)分为PD+RBD组(n=28)和PD-RBD组(n=35)。采用统一帕金森病评定量表(UPDRS)、HoehnYahr(H-Y)分级比较两组运动症状严重程度;采用非运动症状问卷(NMS±quest)比较非运动症状发生情况;采用蒙特利尔认知评估(MOCA)、贝克焦虑量表(BAI)、贝克抑郁量表(BDI)、Epworth嗜睡评分量表(ESS)比较认知、焦虑、抑郁和日间思睡等情况。结果 PD患者中RBD发生率为44.4%(28/63),PD+RBD组病程显著长于PD-RBD组(χ~2=12.733,P=0.002),年龄更大(t=-2.292,P=0.025),H-Y分级更高(χ~2=7.014,P=0.008),但在性别、发病年龄、起病类型、左旋多巴等效剂量上两组差异无统计学意义;在运动症状方面,PD+RBD组UPDRSⅡ、Ⅲ评分更高(t=-2.734,P=0.008;U=3.329,P=0.001);在非运动症状方面,PD+RBD组胃肠道功能及睡眠障碍、精神相关症状等方面发生率均显著高于PD-RBD组(P0.05),焦虑及抑郁在PD+RBD组中更常见(χ~2=3.958,P=0.047;χ~2=10.338,P=0.001),但在认知功能、日间思睡上两组差异无统计学意义。此外,便秘(OR=7.257)、长病程(OR=5.389)、高UPDRSⅢ评分(OR=1.060)与PD患者RBD相关。结论病程更长、年龄更大、运动症状及非运动症状受累更严重的PD患者易伴发RBD。便秘、长病程、高UPDRSⅢ评分可能是RBD的危险因素。     

帕金森病相关性疼痛的相关因素及其对生活质量的影响

目的探讨帕金森病(PD)相关性疼痛的相关因素及其对生活质量的影响。方法根据是否伴有疼痛将120例PD患者分为疼痛组(49例)和非疼痛组(71例)。采用PD统一评分量表(UPDRS)和Hoehn-Yahr(H-Y)分级评估患者的严重程度,采用PD生活质量量表-39(PDQ-39)测评其生活质量,用数字评分法(NRS)评估疼痛组患者疼痛程度。采用汉密尔顿抑郁量表(HAMD)、汉密尔顿焦虑量表(HAMA)和MMSE评价患者的焦虑、抑郁及认知情况。结果与无疼痛组比较,疼痛组H-Y分期及UPDRSⅠ、UPDRSⅢ服药后(med-on)、UPDRSⅢ服药前(med-off)、PDQ-39、HAMA、HAMD评分均显著升高(P0.05～0.01)。Spearman相关分析显示,NRS评分与H-Y分级及UPDRSⅠ、UPDRSⅢmed-off、UPDRSⅢmed-on、PDQ-39、HAMA、HAMD评分呈正相关(P0.05～0.01),与年龄、发病年龄、病程、受教育年限及UPDRSⅡ、MMSE评分无相关性(均P0.05)。线性回归分析显示,UPDRSⅡ、HAMA、NRS评分对PDQ-39有显著性影响(均P0.01)。结论 PD相关性疼痛可能与精神活动、运动症状、焦虑抑郁相关。PD相关性疼痛是影响PD患者生活质量的独立预测因子。     

帕金森病患者运动症状进展的临床相关危险因素研究

目的探讨帕金森病(PD)患者运动症状进展的临床相关因素。方法前瞻性纳入南京脑科医院就诊的PD患者[Hoehn-Yahr(H-Y)分期3期]140例,收集基本资料并采用统一PD评定量表(UPDRS)、 H-Y分期进行评估,随访3年。根据PD患者H-Y分期变化情况,分析影响运动症状展加重的相关临床因素。结果随着病程进展,基线及随访强直、运动迟缓、轴性症状、UPDRSⅢ、H-Y分期、左旋多巴等效剂量(LED)值差异均有统计学意义(均P0.001)。随访3年发现,起病年龄大(P=0.016),基线轴性症状重(P=0.006),患者运动症状进展快。基线时震颤症状明显,运动症状进展反而慢(P=0.019)。结论发病年龄晚、轴性症状重,是PD运动症状进展的危险因素。震颤是PD患者良性症状,病情进展慢。临床上应给与充分重视,并采取积极的个体化治疗。     

帕金森病患者非运动症状波动的临床特点

目的探讨帕金森病(PD)患者非运动症状波动的临床特点。方法采用剂末现象问卷(WOQ-19)评价121例原发性PD患者的运动症状波动和非运动症状波动,并采用视觉模拟评分法(VAS)对WOQ-19的每一项症状进行量化。采集患者的一般信息及服药情况,同时采用统一PD评定量表Ⅲ(UPDRSⅢ)和Hoehn-Yahr量表(H-Y分级)评价患者运动功能及对进行病程分级。结果 121例PD患者中,114例(94.2%)有非运动症状,其中44例(38.6%)有非运动症状波动。非运动症状中,焦虑、情绪低落/思维迟钝、情绪变化的发生率较高。在非运动症状波动中,焦虑、情绪变化、多汗、情绪低落/思维迟钝的症状波动发生率较高。神经精神性症状波动发生率(42.3%)显著高于自主神经性症状(27.9%)与感觉性症状(23.4%)(均P0.05)。患者焦虑、情绪变化、情绪低落/思维迟钝、多汗、疼痛、酸痛、麻木、腹部不适感的VAS评分在服药后明显降低(均P0.05)。非运动症状波动患者病程、服药年限、H-Y分级、UPDRSⅢ开期及关期评分、复方左旋多巴剂量及左旋多巴等效剂量均显著高于无波动患者(均P0.05)。兼有运动症状、非运动症状波动患者UPDRSⅢ关期评分及左旋多巴等效剂量均明显高于单纯运动症状波动患者(均P0.05)。结论 PD患者非运动症状波动发生率约40%,神经精神性非运动症状波动更频繁。非运动症状波动与病程及服药年限长,H-Y分级、UPDRSⅢ评分及左旋多巴等效剂量高,同时兼有运动症状波动等因素有关。     

住院帕金森病患者24小时动态血压及心率变化的临床研究

目的调查住院帕金森病(PD)患者24 h动态血压、心率、餐后血压变化特点及其可能的影响因素。方法采用无创性携带式动态血压监测仪进行24 h动态血压及心率监测,评估受试者的动态血压变化节律及餐后血压变化特点,并进行住院PD患者相关量表评分,探讨病理性血压节律、餐后低血压的相关影响因素。结果 (1)PD组血压节律倾向于反勺型血压,对照组血压节律倾向于非勺形血压(P0.001)。(2)PD组夜间血压下降水平与年龄呈负相关(r=-0.454,P=0.005),与病程、统一PD评定量表第三部分(UPDRSⅢ)评分和Hoehn-Yahr(H-Y)分期、左旋多巴等效日剂量无相关性。(3)PD组早餐和晚餐后收缩压下降水平、低血压发生率较对照组均明显升高(均P0.05)。(4)PD组早餐后收缩压下降水平与年龄呈正相关(r=0.361,P=0.028),与病程、UPDRSⅢ评分、H-Y分期、左旋多巴等效日剂量无相关性。结论住院PD患者广泛存在夜间高血压、餐后低血压。这些异常血压调节与年龄有关。     

Mechanism of action of tubocurarine on nicotinic cholinoreceptors of neurons of the sympathetic ganglia of rats

Tubocurarine (Tc) effect on membrane currents elicited by acetylcholine (ACh) was studied in isolated superior cervical ganglion neurons of rat using patch-clamp method in the whole-cell recording mode. The "use-dependent" block of ACh current by Tc was revealed in the experiments with ACh applications, indicating that Tc blocked the channels opened by ACh. Mean lifetime of Tc-open channel complex, tau, was found to be 9.8 +/- 0.5 s (n = 7) at -50 mV and 20-24 degrees C. tau exponentially increased with membrane hyperpolarization (e-fold change in tau corresponded to the membrane potential shift by 61 mV). Inhibition of the ACh-induced current by Tc (3-30 microM/1) was completely abolished by membrane depolarization to the level of 80-100 mV. Inhibition of ACh-induced current was augmented at increased ACh doses. It is concluded that the open channel block produced by Tc is likely to be the only mechanism for Tc action on nicotinic acetylcholine receptors in superior cervical ganglion neurons of rat.     

The effect of age of onset of PD on risk of dementia

Background Dementia occurs in the majority of patients with Parkinson’s disease (PD). Late onset of PD has been reported to be associated with a higher risk for dementia. However, age at onset (AAO) and age at baseline assessment are often correlated. The aim of this study was to explore whether AAO of PD symptoms is a risk factor for dementia independent of the general effect of age. Methods Two community-based studies of PD in New York (n = 281) and Rogaland county, Norway (n = 227) and two population-based groups of healthy elderly from New York (n = 180) and Odense, Denmark (n = 2414) were followed prospectively for 3–4 years and assessed for dementia according to DSM-IIIR. All PD and control cases underwent neurological examination and were followed with neurological and neuropsychological assessments. We used Cox proportional hazards regression based on three different time scales to explore the effect of AAO of PD on risk of dementia, adjusting for age at baseline and other demographic and clinical variables. Findings In both PD groups and in the pooled analyses, there was a significant effect of age at baseline assessment on the time to develop dementia, but there was no effect of AAO independent of age itself. Consistent with these results, there was no increased relative effect of age on the time to develop dementia in PD cases compared with controls. Interpretation This study shows that it is the general effect of age, rather than AAO that is associated with incident dementia in subjects with PD. Received in revised form: 22 December 2005     

Limits of deinstitutionalization--perspectives of relatives of psychiatric patients

After a hopeful beginning, the social process of the reintegration of those with severe mental illness has come to a standstill. I am led to wonder whether "the community" really wants to live together with people suffering from severe mental illness, and if so, how closely? As long as the medical treatment of mental illness provided by the general practitioners is fundamentally deficient, as they are not able to prescribe the necessary interventions--such as out-patient psychiatric nursing, and service providers in the out-patient sector are content with offering increasingly intensive forms of care for the less seriously ill at the cost of the Social Welfare System--the reintegration of those with serious mental illness remains an illusion--which is mainly to the benefit of providers of residential care in homes and hostels.     

Denervation study of synapses of organ of corti of old world monkeys

Fine structural characteristics of synapses in the spiral organ of Corti were examined, with reference to differences between inner and outer haircell systems, and to location of neurons of origin of efferent axons. Surgical interruption of crossed olivocochlear bundle, of vestibular nerve, of facial nerve, and excision of superior cervical ganglia were used to determine the pathways of efferent axons. Interruption of the vestibular nerve near the brainstem results in degeneration of all efferent terminals on outer hair cells. Mid-line lesions at, and caudal to, the facial colliculus result in degeneration of about half of these efferent terminals. Efferent synaptic bulbs to the inner hair-cell system are small, of the order of one micron, and form type 2 junctions with afferent dendrites. They tend to have more large dense-core vesicles (about 80 nm) than the large efferent terminals of the outer hair-cell system, and appear to be the terminals of axons in the habenula perforata, which exhibit varicosities laden with large dense core vesicles. The varicosities are unaffected by excision of the superior cervical ganglia. So far as our material can reveal, it appears that the varicosities in the habenula perforata do not survive vestibular root interruption, nor do the efferent processes in the internal spiral bundle or at the base of inner hair cells. Most interestingly, the afferent processes of the inner hair-cell system, as identified for example by their relation to pre-synaptic bodies in the inner hair cells, are subject to a trans-synaptic reaction after severance of the vestibular root. They undergo a dramatic cytological transformation, characterized by increase of volume, engorgement with microtubules, microfilaments, microvesicles of various sizes, and clusters of lysosomes. Thus, both the efferent and afferent terminals of the inner hair-cell system show marked cytological differences from the corresponding terminals of the outer hair cell system.     

Summary of legislation of 1935 of interest to the department of Mental Hygiene

Psychiatric Quarterly -