本文選題：帕金森病 + 便秘　； 參考：《蘇州大學(xué)》2016年碩士論文

【摘要】：研究背景:帕金森病(Parkinson’s Disease,PD)是一種中老年常見(jiàn)的神經(jīng)變性疾病,其臨床表現(xiàn)具有高度異質(zhì)性。不同PD患者表型不同,非運(yùn)動(dòng)癥狀及臨床進(jìn)展各異。有學(xué)者認(rèn)為不同PD亞型其發(fā)病機(jī)制和病理生理過(guò)程存在差異。便秘是PD常見(jiàn)的非運(yùn)動(dòng)癥狀,但其在PD病程中出現(xiàn)與否、出現(xiàn)的時(shí)間在個(gè)體PD患者中表現(xiàn)較大差異。目的:本研究旨在初步探討便秘與運(yùn)動(dòng)癥狀發(fā)生的關(guān)系,并分析可能的機(jī)制。方法:收集2014年5月至2015年5月在蘇州大學(xué)附屬第二醫(yī)院PD專(zhuān)科門(mén)診就診的PD患者的一般資料。對(duì)所有PD患者進(jìn)行帕金森病統(tǒng)一評(píng)分量表(Unified Parkinson's disease Rating Scale,UPDRS)第三部分評(píng)分及簡(jiǎn)易智力狀態(tài)檢查量表(mini-mental state examination,MMSE)評(píng)估。根據(jù)便秘羅馬Ⅲ診斷標(biāo)準(zhǔn),分為PD合并便秘組與PD不合并便秘組;根據(jù)便秘與運(yùn)動(dòng)癥狀出現(xiàn)時(shí)間的先后順序?qū)D伴便秘組再分為便秘PD(便秘發(fā)生在PD運(yùn)動(dòng)癥狀之前)及便秘PD(在PD運(yùn)動(dòng)癥狀出現(xiàn)之后出現(xiàn)便秘)。對(duì)PD合并便秘組與PD不合并便秘組、便秘PD組與便秘PD的一般人口資料及運(yùn)動(dòng)癥狀特征進(jìn)行組間比較,并分析PD合并便秘的影響因素。結(jié)果:158例PD患者,伴便秘患者96例(60.8%),不伴便秘的患者62例(39.2%),便秘發(fā)生于運(yùn)動(dòng)癥狀前的患者41例(42.7%),便秘發(fā)生于運(yùn)動(dòng)癥狀之后的患者共55例(57.3%)。與不伴便秘的PD患者比較,伴便秘的PD患者每日左旋多巴等效劑量大[350(150~500)mg/d比300(19~413)mg/d,z=-2.113,P=0.035],UPDRSⅢ總分更高[(22±10)分比(18±9)分,t=-2.693,P=0.008],伴便秘較不伴便秘的PD患者中軸分、姿勢(shì)步態(tài)分高[(6.8±3.4)分比(4.3±2.5)分,t=-4.887,P=0.000;(3.9±2.4)分比(2.4±1.5)分,t=-4.529,P=0.000],中軸分及姿勢(shì)步態(tài)分分別在UPDRSⅢ總分中所占的比例大(32%±11%比25%±12%,t=-3.485,P=0.001;18%±9%比15%±10%,t=-2.278,P=0.024),中軸癥狀及姿勢(shì)步態(tài)癥狀進(jìn)展快[0.147(0.100~0.248)分/月比0.121(0.058~0.222)分/月,z=-2.085,P=0.037;0.08(0.05~0.14)分/月0.07(0.03~0.11)分/月,z=-2.052,P=0.04],其他亞運(yùn)動(dòng)癥狀分及運(yùn)動(dòng)癥狀進(jìn)展組間比較差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。運(yùn)動(dòng)癥狀出現(xiàn)前出現(xiàn)便秘的患者與運(yùn)動(dòng)癥狀出現(xiàn)后出現(xiàn)便秘的PD患者比較,中軸分及姿勢(shì)步態(tài)分在UPDRSⅢ總分中占的比例高(35%±11%比30%±10%,t=2.167,P=0.033;21%±9%比16%±8%,t=2.733,P=0.008),中軸癥狀及姿勢(shì)步態(tài)癥狀的進(jìn)展更快[0.174(0.120~0.286)分/月比0.123(0.089~0.229)分/月,z=-1.974,P=0.048;0.10(0.07~0.17)分/月比0.07(0.05~0.12)分/月,z=-2.530,P=0.011],起病年齡大[(64±8)歲比(61±7)歲,t=2.301,P=0.024],病程短[(41±25)月比(55±37)月,t=-2.274,P=0.025]。非條件二分類(lèi)Logistic回歸分析顯示,中軸分是PD發(fā)生便秘的影響因素(P=0.000,OR=1.330)。結(jié)論:伴便秘尤其是在運(yùn)動(dòng)癥狀出現(xiàn)前出現(xiàn)便秘的PD患者中軸癥狀嚴(yán)重,進(jìn)展快。中軸癥狀是PD發(fā)生便秘的影響因素。
[Abstract]:Background: Parkinsonian disease (PD) is a common neurodegenerative disease in the middle and old age, and its clinical manifestations are highly heterogeneous. Different PD patients have different phenotypes, non-motor symptoms and clinical progress. Some scholars believe that the pathogenesis and pathophysiological process of different PD subtypes are different. Constipation is a common non-motor symptom of PD, but it appears or not in the course of PD, and the time of constipation is different in individual PD patients. Objective: to explore the relationship between constipation and motor symptoms and analyze the possible mechanism. Methods: from May 2014 to May 2015, the general data of PD patients in the second affiliated Hospital of Suzhou University were collected. All PD patients were evaluated with Unified Parkinson's disease Rating scale (Unified Parkinson's disease Rating scale) and mini-mental state examination scale (MMSE). According to the Rome 鈪，

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