2023 年第 1 期 第 18 卷

帕金森病合并脑微出血患者的认知和运动功能差异及其影响因素分析

Differences and influencing factors of cognitive and motor function in Parkinson′s disease patients complicated with cerebral microbleeds

作者：王伟曹庆华孙光玲应涛苏杭

英文作者：Wang Wei Cao Qinghua Sun Guangling Ying Tao Su Hang

单位：宁波大学医学院附属医院脑科中心，宁波315020

英文单位：Brain Center the Affiliated Hospital of Medical School Ningbo University Ningbo 315020 China

关键词：帕金森病；脑微出血；认知功能；运动功能

英文关键词：Parkinson′sdisease;Cerebralmicrobleeds;Cognitivefunction;Motorfunction

• 摘要：

• 目的  探讨帕金森病合并脑微出血患者的认知及运动功能差异及其影响因素。方法 选择2016年2月至2019年6月宁波大学医学院附属医院收治的原发性帕金森病患者256例为研究对象。根据患者是否合并脑微出血分为非脑微出血组（214例）及脑微出血组（42例）。所有患者均采用简易智力状态检查量表（MMSE）评估认知功能，以统一帕金森病评定量表Ⅲ（UPDRS Ⅲ）、Hoehn & Yahr分期评估其运动功能，Logistic回归方法分析认知功能的影响因素。分析脑微出血与认知功能和运动功能的关系。结果 脑微出血组MMSE评分定向力、注意力和计算力、语言能力项得分及总分低于非脑微出血组（均P<0.01），认知功能障碍（轻、中、重度）比例高于非脑微出血组［83.3%（35/42）比55.6%（119/214）］（P<0.05）。脑微出血组帕金森病患者UPDRS Ⅲ评分震颤、肌强直、运动迟缓、轴性运动症状项得分及总分均高于非脑微出血组（均P<0.01），中、重度运动障碍比例高于非脑微出血组［57.1%（24/42）比37.4%（80/214）］（P<0.05）。二元Logistic回归分析结果显示，侧脑室周围白质病变及深部白质病变Fazekas评分和UPDRS Ⅲ评分为帕金森病患者认知和运动功能的影响因素（均P<0.05）。排除年龄、高血压等混杂因素后，脑微出血与MMSE评分呈显著负相关（r=-0.245，P<0.001），与UPDRS Ⅲ评分呈显著正相关（r=0.308，P<0.001）。结论 帕金森病并发脑微出血患者认知功能及运动功能均较差，且其脑白质损害程度更严重，Fazekas和UPDRS Ⅲ评分是以上差异的影响因素。

• Objective To explore the differences and influencing factors of cognitive and motor function in Parkinson′s disease(PD) patients complicated with cerebral microbleeds(CMB). Methods A total of 256 patients with primary PD who were admitted to the Affiliated Hospital of Medical School, Ningbo University from February 2016 to June 2019 were selected as the research subjects. According to whether the patients had CMB or not, they were divided into the non-CMB group(214 cases) and the CMB group(42 cases). Cognitive function was assessed by Mini-Mental State Examination(MMSE) in all patients, and motor function was assessed by Unified Parkinson′s Disease Rating Scale Ⅲ(UPDRS Ⅲ) and Hoehn & Yahr stage. Logistic regression analysis was used to analyze the influencing factors of cognitive function. The relationship of CMB to cognitive function and motor function was analysis. Results The orientation, attention and calculation, language ability scores and the total score of MMSE in the CMB group were lower than those in the non-CMB group(all P<0.01), and the proportion of cognitive dysfunction (mild, moderate and severe) was higher than that in the non-CMB group［83.3%(35/42) vs 55.6%(119/214)］(P<0.05). The tremor, myotonia, motor retardation, axial motor symptoms scores and the total UPDRS Ⅲ score in the CMB group were higher than those in the non-CMB group(all P<0.01), and the proportion of moderate to severe motor disorders was higher than that in the non-CMB group［57.1%(24/42) vs 37.4%(80/214)］(P<0.05). Bivariate  Logistic regression analysis showed that Fazekas score of white matter lesions around lateral ventricle and deep white matter lesions and UPDRS Ⅲ score were influencing factors of cognitive and motor functions  in patients with PD(all P<0.05). After excluding confounding factors such as age and hypertension, CMB was negatively correlated with MMSE score(r=-0.245, P<0.001) and was positively correlated with UPDRS Ⅲ score(r=0.308, P<0.001). Conclusion PD patients complicated with CMB have poor cognitive and motor function, and the degree of white matter lesions of them is serious, the Fazekas score and UPDRS Ⅲ score were influencing factors for above differences.