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目的探究幻觉在帕金森病(PD)患者中的发生率及其临床相关因素。方法连续纳入2013年6月到2016年11月四川大学华西医院神经内科就诊的PD患者518例。收集详细的临床资料,并进行一系列量表评估,包括统一帕金森病评估量表(UPDRS)、帕金森病生活质量问卷-39(PDQ-39)、非运动症状评估量表(NMSS)、汉密尔顿抑郁量表(HAMD)、汉密尔顿焦虑量表(HAMA)、额叶功能评估量表(FAB)及蒙特利尔认知功能评估量表(MoCA)。将患者分成幻觉组和非幻觉组,比较两组患者的人口统计学资料、临床资料及各个量表的评分并进行多因素分析。结果 49例(9.5%)PD患者出现幻觉症状;幻觉组患者的年龄、病程、左旋多巴等效日剂量、多巴胺受体激动剂的使用率、UPDRS运动评分、H&Y分级及症状波动和异动症的发生率均显著高于非幻觉组(P<0.05);而校正相关混杂因素后,幻觉组患者的NMSS总分及各亚项评分、HAMD总分、HAMA总分及PDQ-39总分均显著高于非幻觉组(P<0.05),但两组FAB总分和MoCA总分差异无统计学意义;向前的二元Logistic回归模型显示,病程(OR=1.142,P<0.001)、NMSS量表中的泌尿系统症状评分(OR=1.058,P=0.001)及HAMA评分(OR=1.058,P=0.009)与PD患者幻觉的发生有关。结论 PD患者出现幻觉并不少见,其出现可能会降低患者生活质量;病程较长的PD患者更容易出现幻觉;PD患者出现幻觉与运动症状无关,可能与某些非运动症状(如泌尿系统症状及焦虑)有关。
Objective To investigate the incidence of hallucinations in patients with Parkinson’s disease (PD) and its related clinical factors. Methods A total of 518 patients with PD were enrolled in the Department of Neurology, West China Hospital, Sichuan University from June 2013 to November 2016. Detailed clinical data were collected and a series of scales were evaluated including the UPDRS, PDQ-39, NMSS, HAMD, HAMA, FAB and MoCA. The patients were divided into hallucination group and non-hallucination group. The demographic data, clinical data and scores of each scale were compared and analyzed by multivariate analysis. RESULTS: Hallucinations were found in 49 patients (9.5%) with PD. The age, duration of disease, equivalent daily dose of levodopa, dopamine receptor agonist use rate, UPDRS score, H & Y score, and symptoms and signs and symptoms (P <0.05). After adjusting for related confounding factors, the NMSS score, sub-item score, HAMD score, HAMA score and PDQ-39 score in the hallucination group were significantly higher than those in the non-hallucination group (P <0.05), but there was no significant difference between the two groups in FAB score and MoCA score. The forward binary logistic regression model showed that the duration of disease (OR = 1.142, P <0.001), NMSS Urinary symptoms scale (OR = 1.058, P = 0.001) and HAMA score (OR = 1.058, P = 0.009) were related to the occurrence of hallucinations in PD patients. Conclusion PD patients with hallucinations are not uncommon, their appearance may reduce the quality of life of patients; PD patients with longer duration are more likely to hallucinations; PD patients with hallucinations and motor symptoms have nothing to do with some non-motor symptoms (such as urinary symptoms And anxiety).