摘要目的 中长期随访分析帕金森病(parkinson's disease,PD)患者抑郁症状的变化及对生活质量的影响,探讨PD患者生活质量下降的预测因素. 方法 检索本研究中心PD患者电子数据库,纳入一般信息、统一帕金森病评定量表(UPDRS)、H-Y分期、简易精神状态量表(MMSE)、汉密尔顿抑郁量表(HAMD)、汉密尔顿焦虑量表(HAMA)、帕金森病生活质量问卷(PDQ-39)等评分完整且完成1年随访的PD患者80例,分析无抑郁组(38例)、抑郁缓解组(22例)、抑郁组(20例)间PD患者生活质量的差异.4年后随访评估,比较基线伴抑郁和不伴抑郁患者疾病进展和生活质量下降的差异.依据PDQ-39变化值,应用聚类分析法将患者重新分为生活质量下降快组(18例)和下降慢组(32例),分析生活质量快速下降的相关因素.Logistic回归探讨PD患者生活质量下降的独立预测因素. 结果 抑郁组患者随访末生活质量较基线下降(P=0.017).抑郁组PDQ-39评分高于无抑郁组和抑郁缓解组患者.4年随访末患者UPDRS总分、UPDRSⅢ评分、H-Y分级、PDQ-39评分均较基线增加(P＜0.05),且PD伴抑郁组患者生活质量下降更显著、病情进展更快.生活质量下降快组和下降慢组比较,病程、UPDRS总分、H-Y分期、HAMD评分差异有统计学意义(P值分别为0.001、0.039、0.003、＜0.001).Logistic回归分析结果显示,病程(OR=1.254,P=0.020)、基线HAMD评分(OR=1.450,P=0.003)是生活质量下降的独立危险因素. 结论 PD伴抑郁患者生活质量较抑郁缓解和无抑郁患者差.PD伴抑郁的患者病情进展更快,生活质量下降更显著.病程和抑郁对PD患者生活质量的下降有预测价值.

abstractsObjective To analyze the impact of depressive symptoms on quality of life in patients with Parkinson's disease(PD)based on middle-and long-term follow-up study,and to explore predictors for the reduced quality of life in PD patients.Methods Clinical data of 80 PD patients were searched from the electronic database in our research center.Patients who had complete general information and the following data of unified Parkinson's disease rating scale(UPDRS),Hoehn and Yahr scale(HY),mini-mental state examination(MMSE),Hamilton depression rating scale(HAMD),Hamilton rating scale for anxiety(HAMA),the 39-item Parkinson's disease questionnaire(PDQ-39),etc.after one-year follow-up were included in this study.The differences in quality of life were analyzed and compared among the non-depression group (n =38),depression remission group (n =22) and depression group(n=20).A follow-up visit was conducted after four years.The disease progression and decline in quality of life were compared between the depression and non-depression groups according to the baseline value of the Hamilton Depression Rating Scale.According to the change in PDQ-39 value,cluster analysis was used to reclassify patients into fast-decline group and slow-decline group.Logistic regression analysis was used to determine independent risk factors for the decline of quality of life.Results At the end of 1 year follow-up,the quality of life was decreased in the depression group as compared with the baseline(P =0.017),and the score of PDQ-39 was higher in the depression group than in the non-depression group and depression remission group.At the end of 4-year follow-up,UPDRS total score,UPDRSⅢ score,HY stage and PDQ-39 score were increased as compared with the baseline,the quality of life decreased more significantly,and the disease progressed faster in the depression group than the other two groups(P ＜0.05).The differences in the disease course,total score of UPDRS,HY stage and HAMD score were statistically significant between the fast-decline group and slow-decline group(P =0.001,0.039,0.003 and ＜0.001,respectively).Logistic regression analysis showed that disease course (OR =1.254,P =0.020),and baseline HAMD score (OR =1.450,P =0.003) were the independent risk factors for the decline of quality of life.Conclusions The quality of life of PD patients is worse in the depression group than in the depression remission group and non-depression group.In PD patients with depressive symptoms,the illness progression is faster,and the quality of life is decreased more significantly.The disease course and depression can predict the decline of quality of life in PD patients.