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重庆医科大学附属第二医院神经内科
纸质出版日期:2020,
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都俊聪, 周璇, 姜瑾, 等. 帕金森病患者自杀风险相关影响因素的研究[J]. 保健医学研究与实践, 2020,17(1):5-8.
Du Juncong, Zhou Xuan, Jiang Jin, et al. Study on the risk factors for suicide among patients with Parkinson’s disease[J]. Health Medicine Research and Practice, 2020,17(1):5-8.
目的探讨帕金森病(PD)患者自杀风险相关影响因素。方法本研究选取2017年6月-2019年10月于重庆市某医院门诊就诊或住院治疗的123例PD患者为研究对象。根据汉密尔顿抑郁量表中自杀维度的评分结果分为无自杀意念组(自杀评分=0
n=77)和有自杀意念组(自杀评分>0
n=46)。比较2组患者的年龄、性别构成、病程、起病年龄、左旋多巴等效剂量、运动及非运动症状、Hoehn-Yahr分期(H-Y分期)、PD药物使用情况、心理状态、睡眠质量及日常生活能力等
并探讨影响患者自杀风险的相关因素。结果 2组患者的性别构成、病程、年龄、H-Y分期、左旋多巴等效剂量等比较
差异无统计学意义(P>0.05)。有自杀意念组患者汉密尔顿焦虑量表、汉密尔顿抑郁量表、帕金森病综合评分量表(UPDRS)及左旋多巴冲击后UPDRS-Ⅲ评分中位数分别为18.0
22.0
37.0及22.0
高于无自杀意念组的6.0
10.0
24.0及15.0
差异均有统计学意义(P<0.05)。有自杀意念组患者蒙特利尔认知评估量表(MoCA)评分中位数为18.0
低于无自杀意念组的21.0
差异有统计学意义(P<0.05)。有自杀意念组患者帕金森病患者生活质量问卷(PDQ39)中家务困难、洗澡困难、穿衣困难、扣纽扣系鞋带困难、感到焦虑、替自己的将来担忧、不想让人知道患有PD、尽量避免公众场合进餐、在公众场合感到尴尬、担心别人对自己患病的反应、觉得被忽视等项目评分高于无自杀意念组
差异均有统计学意义(P<0.05)
而2组患者PDQ39总分比较
差异无统计学意义(P>0.05)。Logistic二元回归分析结果显示
汉密尔顿抑郁量表、MoCA及UPDRS评分是PD患者自杀风险的影响因素(P<0.05)。结论抑郁、认知功能降低及PD患者症状尤其是非运动症状会增加患者自杀风险。因此
推荐临床上使用MoCA或更为全面的认知功能评价量表对PD患者的认知功能进行评估。同时
临床上应对PD患者开展常规的抑郁、认知功能及非运动症状评估
并根据评估结果制定包括健康教育、药物治疗、心理疏导等在内的干预措施
降低患者自杀风险。
Objective To determine factors influencing the risk of suicide among patients with Parkinson′s disease(PD).Methods A total of 123 in-and out-patients with PD who were treated in a hospital in Chongqing from June 2017 to October 2019 were selected as the research subjects.According to the scores for item "suicide"in the Hamilton Depression Rating Scale(HAM-D)
they were divided into the non-suicidal group(suicide score=0
n=77)and the suicidal group(suicide score>0
n=46).The age and sex composition
course of disease
age of onset
equivalent dose of levodopa
motor and non-motor symptoms
Hoehn-Yahr(H-Y)stage
use of PD drugs
mental state
sleep quality
and daily living performance of the two groups were compared to provide basis for determining factors affecting the risk of suicide among patients.Results There were no significant differences in the age and sex composition
course of disease
H-Y stage
and equivalent dose of levodopa between the two groups(P>0.05).The median scores on the Hamilton Anxiety Rating Scale(HAM-A)
HAM-D
the Unified Parkinson′s Disease Rating Scale(UPDRS)
and the UPDR-Ⅲafter levodopa challenge of the suicidal group were 18.0
22.0
37.0
and 22.0
respectively
all significantly higher than those of the non-suicidal group
which were 6.0
10.0
24.0
and 15.0
respectively(P<0.05).The median score on the Montreal Cognitive Assessment(MoCA)of suicidal patients was 18.0
which was lower than 21.0 of the non-suicidal patients
and the difference was statistically significant(P<0.05).Whereas there was no significant difference in the total score on the Parkinson′s Disease Questionnaire(PDQ-39)between the two groups(P>0.05)
patients in the suicidal groups had significantly higher scores for the following questions:’Had difficulty looking after your home?’’Had difficulty washing yourself?’’Had difficulty dressing yourself?’’Had difficulty doing up your shoe laces?’’Felt anxious?’’Felt worried about your future?’’Felt you had to conceal your Parkinson′s from people?’’Avoided situations which involve eating or drinking in public?’’Felt embarrassed in public due to having Parkinson′s disease?’’Felt worried by other people’s reaction to you?’’Felt ignored by people?’(P<0.05).Logistic binary regression analysis showed that scores on HAM-D
MoCA
and UPDRS were factors influencing the risk of suicide among PD patients(P<0.05).Conclusion Depression
cognitive decline
and symptoms
especially non-motor symptoms of PD can increase the risk of suicide among PD patients.Therefore
it is recommended to use MoCA or a more comprehensive cognitive function assessment scale to evaluate the cognitive function of PD patients.At the same time
patients with PD should be routinely evaluated for depression
cognitive function
and non-motor symptoms
and interventions including health education
medication
and psychological counseling should be formulated based on the results of the assessment to reduce the risk of suicide.
帕金森病自杀抑郁睡眠认知损害生活质量神经系统变性疾病
Parkinson′s diseasesuicidedepressionSleepCognitive impairmentQuality of lifeNeurodegenerative disease
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