帕金森病疲劳的影响因素及补充维生素D的意义
| 作者: |
1王秀秀,
2田玉玲,
1王芳
1 山西医科大学第一临床医学院，太原 030001 2 山西医科大学第一医院神经内科，太原 030001 |
| 通讯: |
田玉玲
Email: tyl2019wxx@163.com |
| DOI: | 10.3978/j.issn.2095-6959.2021.01.013 |
摘要
目的：研究血清维生素D水平与帕金森病(Parkinson disease，PD)疲劳的关系，以及补充维生素D后疲劳的改善情况。方法：收集2018年11月至2019年8月在山西医科大学第一医院住院部及门诊就诊的39例PD伴疲劳患者，31例PD非疲劳患者，同时收集39例经相关检查无器质性病变的头晕患者作为对照组。收集3组的年龄、性别、血清25(OH)D水平、甲状旁腺激素(parathyroid hormone，PTH)水平、钙离子(calcium ion，Ca2+)水平，以及PD疲劳组和PD非疲劳组的病程、简易精神状态检查量表(Mini-Mental State Examination，MMSE)评分、蒙特利尔认知评估量表(Montreal Cognitive Assessment，MoCA)评分、日常生活能力评定量表(Activities of Daily Living，ADL)评分、汉密尔顿焦虑(Hamilton Anxiety，HAMA)评分、汉密尔顿抑郁(Hamilton Depression，HAMD)评分、情感淡漠评定量表(Modified Apathy Evaluation Scale，MAES)评分、疲劳严重度量表(Fatigue Severity Scale，FSS)评分、统一PD评定量表第3部分(Unified Parkinson Disease Rating Scale Part 3，UPDRS-III)评分、Hoehn-Yahr分级(Hoehn-Yahr，H-Y)、等效左旋多巴剂量(Levodopa Equivalent Doses，LED)等资料，分析PD疲劳的影响因素，给疲劳组维生素D低的患者补充12周1 200 U/d的维生素D滴剂，观察PD疲劳组的疲劳改善情况。结果：PD疲劳组、PD非疲劳组、对照组的维生素D水平差异有统计学意义，遂进行两两组间比较，发现PD疲劳组维生素D水平显著低于对照组[维生素D水平分别为(25.39±16.93) nmol/L，(47.14±22.34) nmol/L，U=–4.342，P<0.001]，PD非疲劳组维生素D水平显著低于对照组[维生素D水平分别为(35.20±17.86) nmol/L，(47.14±22.34) nmol/L，U=–2.276，P=0.023]，PD疲劳组维生素D水平低于PD非疲劳组[(25.39±16.93) nmol/L，(35.20±17.86) nmol/L，U=–2.855，P=0.004]。PD疲劳组的UPDRS-III(32.08±9.44，26.42±8.54，t=–2.598，P=0.011)、H-Y分级[2(2，3)，2(1.5，2)，U=–2.831，P=0.005]、汉密尔顿焦虑评分(12.18±3.84，9.29±4.76，t=–2.814，P=0.006)、汉密尔顿抑郁评分(11.03±4.09，8.61±5.21，t=–2.171，P=0.033)、情感淡漠评定量表评分(14.62±9.20，10.26±6.58，t=–2.222，P=0.030)均高于PD非疲劳组。根据影响PD疲劳的相关因素分析，结果显示PD疲劳与维生素D水平(r=–0.239，P=0.046)、病程(r=0.386，P=0.001)、UPDRS-III评分(r=0.260，P=0.030)、H-Y分级(r=0.297，P=0.013)、HAMA(r=0.275，P=0.021)、HAMD(r=0.303，P=0.011)相关。Logistic回归分析显示UPDRS-III评分为PD疲劳患者的独立危险因素(OR=1.103，P=0.003)，维生素D水平是PD疲劳的独立保护因素(OR=0.961，P=0.015)。补充维生素D前后疲劳分数的比较发现差异无统计学意义(t=1.880，P=0.069)。结论：维生素D水平虽然是PD疲劳的独立保护因素，但短期补充维生素D不能改善疲劳症状。
关键词：
帕金森病；疲劳；维生素D
Influential factors for fatigue of Parkinson’s disease and the significance of vitamin D supplementation
CorrespondingAuthor: TIAN Yuling Email: tyl2019wxx@163.com
DOI: 10.3978/j.issn.2095-6959.2021.01.013
Abstract
Objective: To study the correlation between serum vitamin D levels and fatigue in Parkinson disease (PD), and the improvement of fatigue after vitamin D supplementation. Methods: Admitted to the First Hospital of Shanxi Medical University from November 2018 to August 2019, 39 patients with PD-related fatigue and 31 patients without PD-related fatigue were enrolled in this study. Thirty-nine patients with dizziness but no organic diseases after examinations served as the control group. We collected patient data in terms of age, gender, serum 25(OH)D level, parathyroid hormone (PTH) level, calcium ion (Ca2+) level in all groups. In both PD groups, duration of patient suffering with PD, Mini-Mental State Examination (MMSE) Scale score, Montreal Cognitive Assessment (MoCA) Scale score, Activities of Daily Living (ADL) Scale score, Hamilton Anxiety (HAMA) Scale, Hamilton Depression (HAMD) Scale, Modified Apathy Evaluation Scale (MAES) score, Fatigue Severity Scale (FSS) score, Unified Parkinson Disease Rating Scale Part 3 (UPDRS-III) score, Hoehn-Yahr rating (H-Y) and Levodopa Equivalent Doses (LED) were also collected as to analyze factors influencing PD-related fatigue. PD-related fatigue group was supplemented with vitamin D drops of 1 200 U/d for 12 weeks, and the fatigue improvement was observed. Results: Vitamin D levels among three groups were statistically significant. A comparison between each two groups revealed that vitamin D levels in PD-related fatigue group were significantly lower than those in the control group [vitamin D levels were (25.39±16.93) nmol/L, (47.14±22.34) nmol/L, U=–4.342, P<0.001]; vitamin D levels in the PD non-fatigue group were lower than those in the control group [vitamin D levels were (35.20±17.86) nmol/L, (47.14±22.34) nmol/L, U=–2.276, P=0.023]; the vitamin D level in the PD-related fatigue group was lower than that in the PD non-fatigue group [(25.39±16.93) nmol/L, (35.20±17.86) nmol/L, U=–2.855, P=0.004]. In PD-related fatigue group, UPDRS-III (32.08±9.44, 26.42±8.54, t=–2.598, P=0.011), H-Y stage [2 (2, 3), 2 (1.5, 2), U=–2.831, P=0.005], HAMA score (12.18±3.84, 9.29±4.76, t=–2.814, P=0.006), HAMD score (11.03±4.09, 8.61±5.21, t=–2.171, P=0.033) and MAES score (14.62±9.20, 10.26±6.58, t=–2.222, P=0.030) were higher than those in the PD non-fatigue group. Analysis showed that PD-related fatigue was related to vitamin D level (r=–0.239, P=0.046), duration of patient suffering with PD (r=0.386, P=0.001), UPDRS-III score (r=0.260, P=0.030), H-Y stage (r=0.297, P=0.013), HAMA (r=0.275, P=0.021) and HAMD (r=0.303, P=0.011). Logistic regression analysis showed that UPDRS-III score was an independent risk factor for patients with PD-related fatigue (OR=1.103, P=0.003), and vitamin D level was an independent protective factor for PD-related fatigue (OR=0.961, P=0.015). Comparison of fatigue scores before and after vitamin D supplementation found no significant difference (t=1.880, P=0.069). Conclusion: Although vitamin D level is an independent protective factor for PD-related fatigue, short-term vitamin D supplementation does not improve fatigue symptoms.
Keywords：
Parkinson’s disease; fatigue; vitamin D