中国神经再生研究(英文版) ›› 2021, Vol. 16 ›› Issue (7): 1336-1343.doi: 10.4103/1673-5374.301029

• 原著:退行性病与再生 • 上一篇    下一篇

短期多学科强化训练帕金森病不同运动亚型患者:3个月随访前瞻性队列研究

  

  • 出版日期:2021-07-15 发布日期:2021-01-07
  • 基金资助:
    国家重点研究与发展计划子项目(2018YFC0115405);中国首都医科大学北京康复医院科研人才创业基金(2019R-006)

Efficacy of short-term multidisciplinary intensive rehabilitation in patients with different Parkinson’s disease motor subtypes: a prospective pilot study with 3-month follow-up 

Ke-Ke Chen1, #, Zhao-Hui Jin2, #, Lei Gao2, Lin Qi2, Qiao-Xia Zhen2, Cui Liu2, Ping Wang2, Yong-Hong Liu2, Rui-Dan Wang2, Yan-Jun Liu2, Jin-Ping Fang2, Yuan Su2, #br# Xiao-Yan Yan3, Ai-Xian Liu2, Bo-Yan Fang2, *#br#   

  1. 1 Beijing Rehabilitation Medical College, Capital Medical University, Beijing, China;  2 Parkinson Medical Center, Beijing Rehabilitation Hospital, Capital Medical University, Beijing, China; 3 Peking University Clinical Research Institute, Beijing, China
  • Online:2021-07-15 Published:2021-01-07
  • Contact: Bo-yan Fang, MD, fangboyanv@ccmu.edu.cn.
  • Supported by:
    This study was supported by the National Key Research and Development Program Sub-project, No. 2018YFC0115405 (to BYF); the Start-up Fund for Scientific Research Talents of Beijing Rehabilitation Hospital, Capital Medical University of China, No. 2019R-006 (to ZHJ). 

摘要:

根据DATATOP帕金森病研究患者的运动分型方法分为姿势不稳/步态障碍型(Postural Instability/Gait Disorder, PIGD)、震颤为主型(Tremor Dominate, TD)和混合型(Indeterminate),3种运动亚型患者的神经病理生理机制存在差异,这可能导致3种患者对治疗的反应不同,试验观察了住院2周以多学科强化康复治疗(Multidisciplinary Intensive Rehabilitation Treatment,MIRT)3种不同运动亚型帕金森病患者的疗效。此项前瞻性队列研究从门诊及网络招募的436例帕金森综合征患者中筛选出H-Y ≤3期的原发性帕金森病患者69例,根据国际运动障碍协会帕金森病统一评定量表(Movement Disorder Society Unified Parkinson’s Disease Rating Scale,MDS-UPDRS)TD/PIGD的比值,将患者分为3组,其中PIGD组36例(TD/PIGD比值≤0.09),TD组19例(TD/PIGD比值≥1.15)以及混合型组14例(TD/PIGD比值0.9-1.15)。所有患者均在住院期间均接受为期2周的MIRT以及远程居家康复的健康教育指导。结果显示:(1)与入院时相比,三组患者出院时的MDS-UPDRS Ⅲ评分、步行能力、平衡和姿势控制均显著改善,其中出院时PIGD组MDS-UPDRS Ⅲ评分的改善优于TD组;(2)收集出院3个月的随访资料,各组患者整体症状改善可以维持1-3个月,各组患者在症状改善的维持以及等级效应上无显著差异;(3)上述结果表明,为期2周的MIRT能够有效改善3种运动分型帕金森病患者的运动功能,PIGD组患者住院期间疗效优于TD,3组患者出院3个月后的维持疗效均差异不显著。

https://orcid.org/0000-0002-9935-433X (Bo-yan Fang)

关键词: 神经退行性变, 帕金森病, 康复, 运动, 震颤, 步态, 平衡, 姿势

Abstract: Parkinson’s disease (PD) can be classified into three motor-based subtypes: postural instability/gait difficulty (PIGD), tremor dominant (TD), and indeterminate. The neuropathophysiological mechanisms of the three motor subtypes are different, which may lead to different responses to therapy. Sixty-nine patients with idiopathic Parkinson’s disease (Hoehn–Yahr stage ≤ 3) were screened from 436 patients with Parkinsonism recruited through outpatient services and the internet. According to the Movement Disorder Society Unified Parkinson’s Disease Rating Scale (MDS-UPDRS) TD/PIGD ratio, the patients were divided into PIGD (TD/PIGD ≤ 0.09; n = 36), TD (TD/PIGD ≥1.15; n = 19), and indeterminate (TD/PIGD = 0.90–1.15; n = 14) groups. All patients received 2 weeks of multidisciplinary intensive rehabilitation treatment (MIRT) during hospitalization, as well as a remote home rehabilitation health education class. Compared with the scores at admission, all patients showed significant improvements in their MDS-UPDRS III score, walking ability, balance, and posture control at discharge. Moreover, the MDS-UPDRS III score improvement was greater in the PIGD group than in the TD group. The follow-up data, collected for 3 months after discharge, showed that overall symptom improvement in each group was maintained for 1–3 months. Furthermore, there were no significant differences in the duration or grade effects of symptom improvement among the three groups. These findings suggest that 2 weeks of MIRT is effective for improving motor performance in all three motor subtypes. Patients in the PIGD group had a better response after hospitalization than those in the TD group. This study was approved by the Institutional Ethics Committee of Beijing Rehabilitation Hospital of Capital Medical University of China (approval No. 2018bkky022) on May 7, 2018 and registered with the Chinese Clinical Trial Registry (registration No. ChiCTR1900020771) on January 19, 2019.

Key words: balance, gait, motor, neurodegeneration, Parkinson’s disease, posture, rehabilitation, tremor