黄运强++蒋爱忠

[摘要] 目的 探讨帕金森病患者血糖和左心室射血分数（LVEF）的变化及其与预后的关系。 方法 选取2010年10月～2012年10月广东省河源市人民医院（以下简称“我院”）收治的帕金森病患者48例作为观察组，另选取30例我院同期健康查体者作为对照组。检测两组空腹血糖（FBG）、LVEF和洛文斯顿作业疗法认知评定量表（LOTCA）得分。观察组患者均接受相应的治疗和为期2年的随访。比较治疗前后观察组FBG和LVEF水平变化、LOTCA得分变化及患者病死率，分析观察组FBG和LVEF水平与LOTCA得分及病死率的关系，并采用ROC曲线分析观察组FBG和LVEF水平对其预后和认知功能损伤的预测价值。 结果 与对照组比较，观察组治疗前FBG水平升高，LVEF水平下降；治疗1个月和3个月FBG均较治疗前下降，LVEF和LOTCA得分则均较治疗前升高，差异有统计学意义（P < 0.05）。观察组患者病死率为8.33%，且死亡患者FBG水平均高于存活患者，LVEF则低于存活患者（P < 0.05）。Pearson相关性分析结果显示，帕金森病患者LVEF与其LOTCA得分呈弱相关（r = 0.279，P < 0.05），FBG与其LOTCA得分则均呈显著负相关（r = -0.876，P < 0.05）。进一步ROC曲线分析结果显示，帕金森病患者FBG及LVEF联合预测其认知功能损伤和不良预后的曲线下面积、灵敏度和准确性均较高。 结论 帕金森病患者FBG和LVEF水平均与认知功能损伤和预后相关，且对其预后的预测价值良好，这可能与高血糖水平造成神经损伤和帕金森病患者心脑血管系统继发性改变相关。因此帕金森病患者FBG升高和LVEF降低时需警惕其不良预后的发生并及时干预以改善患者预后。

[关键词] 帕金森病；血糖；左心室射血分数；预后

[中图分类号] R742.5 [文献标识码] A [文章编号] 1673-7210（2015）05（b）-0066-05

Change of blood glucose and left ventricular ejection fraction of patients with Parkinson disease and its relationship with prognosis

HUANG Yunqiang JIANG Aizhong

Department of Neurology， Heyuan People's Hospital， Guangdong Province， Heyuan 517300， China

[Abstract] Objective To study the change of fasting blood-glucose （FBG） and left ventricular ejection fraction （LVEF） of patients with Parkinson disease and its relationship with prognosis. Methods 48 patients with Parkinson disease in Heyuan People's Hospital （“our hospital” for short） from October 2010 to October 2012 were randomly selected as observation group. 30 healthy persons who had physical exam in our hospital in the same period were selected as the control group. FBG， LVEF and LOTCA score of two groups were detected. Observation group was treated accordingly and received two-year follow-up. FBG， LVEF and LOTCA score change and mortality of two groups were compared. Relationship between FBG， LVEF， LOTCA score and mortality of observation group were analyzed by Pearson method and ROC curve was used in analyzing value of FBG and LVEF predicting prognosis of patients. Results Compared with control group， FBG levels of observation group before treatment was higher， while LVEF was lower； after 1 month and 3 months treatment， FBG of observation group was decreased， while the LVEF and LOTCA score were increased， and the differences were statistically significant （P < 0.05）. Mortality rate of observation group was 8.33%， and the FBG level of death patients was higher than that of survived patients， while LVEF of death patients was lower than that of survived patients （P < 0.05）. Pearson correlation analysis results showed that， the LVEF and LOTCA score was weakly correlated （r = 0.279， P < 0.05）， FBG and LOTCA scores were significantly negatively correlated （r = -0.876， P < 0.05）. ROC curve analysis showed that， FBG and LVEF combined forecasting its cognitive function prognosis had high area under the curve， sensitivity and accuracy. Conclusion FBG and LVEF of patients with Parkinson disease are related to its cognitive impairment and prognosis and value of FBG and LVEF forecasting prognosis is good， it may be related with impact on nerve damage of high blood glucose levels and heart head blood-vessel system secondary change of Parkinson disease. Thus FBG raise and LVEF lower in patients with Parkinson disease should be alert to its poor prognosis and timely intervention to improve the prognosis of patients.

[Key words] Parkinson disease； Blood sugar； LVEF； Prognosis

帕金森病又称震颤麻痹，以黑质多巴胺神经元变性和纹状体多巴胺递质减少为主要特征，其患者可出现运动过缓、肌强直、感觉障碍、认知功能障碍等症状，严重患者亦可出现残疾、死亡等不良预后[1-2]。明确帕金森病的特点并对其患者预后进行早期预测及改善患者的预后具有重要意义。黄静等[3]研究表明，帕金森病患者可存在不同程度的血糖水平升高，且患者认知功能障碍可能与其血糖水平相关。Harnod等[4]研究结果则显示帕金森病患者的心率变异性可出现改变。提示血糖水平和心功能变化可能与帕金森病患者的病情发展相关。……