帕金森病患者睡眠障碍与褪黑素水平的相关性
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摘要
目的:探讨帕金森病(PD)患者自我报告的睡眠质量与褪黑素(MLT)水平的相关性。方法:选取我院神经内科住院治疗的PD患者117例,根据帕金森病睡眠量表(PDSS)评分结果分为睡眠障碍组71例和非睡眠障碍组46例,采用帕金森病评分量表(UPDRS)和Hoehn-Yahr分期评估两组的病情;检测两组6个时间点血清MLT水平;分析PD患者睡眠障碍的影响因素。结果:(1)睡眠障碍组UPDRS各分量表及总分均高于非睡眠障碍组(P <0. 01);在Hoehn-Yahr分期中,睡眠障碍组Ⅲ期患者所占比例高于非睡眠障碍组,Ⅰ期患者所占比例低于非睡眠障碍组(P <0. 05);(2)睡眠障碍组6:00、10:00、14:00、18:00时血清MTL水平均高于非睡眠障碍组(P <0. 01);(3) Logistic回归分析显示,UPDRS-Ⅲ评分、UPDRS总分及血清MTL水平为PD患者发生睡眠障碍的危险因素(P <0. 05)。结论:存在睡眠障碍的PD患者血清MLT水平升高,其可能是导致PD患者睡眠障碍的因素之一。
Objective: To explore the relationship between sleep disturbance and changes of melatonin level in patients with Parkinson's disease( PD). Methods: One hundred and seventeen patients with PD admitted to the Department of Neurology in our hospital were selected. All subjects were divided into two groups,i. e.,sleep disturbance group( n = 71) and non-sleep disturbance group( n = 46),according to the score of Parkinson's disease sleep scale sleep( PDSS),and the illness state and levels of melatonin( MLT) on 6 time points were assessed and compared between the two groups by united Parkinson's disease rating scale( UPDRS) and Hoehn-Yahr staging and enzyme linked immunosorbent assay( ELISA). Multivariate Logistic Regression was used to analyze the factors influencing sleep disturbance in patients with PD. Results:( 1) Each subscale score and total score in UPDRS were higher in sleep disturbance group than those in non-sleep disturbance group( P < 0. 01),and in Hoehn-Yahr staging,the ratio of Ⅲ staging was higher and the ratio of Ⅰ staging was lower in sleep disturbance group than those in non-sleep disturbance group respectively( P < 0. 05).( 2) The serum MTL levels at 6: 00,10: 00,14: 00,18: 00 were higher in sleep disturbance group than those in non-sleep disturbance group( P < 0. 01).( 3) Multivariate Logistic Regression showed that UPDRS-Ⅲ score,UPDRS total score and serum MTL levels were risk factors for sleep disturbance in patients with PD( P < 0. 05). Conclusion: The serum MTL levels are higher in patients with PD,and MTL may be one of the factors leading to sleep disorders in PD patients.
Objective: To explore the relationship between sleep disturbance and changes of melatonin level in patients with Parkinson's disease( PD). Methods: One hundred and seventeen patients with PD admitted to the Department of Neurology in our hospital were selected. All subjects were divided into two groups,i. e.,sleep disturbance group( n = 71) and non-sleep disturbance group( n = 46),according to the score of Parkinson's disease sleep scale sleep( PDSS),and the illness state and levels of melatonin( MLT) on 6 time points were assessed and compared between the two groups by united Parkinson's disease rating scale( UPDRS) and Hoehn-Yahr staging and enzyme linked immunosorbent assay( ELISA). Multivariate Logistic Regression was used to analyze the factors influencing sleep disturbance in patients with PD. Results:( 1) Each subscale score and total score in UPDRS were higher in sleep disturbance group than those in non-sleep disturbance group( P < 0. 01),and in Hoehn-Yahr staging,the ratio of Ⅲ staging was higher and the ratio of Ⅰ staging was lower in sleep disturbance group than those in non-sleep disturbance group respectively( P < 0. 05).( 2) The serum MTL levels at 6: 00,10: 00,14: 00,18: 00 were higher in sleep disturbance group than those in non-sleep disturbance group( P < 0. 01).( 3) Multivariate Logistic Regression showed that UPDRS-Ⅲ score,UPDRS total score and serum MTL levels were risk factors for sleep disturbance in patients with PD( P < 0. 05). Conclusion: The serum MTL levels are higher in patients with PD,and MTL may be one of the factors leading to sleep disorders in PD patients.
引文
[1]汪跃春,王玉琴,陈翔,等.帕金森病患者伴发疲劳的相关因素的研究[J].东南大学学报(医学版),2017,36(6):915-918.
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[7]卞宏生,李廷利.褪黑素对昼夜节律导致大鼠的睡眠模式和能量代谢变化的干预研究[J].中国药理学通报,2015,31:65-66.
[8] BREEN D P,VUONO R,NAWARATHN A,et al. Sleep and circadian rhythm regulation in early Parkinson disease[J]. JAMA Neuml,2014,71(5):589-595.
[9]HASTINGS M H,REDDY A B,MAYWOOD E S. A clockwork web:circadian timing in brain and periphery,in health and disease[J]. Nat Rev Neurosci,2003,4(8):649-661.
[10]YUJNPVSKY I,HIRAYMA J,DOI M,et al. Signaling mediated by the dopamine D2 receptor potentiates circadian reggulation by CLOCK:BMALl[J]. Proc Natl Acad sci U S A,2006,103(16):6386-6391.
[11]FIFEL K,C00PER H M. Loss of dopamine disrupts circadian rhythms in a mouse model of Parkinson’s disease[J]. Neurobiol Dis,2014,71:359-369.
[12]DATIEVA V K,ROSINSKAIA A V,LEVIN O S. The use of melatonin in the treatment of chronic fatigue syndrome and circadian rhythm disorders in Parkinson’s disease[J]. Zh Nevrol Psikhiatr Im S S Korsakova,2013,113(7 Pt 2):77-81.
[2]BARGIOTAS P,EUGSTER L,OBERHPLZER M,et al. Sleepwake functions and quality of life in patients with subthalamic deep brain stimulation for Parkinson’s disease[J]. PLo S One,2017,12(12):e0190027.
[3]VIDENOVIC A,NOBLE C,REID K J,et al. Circadian melatonin rhythm and excessive daytime sleepiness in Parkinson disease[J]. JAMA Neurol,2014,71(4):463-469.
[4]BOLITHO S J,NAISMITH S L,RAJARATNAM S M,et al.Disturbances in melatonin secretion and circadian sleep-Wake regulation in Parkinson disease[J]. Sleep Med,2014,15(3):342-347.
[5]CHAUDHURI K R,PAL S,DIMARCO A,et al. The Parkinson’s disease sleep scale:a new instrument for assessing sleep and nocturnal disability in Parkinson’s disease[J]. J Neurol Neurosurg Psychiatry,2002,73(6):629-635.
[6]陈书娟,罗永杰.帕金森病睡眠障碍的临床表现及相关机制研究进展[J].实用医院临床杂志,2017,14(1):134-137.
[7]卞宏生,李廷利.褪黑素对昼夜节律导致大鼠的睡眠模式和能量代谢变化的干预研究[J].中国药理学通报,2015,31:65-66.
[8] BREEN D P,VUONO R,NAWARATHN A,et al. Sleep and circadian rhythm regulation in early Parkinson disease[J]. JAMA Neuml,2014,71(5):589-595.
[9]HASTINGS M H,REDDY A B,MAYWOOD E S. A clockwork web:circadian timing in brain and periphery,in health and disease[J]. Nat Rev Neurosci,2003,4(8):649-661.
[10]YUJNPVSKY I,HIRAYMA J,DOI M,et al. Signaling mediated by the dopamine D2 receptor potentiates circadian reggulation by CLOCK:BMALl[J]. Proc Natl Acad sci U S A,2006,103(16):6386-6391.
[11]FIFEL K,C00PER H M. Loss of dopamine disrupts circadian rhythms in a mouse model of Parkinson’s disease[J]. Neurobiol Dis,2014,71:359-369.
[12]DATIEVA V K,ROSINSKAIA A V,LEVIN O S. The use of melatonin in the treatment of chronic fatigue syndrome and circadian rhythm disorders in Parkinson’s disease[J]. Zh Nevrol Psikhiatr Im S S Korsakova,2013,113(7 Pt 2):77-81.