伴与不伴快速眼动睡眠期行为障碍的帕金森病临床特征差异的Meta分析

摘要

Objective To compare the clinical differences between Parkinson's disease (PD)patients with and without rapid eye movement sleep behavior disorder (RBD).Methods PubMed,EMBASE,Cochrane Library,Chinese Biology Medicine (CBM) and China National Knowledge Infrastructure (CNKI) databases were used to search for studies on RBD in PD patients.Meticulous data were extracted and Meta-analysis was performed.All analyses were conducted with the software of Revman Manager 5.2.4.Results Five clinical studies involving total 650 PD patients were included.The Meta-analysis showed that PD patients with RBD had an older mean age (WMD =2.870,95％CI:1.490-4.260; P =0.000),a higher Hoehn-Yahr stage (WMD =0.300,95％ CI:0.160-0.450; P =0.000),higher Unified Parkinson's Disease Rating Scale (UPDRS) motor scores during the "on" state (WMD =2.370,95％CI:0.260-4.490; P =0.030),and larger levodopa dose (WMD =90.550,95％CI:31.040-150.060; P =0.003) in comparison with PD patients without RBD.In addition,PD patients with RBD were more likely to develop motor fluctuation (OR =1.520,95％ CI:1.080-2.140; P =0.020) and orthostatic hypotension (OR =11.390,95％ CI:4.790-27.090; P =0.000) as compared to PD patients without RBD.However,gender (OR =1.850,95％CI:0.810-4.230; P =0.150),disease duration (WMD =0.130,95％ CI:-1.230-1.500; P =0.850) and MiniMental State Examination (MMSE) scores (WMD =-0.220,95％CI:-0.600-0.160; P =0.260) did not differ between PD patients with and without RBD.Conclusion PD patients with RBD were more likely to be associated with older age,more severe motor disability,higher levodopa usage,higher incidence of motor fluctuation and orthostatic hypotension,indicating that PD with RBD might be at an advanced stage and had more widespread and severe neurodegeneration.%目的 系统评价伴与不伴快速眼动睡眠期行为障碍(RBD)的帕金森病患者之间存在的临床特征之差异性.方法 计算机检索PubMed、荷兰医学文摘(EMBASE)、英国Cochrane图书馆、中国生物医学文献数据库(CBM)及中国知识基础设施工程(CNKI)数据库中2013年4月之前公开发表的关于帕金森病相关RBD临床研究,经质量评价纳入符合要求的文献,RevMan5.2.4软件进行Meta分析.结果 纳入5项符合标准的临床研究,共计650例帕金森病患者.分析结果显示:与不伴RBD的帕金森病患者相比,伴RBD者年龄更大(WMD＝2.870,95％CI:1.490 ～ 4.260;P=0.000)、Hoehn-Yahr分级(WMD=0.300,95％CI:0.160～0.450；P＝0.000)和“开”期统一帕金森病评价量表运动功能评分(WMD=2.370,95％CI:0.260～4.490；P＝0.030)更高、左旋多巴剂量更高(WMD=90.550,95％CI:31.040～150.060；P=0.003),更易出现运动症状波动(OR＝1.520,95％CI:1.080 ～ 2.140；P=0.020)和直立性低血压(OR=11.390,95％CI:4.790～27.090；P=0.000)；而性别(OR=1.850,95％CI:0.810～4.230；P=0.150)、病程(WMD=0.130,95％CI:-1.230 ～ 1.500；P=0.850)以及简易智能状态检查量表评分(WMD=-0.220,95％CI:-0.600～0.160；P=0.260)组间差异无统计学意义.结论 帕金森病相关RBD与高龄、病情严重程度和大剂量左旋多巴有关,伴RBD的帕金森病患者更易出现自主神经功能障碍如直立性低血压等.提示伴RBD的帕金森病患者存在更为严重和广泛性中枢神经系统变性.