伴发疼痛的帕金森病患者正中神经感觉阈值及疼痛耐受阈值的变化
Current perception threshold and pain tolerance threshold of median nerve of Parkinson's disease patients associated with pain
目的 评价伴发疼痛的帕金森病患者正中神经感觉阈值、痛觉耐受阈值变化,以此探讨外周神经在帕金森病相关性疼痛发生中的作用.方法 采用感觉神经定量检测仪检测64例帕金森病患者及30名年龄、性别与之相匹配的健康人依次以2 000、250、5 Hz的频率测试时双手正中神经的感觉阈值及疼痛耐受阈值.并对帕金森病患者进行统一帕金森病评分量表(UPDRS)、Hoehn-Yahr(H-Y)分级、简易精神状态检查、蒙特利尔认知评估量表(MoCA)、汉密尔顿抑郁量表(HAMD)、视觉模拟量表(VAS)评估.结果 帕金森病组右手正中神经2 000、250、5 Hz的感觉阈值较健康对照组升高(315.3±58.7与290.1±38.6,t=-2.137,P=0.035;112.3±29.3与100.7±12.6,t=-2.701,P =0.008;80.7±29.2与71.1±15.1,t=-2.102,P=0.038).双手正中神经在2 000、250、5Hz的痛觉耐受阈值较健康对照组降低(左手:15.6±2.6与16.7±2.3,t=1.933,P=0.056;8.9±2.7与10.0±1.7,t =2.445,P=0.017;12.1±4.1与13.6±1.9,t=2.395,P=0.019;右手:14.6±3.5与16.1±2.4,t =2.383,P =0.020;8.9±2.3与9.7±1.0,t =2.365,P =0.020;11.5±4.5与13.6±4.0,t=2.191,P=0.032).在帕金森病不伴疼痛组、帕金森病伴有疼痛组二组比较中,伴发疼痛的帕金森病患者双手正中神经在2 000、250、5 Hz的痛觉耐受阈值较帕金森病不伴疼痛患者下降更明显(左手:14.7±2.4与16.6±2.6,t=3.041,P=0.003;8.1±2.3与9.9±2.7,t=2.766,P=0.007;10.9±4.7与13.4±3.0,t=2.439,P=0.018;右手:13.5±3.1与15.8±3.6,t =2.647,P=0.010;8.1±2.0与9.8±2.4,t=3.052,P=0.003;10.3±3.9与13.0±4.7,t=2.546,P=0.013),差异均有统计学意义.与不伴发疼痛的帕金森病患者相比,伴发疼痛的帕金森病患者的UPDRSⅢ、H-Y、HAMD分数更高,MoCA分数更低,差异有统计学意义.结论 帕金森病患者存在正中神经感觉受损及痛觉耐受阈值下降,且伴发疼痛患者双手痛觉耐受阈值下降较明显,表明周围神经感觉异常可能也参与了帕金森病相关疼痛的发生.
更多Objective To explore the role of current perception threshold and pain tolerance threshold of median serve of Parkinson' s disease (PD) patients associated with pain.Methods Sixty-four PD patients and 30 healthy controls were enrolled in the study.Using the Neurometer CPT,current perception threshold and pain tolerance threshold testing at 2 000,250,5 Hz was performed on median nerves of both hands.PD patients were assessed by the following rating scales:Unified Parkinson's Disease Rating Scale (UPDRS),Hoehn-Yahr Scale (H-Y),Hamilton Depressive Scale (HAMD),Visual Analogue Scale (VAS),Montreal Cognitive Assessment (MoCA),and Mini Mental State Examination.Results PD patients had increased current perception threshold at 2 000,250,5 Hz of right hand as compared with control group (315.3 ±58.7 vs 290.1 ±38.6,t =-2.137,P =0.035; 112.3 ±29.3 vs 100.7 ± 12.6,t=-2.701,P=0.008; 80.7 ±29.2 vs 71.1 ± 15.1,t =-2.102,P =0.038) and had reduced pain tolerance threshold at 2 000,250,5 Hz of both hands(left hand:15.6 ± 2.6 vs 16.7 ± 2.3,t =1.933,P=0.056; 8.9 ±2.7 vs 10.0 ± 1.7,t =2.445,P =0.017; 12.1 ±4.1 vs 13.6 ± 1.9,t =2.395,P =0.019; right hand:14.6 ±3.5 vs 16.1 ±2.4,t =2.383,P=0.020; 8.9±2.3 vs 9.7 ±1.0,t =2.365,P=0.020; 11.5±4.5 vs 13.6 ±4.0,t =2.191,P=0.032).PD patients with pain had lower pain tolerance threshold at 2 000,250,5 Hz of both hands,compared with PD patients without pain (left hand:14.7±2.4vs 16.6±2.6,t=3.041,P=0.003; 8.1 ±2.3 vs9.9±2.7,t=2.766,P=0.007; 10.9±4.7 vs 13.4 ±3.0,t =2.439,P=0.018; right hand:13.5 ±3.1 vs 15.8 ±3.6,t =2.647,P=0.010;8.1 ±2.0 vs 9.8 ±2.4,t =3.052,P=0.003; 10.3 ±3.9 vs 13.0 ±4.7,t =2.546,P=0.013).Compared with the PD patients without pain,PD patients with pain had higher scores of UPDRS,H-Y,HAMD and lower scores of MoCA.Conclusions In PD patients,the current perception threshold and pain tolerance threshold are abnormal,especially in the PD patients with pain.The sensory nerve function impairment may be involved in the mechanisms of pain in PD.
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