帕金森病患者的睡眠结构紊乱及快速眼球运动期睡眠行为障碍的电生理研究

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1、中国图书资料资料分类号R741单位代码：10660学号：S090254贵阳医学院2012届硕士学位论文帕金森病患者的睡眠结构紊乱及快速眼球运动期睡眠行为障碍的电生理研究研究生：丁傲导师：焦玲教授年级：2009级专业：神经病学2012年5月17日贵阳医学院2012届神经病学硕士学位论文目录摘要„„„„„„„„„„„„„„„„„„„„„„„„2前言„„„„„„„„„„„„„„„„„„„„„„„„4材料与方法„„„„„„„„„„„„„„„„„„„„„„5结果„„„„„„„„„„„„„„„„„„„„„„„14讨论„„„„„„„„„„„„„„„„„„„„„„„20结论„„„„„„„„„„

2、„„„„„„„„„„„„„„25参考文献„„„„„„„„„„„„„„„„„„„„„„„26英文摘要„„„„„„„„„„„„„„„„„„„„„„„29致谢„„„„„„„„„„„„„„„„„„„„„„„„31缩略词表„„„„„„„„„„„„„„„„„„„„„„„32附录„„„„„„„„„„„„„„„„„„„„„„„„34论文原创性声明„„„„„„„„„„„„„„„„„„„„36附：综述„„„„„„„„„„„„„„„„„„„„„„371贵阳医学院2012届神经病学硕士学位论文帕金森病患者的睡眠结构紊乱及快速眼球运动期睡眠行为障碍的电生理研究专业：神经病学研究生：丁傲导师：焦玲教授摘要

3、：目的:通过多导睡眠监测仪(Polysomnography,PSG)监测帕金森病(Parkinson'sdisease,PD）患者的快速眼球运动期睡眠行为障碍(REMsleepbehaviordisorder,RBD)，并且评估PD患者睡眠质量、睡眠结构及RBD的出现率、临床特征、电生理特点，对PD的发病机制提供电生理方面的基础资料。方法：1)对患者的一般情况进行记录，包括性别、年龄、起病年龄、起病症状、起病部位、病程、治疗史、家族史及伴发疾病史等。应用RBD问卷筛查（RBDSQ）筛查RBD发作情况；PD组采用统一PD评分量表（UPDRS-Ⅲ）、Hoehn-Yahr（H-Y）分

4、期分析运动症状的严重程度和运动并发症的发生情况。2)对35例临床确诊的PD患者和30例无明显中枢神经系统疾病的对照组行PSG监测，分析比较各项睡眠结构参数及REM期视频监测特点。结果：1)经PSG监测结果：PD组总睡眠时间(Totalsleeptime,TST)306.56±67.29min、睡眠潜伏期(Sleeplatency,SL)31.30±17.88min、睡眠效率（Sleepefficiency,SE％）59.67±19.23%、REM期睡眠潜伏期（REMsleeplatency,REM-SL）139.18±107.91min、NREM1期占总睡眠时间百分比（N1%o

5、fTST)20.65±11.54%、NREM2期占总睡眠时间(N2%ofTST)47.52±9.36%、REM占总睡眠时间百分比（REM%ofTST）15.78±9.28%、＞5min的觉醒次数（AT＞5min）5.22±1.97次，对照组TST364.24±54.04min、SL15.00±15.36min、SE％89.91±2.24%、REM-SL85.17±31.35min、N1％ofTST10.60±2.95%、N2％ofTST36.17±19.10%、REM％ofTST18.25±4.95%、AT＞5min2.24±2.74次。PD组较正常组TST缩短、SE％下降(P

6、<0.001)。PD组较正常组REM％ofTST减少、SL、REM-SL延长，AT＞5min次数增加、N1%ofTST及N2%ofTST增加(P<0.05)。PD组总卧床时间（Timeinbed）427.75±80.38min、NREM3期占总睡眠时间百分比（N3%ofTST）11.09±8.41%，对照组TIB422.51±14.63min，N3％ofTST11.87±10.43%。两组之间差异无统计学意义(P>0.05)。相关性分析显示PD患者部分睡眠结构参数与病程、H-Y分期有相关性（P＜0.05～0.001），而与性别、年龄、多巴丝肼每日总剂量无相关性（P>0.05）。

7、2）PD2贵阳医学院2012届神经病学硕士学位论文组中有6例（17.14%）出现REM期睡眠行为障碍(RBD)，28例(80.00%)在REM期睡眠中呈现肌电活动不消失(RWA)；对照组有1例(3.33%)出现RBD,3例(10.00%)出现RWA。统计学分析两组之间RBD、RWA的出现率均有差异（P<0.05），其中RBD的出现率有显著差异（P<0.001）。PD合并RBD最主要的PSG特点：REM期RWA和运动增多。3.PD组RBD及RWA的出现率存在性别差异（P＜0.05），且以男性居