伴与不伴快速眼动睡眠行为障碍帕金森病患者临床差异的meta分析

Differences in clinical features between Parkinson's disease patients with and without rapid eye movement sleep behavior disorder: A meta-analysis

摘要:

目的 系统评价伴与不伴快速眼动睡眠行为障碍（RBD）帕金森病（PD）患者之间临床特征的差异。方法 检索PubMed、EMbase等外文数据库及中国生物医学数据库（CMB）、中国知识基础设施工程（CNKI）、维普中文科技期刊全文数据库（VIP）、万方数据库等中文数据库关于PD与RBD相关性分析的病例对照研究，检索时限从建库至2018年09月01日。对入选文献进行质量评价，并用Stata 12.0软件进行Meta分析。结果 共纳入了17项符合标准的病例对照研究，共计PD患者3006例，Meta分析结果显示：与不伴RBD的PD患者相比，伴RBD的PD患者年龄更大（SMD=0.26；95%CI 0.19~0.34；P<0.00 001）、病程更长（SMD=0.29；95%CI 0.21~0.37；P<0.00 001）、Hoehn-Yahr分级更高（SMD=0.22；95%CI 0.11~0.33；P<0.00 001）、UPDRS-Ⅲ评分更高（SMD=0.25；95%CI 0.15~0.36；P<0.00 001）、左旋多巴剂量更大（SMD=0.17；95%CI 0.08~0.26；P<0.00 001），更易出现症状波动（OR=1.65；95%CI1.34~2.03；P<0.00 001）、异动症（OR=2.24；95%CI 1.74~2.88；P<0.00 001），MMSE评分更低（SMD=-0.23；95%CI-0.40~-0.06；P=0.008），幻觉（OR=3.15；95%CI 2.06~4.80；P<0.00 001）更多见，而性别（OR=1.15；95%CI 0.99~1.35；P=0.07）、发病年龄（SMD=0.09；95%CI-0.01~0.19；P=0.08）组间差异不明显。结论 PD患者中RBD的发生与患者年龄、病程有关，且伴RBD的PD患者需要更高的左旋多巴剂量、更易出现运动并发症，非运动症状更明显，提示伴RBD的PD患者中枢神经系统变性程度更严重、损害范围更广泛。

Abstract:

Objective To systematically evaluate the differences in clinical features between Parkinson's disease (PD) patients with and without rapid eye movement sleep behavior disorder (RBD).Methods Foreign databases including PubMed and EMbase and Chinese databases including CMB, CNKI, VIP, and Wanfang Data were searched for case-control studies on the association between PD and RBD published up to September 1, 2018. Quality assessment was performed for the articles included in the study, and Stata 12.0 was used to perform a meta-analysis.Results A total of 17 case-control studies which met the inclusion criteria were included, with 3006 PD patients in total. The meta-analysis showed that compared with those without RBD, the PD patients with RBD had a significantly older age (standardized mean difference[SMD]=0.26, 95% confidence interval[CI]:0.19-0.34;P<0.00 001), a significantly longer course of the disease (SMD=0.29, 95%CI:0.21-0.37;P<0.00 001), a significantly higher Hoehn-Yahr stage (SMD=0.22, 95%CI:0.11-0.33,P<0.00 001), a significantly higher UPDRS-Ⅲ score (SMD=0.25, 95%CI:0.15-0.36,P<0.00 001), a significantly higher dose of levodopa (SMD=0.17, 95%CI:0.08-0.26,P<0.00 001), a significantly lower Mini-Mental State Examination score (SMD=-0.23, 95%CI:-0.40 to -0.06,P=0.008), and a significantly higher proportion of patients with symptom fluctuations (OR=1.65, 95%CI:1.34-2.03,P<0.00 001), dyskinesia (OR=2.24, 95%CI:1.74-2.88,P<0.00 001), or hallucination (OR=3.15, 95%CI:2.06-4.80,P<0.00 001). There were no significant differences between the two groups in sex (OR=1.15, 95%CI:0.99-1.35,P=0.07) and age of onset (SMD=0.09, 95%CI:-0.01 to 0.19,P=0.08).Conclusions In PD patients, the development of RBD is associated with patient's age and course of disease, and the PD patients with RBD need a higher dose of levodopa, are more prone to motor complications, and have more marked non-motor symptoms, suggesting that such patients have more severe and extensive central nervous system degeneration.