摘要
目的探究早期帕金森病(Parkinson's disease,PD)合并睡眠障碍患者的步态参数与眼动参数特征,并分析其与潜在病理生理机制的关联。方法本研究为单中心横断面调查研究设计,纳入了2023年10月至2025年5月就诊于北京医院82例Hoehn-Yahr(H-Y)分期≤2.5期的早期PD受试者。根据PDSS-2评分(总分≤15分为无睡眠障碍组,总分>15分为睡眠障碍组)将患者分为两组。通过ReadyGo系统和EyeKnow眼动系统分别采集步态与眼动参数,并结合临床量表进行分析,运用多因素logistic回归分析筛选与睡眠障碍独立相关的特征参数。结果步态方面,睡眠障碍组的步速、左右跨步速度及左右摆动速度均显著降低(均P<0.05),且左右跨步时间变异度显著更高(P=0.017、0.026)。眼动方面,睡眠障碍组垂直平滑追踪的偏移次数显著增多[(56.24±22.87)次比(45.98±18.18)次,P=0.040],光刺激反应右眼最大实时变化率显著更高(90.75%比67.95%,P=0.006),反扫视任务错误反应潜伏期更长(337.06 ms比286.63 ms,P=0.005)。为精确控制混杂因素,多因素logistic回归模型纳入了情绪、疾病严重程度等关键协变量。在全面校正后,更高的焦虑垂直汉密尔顿焦虑量表(Hamilton Anxiety Rating Scale,HAMA)(OR=1.32,P<0.001)和更多的垂直平滑追踪偏移次数(OR=1.06,P=0.010)为早期PD患者睡眠障碍的独立相关因素。结论在早期PD患者中,睡眠障碍与特定的步态和眼动参数异常密切相关。其中,垂直平滑追踪偏移有望成为一个独立于情绪状态的、反映其背后共享神经环路功能障碍的客观生物标志物。但其是否反映共享神经环路功能障碍仍需进一步机制研究验证。
Objective To explore the gait and eye movement parameters in early Parkinson's disease(PD)with sleep disorders,and analyze their association with underlying pathophysiological mechanisms.Methods This study was a cross-sectional single-center design that included 82 early PD patients with Hoehn-Yahr(H-Y)staging≤2.5 who visited Beijing Hospital from October 2023 to May 2025.Patients were divided into two groups according to the PDSS-2 score(total score≤15 for the no sleep disorder group and total score>15 for the sleep disorder group).Gait and eye movement parameters were collected respectively through the ReadyGo system and the EyeKnow eye movement system,and analyzed in combination with clinical scales.Multivariate logistic regression was employed to identify independent characteristic parameters associated with sleep disorders.Results In terms of gait,the sleep disorder group had significantly lower step speed,left-right stride speed,and left-right swing speed(all P<0.05),and significantly higher variability of left-right stride time(P=0.017,0.026).Regarding eye movements,the sleep disorder group had significantly more vertical smooth pursuit offsets[(56.24±2.87)times vs.(45.98±18.18)times,P=0.040],significantly higher maximum real-time variability of the right eye in response to light stimuli(90.75 vs.67.95%,P=0.006),and a longer latency to error responses in the counter-scanning task(337.06 vs.286.63 ms,P=0.005).To precisely control for confounding factors,key covariates such as mood and disease severity were included in the multivariate logistic regression model.After comprehensive adjustment,higher anxiety levels(Hamilton Anxiety Rating Scale,HAMA)(OR=1.32,P<0.001)and an increased number of vertical smooth pursuit offsets(OR=1.06,P=0.010)were independent factors associated with sleep disorders in early PD patients.Conclusions In early PD patients,sleep disorders are closely associated with specific abnormalities in gait and eye movement parameters.In particular,vertical smooth pursuit offsets may serve as an objective biomarker independent of emotional status,reflecting the dysfunction of shared neural circuits.However,further mechanism studies are needed to verify whether they reflect the dysfunction of shared neural circuits.
作者
谢妙贤
刘慧菁
刘玥滢
陈慧敏
林正挺
徐焕昌
苏闻
Xie Miaoxian;Liu Huijing;Liu Yueying;Chen Huimin;Lin Zhengting;Xu Huanchang;Su Wen(Neurology Department,Beijing Hospital,National Center of Gerontology,Institute of Geriatric Medicine,Peking University Fifth School of Clinical Medicine,Beijing 100730,China;Department of Neurology,Beijing Hospital,National Center of Gerontology,Institute of Geriatric Medicine,Chinese Academy of Medical Sciences,Beijing 100730,China;Department of Neurology,Beijing Hospital,National Center of Gerontology,Institute of Geriatric Medicine,Chinese Academy of Medical Sciences&Peking Union Medical College,Beijing 100730,China)
出处
《中华老年医学杂志》
北大核心
2025年第12期1690-1697,共8页
Chinese Journal of Geriatrics
基金
中央高水平医院临床科研业务费(BJ-2023-067)
国家重大疾病MDT合作诊疗能力建设项目(FTJ19-03)。
关键词
帕金森病
睡眠障碍
眼球运动
步态
Parkinson'sdisease
Sleepdisorder
Eyemovements
Gait
