Clinical Factors Associated with Abnormal Postures in Parkinson's Disease

BackgroundAbnormal posture (AP) is often seen in Parkinson's disease (PD), and marked forms known as dropped head syndrome and camptocormia encumber daily living activities. Unlike other motor disabilities such as bradykinesia or muscular rigidity, AP is not always improved but rather deteriorated by PD medication.PurposeTo clarify factors associated with neck and thoracolumbar AP.MethodsNeck flexion (NF) and thoracolumbar (TL) angles were measured in 216 consecutive PD patients and 175 elderly healthy controls. The differences in NF and TL angles between PD patients and controls were designated as ΔNFA and ΔTLA, respectively. The association of ΔNFA or ΔTLA and predictable factors such as age, sex, duration of PD, Hoehn Yahr (H–Y) stage, Unified Parkinson's Disease Rating Scale Part 3 (UPDRS-3), daily dose of dopamine agonists, and comorbid orthopedic spinal lesions was investigated in PD patients. Patients were divided into quartiles according to ΔNFA or ΔTLA. The association between predictable factors and ΔNFA or ΔTLA was estimated as odds ratio (OR), comparing with the lowest quartile as the reference by multivariate regression analysis.ResultsCompared with controls, distributions of all three posture angles were significantly shifted rightward in PD patients. Although there were no difference in UPDRS-3 scores in the quartiles of ΔNFA, the highest quartile was associated with H–Y stage ≥3 [OR 2.99, 95% confidence interval (CI) 1.33–6.70, p = 0.008] after adjustment for age, sex and comorbid orthopedic spinal lesions. The highest quartile of ΔTLA was associated with comorbid orthopedic spinal lesions [OR 5.83 (1.42–23.8), p = 0.014], and UPDRS-3 score [OR 3.04 (1.80–5.15)/10 points, pConclusionThoraco-lumbar AP was associated with UPDRS-3 scores and orthopedic spinal lesions, and in contrast, neck AP was not associated with these factors, suggesting that they had different pathomechanisms.背景：异常姿势（Abnormal posture, AP）在帕金森病（Parkinson's disease, PD）中颇为常见，其中严重亚型包括垂头综合征（dropped head syndrome）与躯干前屈症（camptocormia），会显著妨碍患者的日常生活活动。与运动迟缓（bradykinesia）、肌肉强直（muscular rigidity）等其他运动障碍不同，异常姿势并不会因帕金森病药物治疗得到改善，反而可能出现加重。 研究目的：本研究旨在明确与颈部及胸腰椎异常姿势相关的影响因素。 方法：纳入216例连续性帕金森病患者与175例老年健康对照者，测量其颈部屈曲（neck flexion, NF）角度与胸腰椎（thoracolumbar, TL）角度。将帕金森病患者与健康对照者的颈部屈曲角度差值、胸腰椎角度差值分别记为ΔNFA与ΔTLA。在帕金森病患者群体中，分析ΔNFA或ΔTLA与年龄、性别、帕金森病病程、Hoehn-Yahr（H-Y）分期、统一帕金森病评定量表第三部分（Unified Parkinson's Disease Rating Scale Part 3, UPDRS-3）评分、多巴胺能激动剂（dopamine agonists）每日给药剂量以及合并脊柱骨科病变等可预测因素的相关性。根据ΔNFA或ΔTLA将患者分为四个四分位数组，以最低四分位数组作为参照，通过多因素回归分析估算各可预测因素与ΔNFA或ΔTLA的比值比（odds ratio, OR）。 结果：与健康对照者相比，帕金森病患者的三类姿势角度分布均显著右移。尽管ΔNFA的四分位数组间UPDRS-3评分无显著差异，但在校正年龄、性别及合并脊柱骨科病变后，最高四分位数组与H-Y分期≥3存在显著相关性[OR=2.99，95%置信区间（CI）1.33~6.70，p=0.008]。ΔTLA最高四分位数组与合并脊柱骨科病变[OR=5.83（1.42~23.8），p=0.014]及UPDRS-3评分[OR=3.04（1.80~5.15）/每10分，p]相关。 结论：胸腰椎异常姿势与UPDRS-3评分及脊柱骨科合并病变显著相关，而颈部异常姿势则与上述因素无明显关联，提示二者的病理生理机制存在差异。