| Parkinson's disease(PD) is a common neurological disorder, mainly in the older people, the incidence of which increased with age. The selective degeneration and lose of dopaminergic neurons of substantia nigra pars compacta(SNpc) and the form of the Lewy body(LB) has been known as the pathological characteristics of PD. The main clinical features are bradykinesia, muscular rigidity, rest tremor and postural instability.Modern traditional Chinese medicine(TCM) on the understanding and treatment of PD is developing. Treatment based on syndrome differentiation, as a unique theoretical system, is the essence of TCM. The understanding of PD was described as a long history. In this study, we use the method of "Combination of disease and syndrome", which is meaning that PD patients must diagnosis by western medicine and then carry on the syndrome differentiation by TCM. It can summarize the distribution of TCM syndromes and clinical characteristics of PD. Hence, it can offer the clinical reference for the diagnosis and treatment in TCM and Western medicine.In recent years, the non-motor symptoms(NMS) of PD are more and more attention by clinicians. PD-NMS is mainly divided into: autonomic symptoms, neuropsychiatric symptoms, sensory symptoms and sleep disorders and so on. NMS can appear throughout in PD. It can exhibit before the onset of motor symptoms. It also can seriously affect the patients in the last stage, which obviously aggravates the motion symptoms, reduces the quality of life of patients and their families, and even may shorten the life expectancy. Therefore, early detection and early diagnosis of NMS and the searching for reasonable intervention and treatment of NMS are great significant for the treatment of PD and improving the quality of life of patients.?Objective?This study aims to find the distribution of the clinical characteristic(including motor symptoms and non-motor symptoms) and TCM syndromes of PD, in order to provide reference for clinical diagnosis and treatment of PD.?Methods?In this study, a prospective, cross-sectional design was used for the epidemiological investigation. Detailed information of the 170 cases which based on the diagnosis and exclusion criteria for PD was inputted according to our group designed and “The clinical observation table of Parkinson's disease”. The questionnaires included the name, sex, age and other basic information, history related items, signs, TCM related items, diagnosis conclusion of TCM and Western medicine, non motor symptoms and medication and so on. It also collected the patients' clinical data and imaging data. The specialist doctors diagnosed the disease and made TCM syndrome differentiation. The Hoehn-Yahr(H-Y) staging scale was used to evaluate the severity of the disease.?Results?1. There were 93 male(54.71%) and 77 female(45.29%) among 170 PD cases. The male and female sex ratio was 1.2:1. Tremor was the dominant initial symptoms of PD, 101 cases(59.41%). The rigidity type was 46(27.06%). And 23 cases(13.53%) showed both the tremor and the rigidity. The frequency of initial limb from high to low was right upper limb(47 cases), left upper limb(31 cases), right leg(27 cases), right limbs(20 cases), left lower limb(14 cases), double lower limbs(12 cases), the left side of the body and double upper limbs(8 cases), extremities(3 cases); The cases of initial symptoms occurred on a limb were 147 cases(86.47%) and on bilateral limbs were 23 cases(13.53%). The patients in the early stage of the disease were 94 cases(55.29%), mid-term patients were 68 cases(40%), and the patients in the advanced stage were 8 cases(4.71%).2. The type of TCM syndrome differentiation of 170 PD cases was in an order of liver and kidney yin deficiency 65 cases(38.24%), blood stasis and wind-stirring 46 cases(27.06%), phlegm heat and wind-stirring 40 cases(23.53%), bothe qi and blood deficiency 16 cases(9.41%), both yin and yang deficiency 3 cases(1.76%).3. Of the 170 cases, 164 cases were accompanied with NMS, and the incidence of NMS was 96.47%. Among them, the highest incidence was autonomic dysfunction accounted for 84.12%, followed by the neuropsychiatric disorders accounted for 66.47%, and then the sleep disorders and sensory disorders accounted for 54.12% and 37.65%.4. Of all the NMS items, the frequent urination, sexual dysfunction, sleep disorders significantly associated with gender(P < 0.01), salivation, psychiatric symptoms associated with gender(P<0.05); sweat significantly associated with age of onset(P<0.01), constipation, frequent urination, salivation associated with age of onset(P<0.05); neuropsychiatric disorders, psychiatric symptoms significantly associated with the scores of H-Y stage(P<0.01), frequent urination, pain, mood disorders and cognitive impairment associated with the scores of H-Y stage(P<0.05); constipation, neuropsychiatric disorders, psychiatric symptoms significantly associated with disease duration(P<0.01), autonomic disorder, fat Yan, cognitive dysfunction associated with disease duration(P<0.05); Yan fat associated with onset(P<0.05).5. Liver and kidney yin deficiency was positively related with neuropsychiatric disorders, cognitive disorders, sleep disorders, and was negatively related with fat Yan; phlegm heat and wind-stirring was positively related with fat Yan, and was negatively related with neuropsychiatric disorders, cognitive impairment; blood stasis and wind-stirring was positively related with salivation, and was negatively related with constipation; both qi and blood deficiency was positively related with orthostatic hypotension; both yin and yang deficiency was negatively related with urinary frequent urination.?Conclusion?Through the analysis of this study in 170 cases of PD patients with clinical features and TCM syndrome, it was found that the proportion of liver and kidney yin deficiency patients was the most(38.24%), and throughout the disease. In the early stage of PD, blood stasis and wind-stirring was the most, and liver and kidney yin deficiency was the most in the middle period of the disease. Liver and kidney yin deficiency and both yin and yang deficiency were common in the last stage of PD. Secondly, NMS occurrence rate of the PD patients was high(96.47%). The autonomic nerve disorder had the highest incidence of accounting for 84.12% and constipation was the most common problem in autonomic nervous disorders. The neuropsychiatric disorder accounted for 66.47% and the most common neuropsychiatric symptoms was cognitive impairment. Sleep disorders and sensory disturbance occurrence rates accounted for 54.12% and 37.65%. NMS associated with gender, age of onset, duration, the scores of H-Y stage and mode of onset. There was a relationship between the five kinds of TCM syndrome type and multiple NMS projects. Patients of liver and kidney yin deficiency were common suffering from neuropsychiatric disorders, cognitive disorders, sleep disorders, rare lipid Yan. Patients of phlegm heat and wind-stirring were common suffering from fat Yan, rare neuropsychiatric disorders, cognitive disorders. Patients of blood stasis and wind-stirring were common suffering from with salivation, rare constipation. Patiens of both qi and blood deficiency were common suffering from postural hypotension. Patients of yin and yang deficiency were common suffering from with frequent urination. |
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