帕金森的8个初期征兆，看你有没中招？
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">今天是第28个“世界帕金森病日”，今年的主题是“和谐共生，美好生活”。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">帕金森病是一种好发于老年人的慢性神经系统退行性<span style="color: black;">疾患</span>。流行病学统计<span style="color: black;">表示</span>，我国<span style="color: black;">日前</span><span style="color: black;">大概</span>365万名帕金森病<span style="color: black;">病人</span>。该病<span style="color: black;">作为</span>继心脑血管<span style="color: black;">疾患</span>和肿瘤之后的“中老年第三大健康杀手”。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">本期《有请大<span style="color: black;">大夫</span>》</strong><span style="color: black;"><strong style="color: blue;"><span style="color: black;">春雨<span style="color: black;">大夫</span>CEO王羽潇</span></strong></span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">将携手中国人民解放军总医院<span style="color: black;">第1</span>医学中心</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">神经外科<span style="color: black;">专家</span>医师 毛之奇</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">带来<strong style="color: blue;">帕金森专</strong><strong style="color: blue;">题直播</strong></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">戳图<span style="color: black;">就可</span>预约</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">今晚<span style="color: black;"><strong style="color: blue;">19点</strong></span>直播间见</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">帕金森的<span style="color: black;">初期</span>征兆</strong></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">帕金森病的临床表现<span style="color: black;">包含</span>运动症状和非运动症状，症状多样，起病隐匿，<span style="color: black;">很难</span>察觉，<span style="color: black;"><strong style="color: blue;">许多<span style="color: black;">病人</span><span style="color: black;">一般</span>是在家人或<span style="color: black;">伴侣</span>的提醒下才<span style="color: black;">发掘</span><span style="color: black;">自己</span>的运动性症状，而非运动性症状<span style="color: black;">仅有</span>自己<span style="color: black;">才可</span>察觉，</strong></span>且<span style="color: black;">发掘</span>较晚。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">非运动性症状</strong></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><img src="https://q0.itc.cn/q_70/images03/20240411/cb95713eef7f40f9bb4ee6d18d5fd252.png" style="width: 50%; margin-bottom: 20px;"></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">1）嗅觉<span style="color: black;">阻碍</span>：</strong>嗅觉<span style="color: black;">衰退</span>或缺失存在于超过90％的<span style="color: black;">病人</span>中，<span style="color: black;">一般</span>为双侧，且可能先于多巴胺缺陷<span style="color: black;">引起</span>的运动性症状<span style="color: black;">显现</span>。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">虽然嗅觉<span style="color: black;">衰退</span>并不存在于每例帕金森病<span style="color: black;">病人</span>中，但它的存在或发展可能会<span style="color: black;">作为</span><span style="color: black;">初期</span>帕金森病<span style="color: black;">病人</span><span style="color: black;">显现</span>运动性症状前的特异性标志，尤其当嗅觉<span style="color: black;">衰退</span>与其他<span style="color: black;">初期</span>临床表现、影像学证据或生物学标志物<span style="color: black;">关联</span>联时，如静止性震颤和认知功能<span style="color: black;">阻碍</span>。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><img src="https://q6.itc.cn/q_70/images03/20240411/ef937470d5b9408d879f7e6f6dff2602.png" style="width: 50%; margin-bottom: 20px;"></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;"><span style="color: black;">2）焦虑和抑郁：</span></strong><span style="color: black;">焦虑影响了 60％的 PD <span style="color: black;">病人</span>，<span style="color: black;">包含</span>广泛性焦虑（焦虑、恐惧和<span style="color: black;">懊恼</span>）、恐慌症、社交恐惧症，其<span style="color: black;">一般</span><span style="color: black;">伴同</span>抑郁。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">焦虑可出<span style="color: black;">此刻</span>帕金森病运动性症状之前，<span style="color: black;">显示</span>其可能与黑质纹状体通路的<span style="color: black;">反常</span>状态<span style="color: black;">关联</span>。抑郁在临床<span style="color: black;">亦</span>很<span style="color: black;">广泛</span>，影响着 35％的 PD <span style="color: black;">病人</span>。</span><span style="color: black;">与非帕金森病抑郁<span style="color: black;">病人</span>相比，其对抑郁的自知力更为缺乏。<span style="color: black;">另外</span>，认知衰退和<span style="color: black;">痴傻</span>、精神病<span style="color: black;">爆发</span>、焦虑、<span style="color: black;">睡觉</span><span style="color: black;">阻碍</span>和自主神经症状<span style="color: black;">亦</span>与帕金森病的抑郁<span style="color: black;">危害</span><span style="color: black;">增多</span><span style="color: black;">相关</span>。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">3）<span style="color: black;">睡觉</span><span style="color: black;">阻碍</span>：</strong><span style="color: black;">睡觉</span>和觉醒<span style="color: black;">阻碍</span>影响着大<span style="color: black;">都数</span>帕金森病<span style="color: black;">病人</span>，其程度随患病时间的延长而<span style="color: black;">增多</span>。<span style="color: black;">白日</span>嗜睡可与夜间<span style="color: black;">睡觉</span><span style="color: black;">阻碍</span>相区别，夜间<span style="color: black;">睡觉</span><span style="color: black;">阻碍</span><span style="color: black;">包含</span><span style="color: black;">疾患</span>或<span style="color: black;">药品</span><span style="color: black;">关联</span>性失眠，如<span style="color: black;">睡觉</span>断断续续、觉醒时间延长、快速眼动<span style="color: black;">睡觉</span>行为<span style="color: black;">阻碍</span>、周期性肢体运动、不宁腿<span style="color: black;">综合症</span>和静坐<span style="color: black;">不可</span>。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><img src="//q9.itc.cn/q_70/images03/20240411/d5f6e25abc8e4d1594d15deb3be4b0c0.jpeg" style="width: 50%; margin-bottom: 20px;"></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">夜晚当药效消失时，运动性症状会再次<span style="color: black;">显现</span>，肌张力<span style="color: black;">阻碍</span>、噩梦、幻觉、夜尿等均会加剧<span style="color: black;">睡觉</span><span style="color: black;">阻碍</span>。帕金森病<span style="color: black;">病人</span>的失眠症状可能与<span style="color: black;">疾患</span>的病理<span style="color: black;">相关</span>，但多巴胺能<span style="color: black;">药品</span>的治疗效果却微乎其微。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">4）自主神经功能<span style="color: black;">阻碍</span>：</strong>自主神经功能<span style="color: black;">阻碍</span>症状<span style="color: black;">广泛</span>存在于帕金森病<span style="color: black;">病人</span>中，其可能先于运动性症状<span style="color: black;">显现</span>，<span style="color: black;">包含</span>膀胱括约肌功能<span style="color: black;">阻碍</span>、胃肠功能失调、心血管功能<span style="color: black;">反常</span>、多汗、便秘等。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">自主神经功能<span style="color: black;">阻碍</span>的病理<span style="color: black;">基本</span>为其调节区域的神经元缺失及路易小体形成，<span style="color: black;">包含</span>下丘脑、交感和副交感神经系统、消化系统、心脏及泌尿系统等神经丛分布，深入<span style="color: black;">科研</span>有助于帕金森病的<span style="color: black;">初期</span>诊断及治疗，对改善<span style="color: black;">病人</span>的生活质量<span style="color: black;">特别有</span><span style="color: black;">道理</span>。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">运动性症状</strong></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">帕金森的运动性症状较为典型，但与非运动性症状相比，其<span style="color: black;">显现</span>时间较晚，这可能是<span style="color: black;">因为</span>神经<span style="color: black;">守护</span>机制或自动<span style="color: black;">赔偿</span>机制发挥了<span style="color: black;">功效</span>，如残存多巴胺神经元的侧支轴突再生。<strong style="color: blue;">运动性症状<span style="color: black;">重点</span><span style="color: black;">包含</span>以下 4 种：</strong></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">1）震颤：</strong>帕金森病<span style="color: black;">初期</span>的震颤<span style="color: black;">不足</span>典型，<span style="color: black;">都数</span>仅表现为兴奋或精神紧张时的微小颤动，<span style="color: black;">没</span>典型“搓丸样”动作，且与<span style="color: black;">心情</span>、<span style="color: black;">重视</span>力<span style="color: black;">关联</span>，需与其他<span style="color: black;">导致</span>震颤的<span style="color: black;">疾患</span>相鉴别，如特发性震颤、焦虑抑郁和精神性<span style="color: black;">药品</span><span style="color: black;">导致</span>的震颤及酒精中毒等。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><img src="//q2.itc.cn/q_70/images03/20240411/f89defea93ef4153a2e31b2dd7ba7f7c.jpeg" style="width: 50%; margin-bottom: 20px;"></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;"><span style="color: black;">2）肌强直：</span></strong><span style="color: black;"><span style="color: black;">病人</span><span style="color: black;">初期</span><span style="color: black;">显现</span>肢体僵硬，即令<span style="color: black;">病人</span>将双肘置于桌面上，使前臂与桌面垂直，腕关节放松。<span style="color: black;">针对</span>正<span style="color: black;">一般人</span>，前臂与腕关节约呈 90°屈曲，而帕金森病<span style="color: black;">初期</span><span style="color: black;">病人</span>腕关节或多或少仍呈伸直状态，状如路标，<span style="color: black;">叫作</span>为“路标现象”。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">帕金森病<span style="color: black;">初期</span>最常<span style="color: black;">显现</span>的是肩部不适及<span style="color: black;">病痛</span>，易被误诊为滑囊炎、关节炎或回旋肌群的<span style="color: black;">损害</span>。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;"><span style="color: black;">3）行动迟缓</span></strong><span style="color: black;">：<span style="color: black;">病人</span>表现为随意运动减少，行动缓慢、笨拙，如穿衣系扣、系鞋带等动作缓慢，面部表情及瞬目减少，双眼凝视，写字<span style="color: black;">亦</span>越来越小，行走时碎步，摆臂动作及幅度减少，说话语速变慢，音调变低，做快速重复性动作（拇、食指对指）时速度缓慢和幅度减小。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">4）姿势平衡<span style="color: black;">阻碍</span>：</strong>在<span style="color: black;">疾患</span><span style="color: black;">初期</span>，帕金森病<span style="color: black;">病人</span>表现为走路时上肢摆动幅度减小，次数减少，下肢拖拽，有时行走中全身僵住，<span style="color: black;">叫作</span>为“冻结” 现象。<span style="color: black;">同期</span>，起步及转身困难，步伐越来越小，越走越快，呈前冲状态，且<span style="color: black;">不可</span><span style="color: black;">即时</span>停止，<span style="color: black;">叫作</span>为“慌张步态”。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">当<span style="color: black;">发掘</span>自己或家人<span style="color: black;">显现</span>以上症状时，要<span style="color: black;">即时</span><span style="color: black;">看病</span>诊治，<span style="color: black;">以避免</span><span style="color: black;">错失</span>最佳治疗时间。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">帕金森的预防及治疗</strong></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">尽管帕金森病多见于老年人群，但近年来有<span style="color: black;">青年</span>化的发展趋势，<strong style="color: blue;"><span style="color: black;">科研</span><span style="color: black;">显示</span>，有些<span style="color: black;">病人</span>的发病年龄早于50岁，占帕金森病的5%~10%。</strong></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">虽然<span style="color: black;">日前</span>对原发性帕金森病的发病<span style="color: black;">原由</span>尚不完全清楚，<span style="color: black;">通常</span>认为<span style="color: black;">重点</span>与年龄老化、遗传和环境等综合<span style="color: black;">原因</span><span style="color: black;">相关</span>。而继发性帕金森病则多由脑炎、脑动脉硬化或锰、一氧化碳中毒等<span style="color: black;">原由</span><span style="color: black;">导致</span>。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">因此呢</span>，从以下方面进行<span style="color: black;">干涉</span>，或可实现对帕金森病的早预防、早<span style="color: black;">发掘</span>、早诊断、早治疗。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">5招预防帕金森</strong></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">1.防治脑动脉硬化是预防帕金森病的<span style="color: black;">基本</span><span style="color: black;">办法</span>，临床上要认真治疗高血压、糖尿病、高脂血症；</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">2.避免或减少接触对人体神经系统有毒的物质，如一氧化碳、二氧化碳、锰、汞等；</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">3.避免或减少应用奋乃静、利血平、氯丙嗪等诱发震颤麻痹的<span style="color: black;">药品</span>；</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">4.加强体育运动及脑力活动，延缓脑神经组织衰老；</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">5.<span style="color: black;">发掘</span>老年人有嗅觉<span style="color: black;">阻碍</span>、<span style="color: black;">睡觉</span><span style="color: black;">阻碍</span>、焦虑抑郁、上肢震颤、手抖、动作迟缓等帕金森病先期征兆时，应<span style="color: black;">即时</span>到医院就诊，争取早诊断、早治疗。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">若确诊帕金森病，<span style="color: black;">亦</span>不要太悲观、紧张，该病<span style="color: black;">日前</span>虽然<span style="color: black;">不可</span>被治愈，但<span style="color: black;">经过</span><span style="color: black;">药品</span>治疗、手术治疗、运动疗法、心理<span style="color: black;">干涉</span>、照料护理等，可有效改善或延缓症状、避免或降低不良反应、<span style="color: black;">加强</span>工作能力和生活质量。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">在众多治疗<span style="color: black;">办法</span>中，<span style="color: black;">药品</span>治疗是首选，且是<span style="color: black;">全部</span>治疗过程中的<span style="color: black;">重点</span>治疗手段，手术治疗则是<span style="color: black;">药品</span>治疗<span style="color: black;">不良</span>时的一种有效<span style="color: black;">弥补</span>手段，肉毒毒素注射是治疗局部痉挛和肌张力<span style="color: black;">阻碍</span>的有效<span style="color: black;">办法</span>，运动与<span style="color: black;">恢复</span>治疗、心理<span style="color: black;">干涉</span>与照料护理则适用于帕金森病治疗全程。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><img src="https://q8.itc.cn/q_70/images03/20240411/46275a33e6ad4bc39b430601e715cbd8.png" style="width: 50%; margin-bottom: 20px;"></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">帕金森病的<span style="color: black;">药品</span>治疗流程/图源：中国帕金森病治疗指南（第四版）</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">必须</span><span style="color: black;">重视</span>的是，帕金森病容易受到内环境不稳定的干扰，<span style="color: black;">倘若</span>有感染、离子<span style="color: black;">错乱</span>、精神情感刺激等<span style="color: black;">出现</span>，会加重帕金森病<span style="color: black;">自己</span>的症状，如震颤、强直以及加重行动困难等。<span style="color: black;">因此呢</span><span style="color: black;">药品</span>治疗<span style="color: black;">时期</span><span style="color: black;">必定</span>要遵医嘱<span style="color: black;">吃下</span>，不要随意改动或删减<span style="color: black;">药品</span>。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">图源：壹图网</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">编辑：春雨君</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">参考文献：</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">中华医学会神经病学分会帕金森病及运动<span style="color: black;">阻碍</span>学组, 中国医师协会神经内科医师分会帕金森病及运动<span style="color: black;">阻碍</span>学组. 中国帕金森病治疗指南（第四版） . 中华神经科杂志, 2020, 53(12) : 973-986. DOI: 10.3760/cma.j.cn113694-20200331-00233.</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">Manyam BV. Paralysis agitans and levodopa in "Ayurveda": ancient Indian medical treatise. Mov Disord 1990; 5:47.</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">肖雪洋,武治印,胡琳珍. 帕金森发病机制及其最新治疗策略. 湖北大学学报（自然科学版）,2021,43(5):514-521. DOI:10.3969/j.issn.1000-2375.2021.05.007.</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">王营飞,贺娟,张学敏. 帕金森病的<span style="color: black;">初期</span>症状与诊断<span style="color: black;">办法</span><span style="color: black;">科研</span><span style="color: black;">发展</span>. 医学综述,2018,24(12):2441-2445. DOI:10.3969/j.issn.1006-2084.2018.12.028.</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">中华医学会神经病学分会帕金森病及运动<span style="color: black;">阻碍</span>学组,中国医师协会神经内科医师分会帕金森病及运动<span style="color: black;">阻碍</span>学组. 早发型帕金森病的诊断与治疗中国专家共识. 中华神经医学杂志,2021,20(2):109-116. DOI:10.3760/cma.j.cn115354-20201119-00903.</p>
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<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">责任编辑：网友投稿</span></p>
你的话语如春风拂面，让我感到无比温暖。 你的见解真是独到，让我受益匪浅。 “NB”（牛×的缩写，表示叹为观止）
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