早期帕金森病患者出院后24小时活动行为达标现状及影响因素分析-现代医学

早期帕金森病患者出院后24小时活动行为达标现状及影响因素分析

单位：南京医科大学附属脑科医院老年医学科, 江苏南京 210029

分类号：R742.5

出版年·卷·期（页码）：2026·54·第六期（1002-1009）

摘要：

目的：探讨早期帕金森病(PD)患者出院后24 h活动行为达标现状及其影响因素。方法：便利抽样选择2024年2月至2025年7月我院收治的208例早期PD患者作为研究对象。采用一般资料调查表、简易应对方式问卷(SCSQ)和简明国际跌倒效能感量表(FES-I)、医院焦虑抑郁量表(HADS)对208例患者进行调查，另在患者出院前发放测量手环，要求患者出院后连续佩戴1周，根据24 h活动行为指南推荐的3项(身体活动、久坐行为和睡眠时间)标准，根据24 h活动行为达标情况将患者分为达标组(n=52)、部分达标组(n=121)和未达标组(n=35)。以早期PD患者出院后24 h活动行为作为因变量(以达标组作为参照)，将单因素分析中差异有统计学意义的7个变量作为自变量进行无序多分类Logistic回归分析早期PD患者出院后24 h活动行为达标情况的影响因素。结果：208例早期PD患者达标率为25.00%。Logistic回归分析显示，与达标组相比，FES-I评分越高(OR=1.340，95%CI 1.132～1.585)、年龄≥70岁(OR=3.543，95%CI 1.214～10.340)、合并慢性病数>3种(OR=2.818，95%CI 1.001～7.927)、首发症状为姿势步态异常(OR=4.347，95%CI 1.295～14.595)、有抑郁症状(OR=5.045，95%CI 1.636～15.552)及消极应对方式(OR=4.565，95%CI 1.479～14.085)是未达标组的危险因素，而文化程度初中以上(OR=0.230，95%CI 0.073～0.724)是未达标组保护因素；与达标组相比，FES-I评分越高(OR=1.259，95%CI 1.107～1.432)、年龄≥70岁(OR=2.288，95%CI 1.051～4.978)、首发症状为姿势步态异常(OR=2.928，95%CI 1.047～8.183)、有抑郁症状(OR=3.723，95%CI 1.476～9.388)及消极应对方式(OR=3.036，95%CI 1.197～7.703)是部分达标组的危险因素，而文化程度初中以上(OR=0.313，95%CI 0.139～0.704)是部分达标组的保护因素。结论：早期PD患者出院后24 h活动行为整体达标率低，以部分达标为主。医务人员可针对高龄、低文化程度、姿势步态异常起病、有抑郁症状、消极应对及高跌倒恐惧患者制定并实施个体化干预方案，以提高早期PD患者的24 h活动行为达标率。

Objective: To investigate the status and influencing factors of 24-hour activity behavior compliance in patients with early Parkinson's disease(PD) after discharge.Methods: By convenience sampling, 208 early PD patients admitted to our hospital from February 2024 to July 2025 were enrolled. All patients were surveyed using a general information questionnaire, the Simplified Coping Style Questionnaire(SCSQ), the Falls Efficacy Scale-International(FES-I), and the Hospital Anxiety and Depression Scale(HADS). Before discharge, each patient was provided with a wristband to wear continuously for one week after discharge. According to the three recommendations(physical activity, sedentary behavior, and sleep duration) from the 24-hour activity behavior guidelines, patients were classified into the compliance group(n=52), partial compliance group(n=121), and non-compliance group(n=35) based on their 24-hour activity behavior compliance. The 24-hour activity behavior of early PD patients after discharge was taken as the dependent variable(with the compliance group as the reference). Seven variables that showed statistically significant differences in univariate analysis were entered as independent variables into a multinomial logistic regression analysis to identify factors influencing compliance status. Results: The overall compliance rate of the 208 early PD patients was 25.00%. Multinomial Logistic regression analysis revealed that, compared with the compliance group, higher FES-I score(OR=1.340, 95%CI 1.132-1.585), age ≥70 years(OR=3.543, 95%CI 1.214-10.340), number of chronic diseases >3(OR=2.818, 95%CI 1.001-7.927), initial symptom as posture and gait abnormality(OR=4.347, 95%CI 1.295-14.595), having depressive symptoms(OR=5.045, 95%CI 1.636-15.552), and negative coping style(OR=4.565, 95%CI 1.479-14.085) were risk factors for the non-compliance group, while education level above junior high school(OR=0.230, 95%CI 0.073-0.724) was a protective factor for the noncompliance group. Compared with the compliance group, higher FES-I scores(OR=1.259, 95%CI 1.107-1.432), age ≥70 years(OR=2.288, 95%CI 1.051-4.978), initial symptoms as posture and gait abnormality(OR=2.928, 95%CI 1.047-8.183), having depressive symptoms(OR=3.723, 95%CI 1.476-9.388), and negative coping style(OR=3.036, 95%CI 1.197-7.703) were risk factors for the partial compliance group, while education level above junior high school(OR=0.313, 95%CI 0.139-0.704) was a protective factor for the partial compliance group.Conclusion: The overall compliance rate of 24-hour activity behavior in early PD patients after discharge is low, and most patients achieve only partial compliance. Medical staff should develop and implement individualized intervention programs targeting patients who are elderly, have low education level, present with posture and gait abnormality as the initial symptom, have depressive symptoms, adopt negative coping styles, or have high fear of falling, so as to improve the 24-hour activity behavior compliance in early PD patients.

参考文献：

[1] 巩梁旭,铁子慧,何培坤,等.帕金森病患者胶质淋巴系统功能与自主神经功能障碍相关性研究[J]. 现代医学,2026,54(2):201-210.
[2] POPESCU B O,BATZU L,RUIZ P J G,et al.Neuroplasticity in Parkinson's disease[J]. J Neural Transm,2024,131(11):1329-1339.
[3] 苏剑玮,叶民.帕金森病睡眠障碍机制研究进展[J]. 中国现代神经疾病杂志,2026,26(4):361-366.
[4] FEIGIN V L,NICHOLS E,ALAM T,et al.Global,regional,and national burden of neurological disorders,1990—2016:a systematic analysis for the global burden of disease study 2016[J]. Lancet Neurol,2019,18(5):459-480.
[5] 翟明月,张硕,高健,等.帕金森病药物治疗的研究进展[J/OL]. 吉林医药学院学报,1-7[2026-06-17]. https://doi.org/10.13845/j.cnki.issn1673-2995.20251217.001.
[6] 钟飞,黄聪,徐勇进,等.太极拳训练改善帕金森病患者轴向运动症状:效果与机制[J]. 中国康复医学杂志,2025,40(10):1560-1568.
[7] SMAGULA S F,ZHANG G,GUJRAL S,et al.Association of 24-hour activity pattern phenotypes with depression symptoms and cognitive performance in aging[J]. JAMA Psychiatry,2022,79(10):1023.
[8] GRGIC J,DUMUID D,BENGOECHEA E G,et al.Health outcomes associated with reallocations of time between sleep,sedentary behaviour,and physical activity:a systematic scoping review of isotemporal substitution studies[J]. Int J Behav Nutr Phys Act,2018,15(1):69.
[9] LUO L,CAO Y,HU Y,et al.The associations between meeting 24-hour movement guidelines(24-HMG) and self-rated physical and mental health in older adults—cross sectional evidence from China[J]. Int J Environ Res Public Health,2022,19(20):13407.
[10] 蒙金苗,贾艳滨,杜若菲,等.糖尿病合并高血压患者身体活动、久坐行为与抑郁风险:睡眠障碍中介效应[J]. 暨南大学学报(自然科学与医学版),2025,46(5):689-697.
[11] 兰磊,郎欣月,陈飞龙,等.中国人群中久坐时间与全因死亡及心血管疾病的关联[J]. 基础医学与临床,2025,45(11):1438-1443.
[12] TAPIA-SERRANO M A,SEVIL-SERRANO J,SÁNCHEZ-MIGUEL P A,et al.Prevalence of meeting 24-Hour Movement Guidelines from pre-school to adolescence:a systematic review and meta-analysis including 387 437 participants and 23 countries[J]. J Sport Health Sci,2022,11(4):427-437.
[13] KRACHT C L,BURKART S,GROVES C I,et al.24-hour movement behavior adherence and associations with health outcomes:an umbrella review[J]. J Act Sedentary Sleep Behav,2024,3(1):25.
[14] 赵晗华,王地,高莹.儿童青少年24小时活动行为的演化路径与热点解析[J]. 中国儿童保健杂志,2024,32(12):1343-1348.
[15] 中华医学会,中华医学会杂志社,中华医学会全科医学分会,等.帕金森病基层诊疗指南(2019年)[J]. 中华全科医师杂志,2020,19(1):5-17.
[16] 伍立志,杨文,贾孝霞,等.线性模型中自变量相对重要性常见估计方法的模拟比较研究[J]. 中国卫生统计,2015,32(5):908-911.
[17] 邓宁,张彤,史宝欣.简明国际跌倒效能感量表在脑梗死患者中的信度和效度检验[J]. 中国康复理论与实践,2015,21(12):1438-1442.
[18] 王端卫,张敬悬.简易应对方式问卷的因子分析[J]. 山东大学学报(医学版),2014,52(3):96-100.
[19] ZIGMOND A S,SNAITH R P.The hospital anxiety and depression scale[J]. Acta Psychiatr Scand,1983,67(6):361-370.
[20] 王瑞青,孔宪菲,张华,等.世界卫生组织身体活动和久坐行为指南[J]. 中国卒中杂志,2021,16(4):390-397.
[21] GU W,TIAN Z,HOU W,et al.The association of 24-hour behavior rhythms with stroke among American adults with prediabetes/diabetes:evidence from NHANES 2011—2014[J]. BMC Public Health,2024,24(1):3265.
[22] ZHANG Y,YAO L,CHEN L,et al.Longitudinal relationship between 24-Hour Movement behavior patterns and physical function and quality of life after stroke:a latent transition analysis[J]. Int J Behav Nutr Phys Act,2024,21(1):141.
[23] ONO K,YU K.Characteristics of the rest and activity patterns in patients with mild to moderate Parkinson's syndrome[J]. Psychogeriatrics,2025,25(3):e70047.
[24] 陈一萍.主观认知下降老年人身体活动行为调查、影响因素作用路径及促进策略研究[D]. 太原:山西医科大学,2024.
[25] 王德荣.膝骨关节炎患者身体活动模式的潜在剖面分析及影响因素研究[D]. 青岛:青岛大学,2024.
[26] ROE L S,STROTMEYER E S,CAWTHON P M,et al.24-hour activity composition is associated with lower fall and fracture risk in older men[J]. J Bone Miner Res,2024,40(1):27-37.
[27] HALLGREN M,OWEN N,STUBBS B,et al.Passive and mentally-active sedentary behaviors and incident major depressive disorder:a 13-year cohort study[J]. J Affect Disord,2018,241:579-585.
[28] 张洁,来艳丽,王亚霖,等.创伤后成长在中青年脑卒中患者医学应对方式与康复锻炼依从性间的中介效应[J]. 中华现代护理杂志,2025,31(9):1184-1189.
[29] 姚晶莹.基于Hook模型衰弱老年人身体活动行为研究[D]. 南京:南京医科大学,2023.

服务与反馈：

【文章下载】【发表评论】【查看评论】【加入收藏】

提示：您还未登录，请登录！点此登录