【作者】 刘婷婷；

【导师】 韩芳； 房季冬；

【作者基本信息】 滨州医学院 ， 内科学， 2017， 硕士

【摘要】 目的:探讨发作性睡病1型的临床特征,评价发作性睡病1型多次睡眠潜伏期实验(Multiple Sleep Latency Test,MSLT)两次测量的一致性,MSLT阳性的可重复性。方法:自1999年1月至2017年2月,按照国际睡眠障碍第三版(International Classification Of Sleep Disorders Third Edition,ICSD-3)发作性睡病诊断标准入选发作性睡病1型患者350例(男性242例,女性108例;平均发病年龄10.43±7.89,年龄范围为2-58岁)。所有的患者均行至少2次MSLT及前夜的多导睡眠监测(Polysomnography,PSG)。收集患者的基本信息包括发病年龄、初次就诊年龄及复查就诊年龄、性别、体重指数(BMI)、两次就诊的间隔时间,临床资料包括家族史、幻听、幻视、睡瘫、夜间睡眠障碍、情绪障碍、HLADQB1*0602情况、夜间睡眠潜伏期(SL)和REM睡眠潜伏期(RSL)、MSLT平均睡眠潜伏期(MSL)和REM起始睡眠次数(SOREMPS)、检查时治疗情况。结果:在350例发作性睡病1型的患者中,除嗜睡与猝倒症状以外,临床表现最多的是夜间睡眠行为异常,其次为出现性格障碍,幻觉及睡瘫阳性率并不高。在两次MSLT检查中,复查时比初次检查时的平均睡眠潜伏期时间明显更长(P<0.05)、REM起始睡眠次数明显更少(P<0.05)以及MSLT的阳性率更低(P<0.05),在未服药患者(对照组)中两次MSLT结果的MSL及SOREMPs均无明显差别(P>0.05),但是在服药患者(实验组)中,结果与总体患者两次MSLT结果的对比一致,MSL时间明显变长,SOREMPs次数明显变少。性别与HLA DQB1*0602基因对两次MSLT检查结果的MSL和SOREMPS的可重复性及阳性率均无明显差别(P>0.05),但是伴有HLA DQB1*0602基因阳性的患者比不伴有该基因的患者MSL时间更短,SOREMPS次数更多,MSLT检查的阳性率也更高,在不同性别之间的比较中并无此发现。结论:患者应用盐酸哌甲酯和盐酸氯米帕明时明显影响MSLT的MSL时间及SOREMPs次数和MSLT的阳性率,使MSLT检查的可重复性明显降低,不伴有HLADQB1*0602基因的患者MSLT阳性率也较低,所以,必要时重复检查MSLT可以提高发作性睡病1型的诊断率,避免漏诊。更多还原

【Abstract】 Objective:To explore the clinical characteristics of Narcolepsy type 1,evaluate of positive repeatability and the consistency of the two MSLT of Narcolepsy type 1.Methods:According to the International Sleep disorder in the Third Edition(International Classification Of Sleep Disorders,Third Edition,ICSD-3),Diagnostic criteria of Narcolepsy type 1,350 cases(male 242,female 108 cases;the average age Of 10.43 ±7.89,age range is 2-58)were selected Since January 1999 to February 2017.All patients were performed at least twice MSLT and on the eve of the polysomnography(PSG).All of the basic information of the patients including age of onset,age first visits to hospital and review of the age,sex.body mass index(BMI),the time interval between two visits,clinical data,including family history,auditory hallucination were collected.Results:In 350 cases of Narcolepsy type 1,in addition to the EDS and cataplexy symptoms,Night Sleep Behavior Disorder was the most clinical features,Character disorder was the secondly,illusion and sleep paralysis positive rate was not common.At two MSLT,mean sleep latency of the second MSLT was longer than the first MSLT(P<0.05),SOREMPS was fewer(P<0.05),and the MSLT positive rate was lower,too(P<0.05).Both MSLTs of patients without medicine(control group),MSLs and SOREMPs results no significant difference(P>0.05),but in the patients with medicine(experimental group),the results were consistent with overall patient two MSLT results contrast,MSL time was longer obviously,SOREMPs were less significantly.Gender and HLA DQB1*0602 genes for two MSLT test results of MSL and SOREMPS repeatability and positive rate of no significant difference(P>0.05),Compared with patients with HLA DQB1*0602 genes,MSL of the patients without the gene was shorter,SOREMPS more.Different gender was not same as above.ConcIusions:The mean sleep latency time and SOREMPs and positively MSLT was obviously influenced by the medicine such as methylphenidate hydrochloride and clomipramine hydrochloride.MSLT positive rate was low that patients without HLA DQB 1*0602 gene.lt was necessary repeat MSLT that diagnosis exactly.更多还原