良性特发性眼睑痉挛的发病危险因素分析
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摘要
目的：探讨良性特发性眼睑痉挛发病的危险因素以及各因素的作用强度。
方法：病例组为2009-4至2010-3在北京协和医院神经内科就论的良性特发性眼睑痉挛患者100例,可合并相邻部位的肌张力障碍,如Meige综合征及颅颈肌张力障碍；除此之外无其他神经系统症状和体征。排除其他因素引起的继发性眼睑痉挛。对照组来自同期神经内科门诊就诊的与病例组偏侧面肌痉挛患者100例,性别与病例组相同,以及眼睑痉挛及面肌痉挛患者配偶40例,男女比例与病例组匹配,无锥体外系及其他神经系统疾病。对所有受试者进行问卷调查,包括一般情况、社会行为因素、环境因素、精神因素、遗传因素、既往病史。主要变量为：居住地域、生活环境、生活事件、文化程度、体力劳动、杀虫剂接触、伴和不伴意识障碍的头部外伤史、眼病、汉密尔顿焦虑及抑郁量表评分、强迫观念、肌张力障碍或震颤家族史、帕会森病家族史、CO中毒史、高血压史、糖尿病史、甲状腺疾病史、吸烟史、饮酒史、饮用咖啡、饮茶史。数据录入SPSS11.5软件进行Logistic回归分析。
结果：多因素回归分析显示,眼病、焦虑抑郁状态、与良性特发性眼睑痉挛有显著正关联,饮用咖啡与良性特发性眼睑痉挛有显著负关联。
结论：眼疾、焦虑、抑郁与眼睑痉挛患病成正相关,可能是良性特发性眼睑痉挛发病的独立危险因素。一过性意识障碍的头面部外伤史与眼睑痉挛有一定的相关性。咖啡饮用史与眼睑痉挛发病成负相关,可能是良性特发性眼睑痉挛的保护因素。这一结果显示局部损伤及精神因素作为良性特发性眼睑痉挛发病的危险因素而言可能比遗传因素更重要些。
【Objective】To explore the risk factors of benign essential blepharospasm(BEB)and each factor's intensity.
【Methods】Totally 100 patients with BEB including Meige and cranial-cervical without other neurological abnormalities were recuited from the outpatient clinic of Department of Neurology,Peking Uion Medical College Hospital from April 2009 to March 2010 as case group. Patients with atypical features suggesting secondary blepharospasm were excluded.At the same time,100 outpatients diagnosed with idiopathic hemifacial spasm(HFS) and 40 healty controls including spouses of BEB and HFS patients without extrapyramidal diseases or other neurological diseases were recuited from the same outpatient clinic.All the cases and controls were investigated by questionnaires about general conditions, social behavioral factors,environmental factors, phychiatrical factors,genetic factors,previous diseases, with main variances(dwelling,life events,educational level,manual work,pesticides.head or face trauma with and without loss of consciousness, eye diseases,Hamilton anxiety and Hamilton depression scale,obsessive-compulsive symptoms,family history of dystonia and tremor and Pakinsonism, CO intoxication, hypertension,diabetes,thyroid diseases,wine drinking,cigarette smoking,coffee and tea drinking history).The data was analysed by Logistic regression model with the statistical software SPSS 11.5.
【Results】Multivariate analysis indicated that eye disease,anxiety and depression were positively related with BEB,whereas coffee drinking had a negative relationship with BEB.
【Conclusions】The risk factors of BEB are eye diseases,anxiety and depression.Coffee drinking is protective for BEB.The results suggest that local injury and phychiatrical factors may be more important than genetic factor in the aetiology of BEB.
方法：病例组为2009-4至2010-3在北京协和医院神经内科就论的良性特发性眼睑痉挛患者100例,可合并相邻部位的肌张力障碍,如Meige综合征及颅颈肌张力障碍；除此之外无其他神经系统症状和体征。排除其他因素引起的继发性眼睑痉挛。对照组来自同期神经内科门诊就诊的与病例组偏侧面肌痉挛患者100例,性别与病例组相同,以及眼睑痉挛及面肌痉挛患者配偶40例,男女比例与病例组匹配,无锥体外系及其他神经系统疾病。对所有受试者进行问卷调查,包括一般情况、社会行为因素、环境因素、精神因素、遗传因素、既往病史。主要变量为：居住地域、生活环境、生活事件、文化程度、体力劳动、杀虫剂接触、伴和不伴意识障碍的头部外伤史、眼病、汉密尔顿焦虑及抑郁量表评分、强迫观念、肌张力障碍或震颤家族史、帕会森病家族史、CO中毒史、高血压史、糖尿病史、甲状腺疾病史、吸烟史、饮酒史、饮用咖啡、饮茶史。数据录入SPSS11.5软件进行Logistic回归分析。
结果：多因素回归分析显示,眼病、焦虑抑郁状态、与良性特发性眼睑痉挛有显著正关联,饮用咖啡与良性特发性眼睑痉挛有显著负关联。
结论：眼疾、焦虑、抑郁与眼睑痉挛患病成正相关,可能是良性特发性眼睑痉挛发病的独立危险因素。一过性意识障碍的头面部外伤史与眼睑痉挛有一定的相关性。咖啡饮用史与眼睑痉挛发病成负相关,可能是良性特发性眼睑痉挛的保护因素。这一结果显示局部损伤及精神因素作为良性特发性眼睑痉挛发病的危险因素而言可能比遗传因素更重要些。
【Objective】To explore the risk factors of benign essential blepharospasm(BEB)and each factor's intensity.
【Methods】Totally 100 patients with BEB including Meige and cranial-cervical without other neurological abnormalities were recuited from the outpatient clinic of Department of Neurology,Peking Uion Medical College Hospital from April 2009 to March 2010 as case group. Patients with atypical features suggesting secondary blepharospasm were excluded.At the same time,100 outpatients diagnosed with idiopathic hemifacial spasm(HFS) and 40 healty controls including spouses of BEB and HFS patients without extrapyramidal diseases or other neurological diseases were recuited from the same outpatient clinic.All the cases and controls were investigated by questionnaires about general conditions, social behavioral factors,environmental factors, phychiatrical factors,genetic factors,previous diseases, with main variances(dwelling,life events,educational level,manual work,pesticides.head or face trauma with and without loss of consciousness, eye diseases,Hamilton anxiety and Hamilton depression scale,obsessive-compulsive symptoms,family history of dystonia and tremor and Pakinsonism, CO intoxication, hypertension,diabetes,thyroid diseases,wine drinking,cigarette smoking,coffee and tea drinking history).The data was analysed by Logistic regression model with the statistical software SPSS 11.5.
【Results】Multivariate analysis indicated that eye disease,anxiety and depression were positively related with BEB,whereas coffee drinking had a negative relationship with BEB.
【Conclusions】The risk factors of BEB are eye diseases,anxiety and depression.Coffee drinking is protective for BEB.The results suggest that local injury and phychiatrical factors may be more important than genetic factor in the aetiology of BEB.
引文
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[2]Mark Hallett. Blepharospasm:Recent advances.Neurology 2002;59:1306-1312
[3]Grandas F,Traba A,Alonso F,Esteban A. Blink reflex recovery cycle in patients with blepharospasm unilaterally treated with botulinum toxin. Clin Neuropharmacol 1998;21:307-11
[4]Lew H, Jordan C, Jerger J, Jankovic J. Acoustic reflex abnormalities in cranial-cervical dystonia. Neurology 1992;42:594-597
[5]A prevalence study of primary dystonia in eight European countries.J Neurol 2000;247:787-792.
[6]Epidemiologic Study of Dystonia in Europe(ESDE) Collaborative Group.Sex-related influences on the frequency and age of onset of primary dystonia.Neurology 1999;53:1871-1873.
[7]Schrag A, Bhatia KP,Quinn NP, Marsden CD. Atypical and typical cranial dystonia following dental procedures.Mov Disord 1999; 14:492-496
[8]Joseph Jankovic.M.D. Blepharospasm. Neurology Medlink,I.a Jolla.CA:Arbor Publishing,2002(www.medlink.com)
[9]Defazio G, Berardelli A, Abbruzzese G, et al. Possible risk factors for primary adult onset dystonia:a case-control investigation by the Italian Movement Disorders Study Group. J Neurol Neurosurg Psychiatry 1998;64:25-32
[10]Defazio G, Martino D, Abbruzzese G, et al.Influence of coffee drinking and cigarette smoking on the risk of primary late onset blepharospasm:evidence from a multicentre case control study.J Neurol Neurosurg Psychiatry 2007;78:877-879.
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