Clinical College of Neurology, Neurosurgery and Neurorehabilitation, Tianjin Medical University, Tianjin 300070, China; Department of Neurology, Cangzhou People's Hospital, Cangzhou, Hebei 061000, China.
Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China.
J Clin Neurosci. 2023 Mar;109:1-5. doi: 10.1016/j.jocn.2022.12.012. Epub 2023 Jan 10.
The characteristic of nonmotor symptoms in patients with multiple system atrophy (MSA) has varied among previous studies. The objective was to investigatethe nonmotor characteristics in MSA patients with different phenotypes, sex and different onset patterns.
We performed a retrospective review of 1492 MSA patients. All cases were evaluatedby neurologists and assessed with motormanifestations, nonmotor symptoms, auxiliary examinationand brain MRI scans.
Multiple system atrophy-cerebellar ataxia (MSA-C) was the predominant phenotype in 998 patients. Average age of onset (56.8 ± 9.2 years) was earlier, the disease duration (2.4 ± 2.2 year) was shorter and brain MRI abnormalities (49.2 %) were more frequently in MSA-C (P < 0.001). Multiple system atrophy-parkinsonism (MSA-P) patients were more likely to have nonmotor symptoms. After adjusted significant parameters, urinary dysfunction (OR 1.441, 95 %CI = 1.067-1.946, P = 0.017), constipation (OR 1.482, 95 %CI = 1.113-1.973, P = 0.007), cognitive impairment (OR 1.509, 95 %CI = 1.074-2.121, P = 0.018) and drooling (OR 2.095, 95 %CI = 1.248-3.518, P = 0.005) were associated with the MSA-P phenotype. Males were more likely to have orthostatic hypotension, urinary dysfunction, sexual dysfunction, drooling and females in constipation and probable RBD. In different onset patterns, constipation (59.2 %) and probable RBD (28.4 %) were more frequently in autonomiconset pattern.
MSA-C is the predominant phenotype in Chinese patients, while many nonmotor symptoms are more common in MSA-P phenotype. Patients with different sex and onset patterns have different nonmotor characteristics. The different clinical features identified could help the physician counseling of MSA patients more easily and more accurately.
既往研究中，多系统萎缩（MSA）患者的非运动症状特征存在差异。本研究旨在探讨不同表型、性别和不同起病模式的 MSA 患者的非运动特征。
我们对 1492 例 MSA 患者进行了回顾性分析。所有病例均由神经科医生进行评估，并进行运动表现、非运动症状、辅助检查和脑 MRI 扫描。
998 例患者为多系统萎缩-小脑共济失调（MSA-C）表型，为主要表型。MSA-C 组患者的平均发病年龄（56.8±9.2 岁）较早，病程（2.4±2.2 年）较短，脑 MRI 异常（49.2%）更为常见（P<0.001）。MSA-P 患者更易出现非运动症状。调整了显著参数后，尿失禁（OR 1.441，95%CI=1.067-1.946，P=0.017）、便秘（OR 1.482，95%CI=1.113-1.973，P=0.007）、认知障碍（OR 1.509，95%CI=1.074-2.121，P=0.018）和流涎（OR 2.095，95%CI=1.248-3.518，P=0.005）与 MSA-P 表型相关。男性更易出现直立性低血压、尿失禁、性功能障碍、流涎，女性更易出现便秘和可能的 RBD。在不同起病模式中，自主神经起病模式更常见便秘（59.2%）和可能的 RBD（28.4%）。
MSA-C 是中国患者的主要表型，而 MSA-P 表型更常见多种非运动症状。不同性别和起病模式的患者具有不同的非运动特征。识别这些不同的临床特征可以帮助医生更轻松、更准确地为 MSA 患者提供咨询。
