帕金森病患者营养状况、体成分及其与症状的相关性分析

The correlation between nutritional status,body composition,and symptoms in Parkinson′s disease patients

目的研究帕金森病(PD)患者营养状况、体成分及其与帕金森症状的相关性。方法回顾性纳入2020年11月至2021年4月苏州大学附属第二医院神经内科门诊及病房收治的102例PD患者,收集患者年龄、性别、病程、Hoehn-Yahr(H-Y)分期等基本资料,在“开期”状态下采用统一帕金森病评定量表(UPDRS)等量表,对PD患者临床症状进行相关评估;采用微型营养评定量表(MNA)对患者营养状况进行评估,应用体成分分析仪测量PD患者的体成分数据。根据微型营养评定量表将PD患者分为营养良好(45例)、营养不良风险(43例)和营养不良(14例)三组,比较三组间体成分、实验室检查、骨密度、帕金森病症状等。结果102例PD患者中男48例(47.1%),女54例(52.9%),年龄42~86(66±9)岁。与营养不良风险组比较,营养不良组淋巴细胞[(1.45±0.48)×10^(9)/L比(1.76±0.43)×10^(9)/L]、尿酸[(227±54)μmol/L比(282±63)μmol/L]均偏低(均P<0.05)。与营养良好组比较,营养不良组血红蛋白[(125±17)g/L比(136±14)g/L]、前白蛋白[(0.23±0.05)g/L比(0.27±0.06)g/L]、尿酸[(227±54)μmol/L比(312±76)μmol/L]和视黄醇结合蛋白[(33±7)mg/L比(39±10)mg/L]均偏低(均P<0.05)。营养不良风险与营养不良组除了内脏脂肪面积、体脂百分比比较差异无统计学意义外,其他体成分指标、骨密度T值比较均有统计学意义(均P<0.05)。与营养良好组比较,营养不良风险组体脂肪[(16±6)kg比(20±6)kg]、体脂百分比[(26±9)%比(29±7)%]、腰臀比[(0.86±0.05)比(0.89±0.05)]、上臂围度[(29.00±2.59)cm比(30.74±2.75)cm]均偏低(均P<0.05);营养不良与营养良好组体成分所有指标、骨密度T值比较差异均有统计学意义(均P<0.05)。PD患者MNA评分与UPDRS-Ⅰ、UPDRS-Ⅱ、UPDRS-Ⅳ评分呈负相关(r=-0.347、-0.364、-0.303,均P<0.05);体成分指标身体总水分、无机盐与UPDRS-Ⅰ呈负相关(r=-0.206、-0.223,均P<0.05)、体脂肪与左旋多巴等效剂量(LED)呈负相关(r=-0.209,P<0.05)。结论PD患者营养不良风险、营养不良的发生率高;营养不良组淋巴细胞、尿酸、血红蛋白、视黄醇结合蛋白、体成分、骨密度均偏低,PD患者MNA评分与PD症状呈负相关。

Objective To investigate the relationship between nutritional status,body composition and symptoms of Parkinson′s disease(PD).Methods The study was conducted among 102 PD patients between November 2020 to April 2021 in the outpatient and inpatient of Neurology department of the Second Affiliated Hospital of Suzhou University.Basic data,such as age,gender,course of disease and Hoehn-Yahr(H-Y)stage of the patients,were collected.In the"open"state,the Unified Parkinson′s Disease Rating Scale(UPDRS)and other scales were used to evaluate the clinical symptoms of PD patients.The nutritional status of PD patients was evaluated by the micro-nutrition rating Scale(MNA),and the body composition data of PD patients was measured by the body composition analyzer.The patients were divided into three groups according to the MNA:well-nourished group(45 cases),malnutrition-risk group(43 cases)and malnutrition group(14 cases).Body composition,laboratory tests,bone density,and symptoms of PD were compared among the three groups.Results Among 102 PD patients,48 were males(47.1%)and 54 were females(52.9%),aged 42-86(66±9)years old.Compared with the malnutrition-risk group,lymphocytes in the malnutrition group[(1.45±0.48)×10^(9)/L vs(1.76±0.43)×10^(9)/L],uric acid[(227±54)μmol/L vs(282±63)μmol/L]were all low,and the difference was statistically significant(all P<0.05).Compared with the well-nourished group,hemoglobin[(125±17)g/L vs(136±14)g/L],prealbumin[(0.23±0.05)g/L vs(0.27±0.06)g/L],and uric acid[(227±54)μmol/L vs(312±76)μmol/L]and Retinol binding protein[(33±7)mg/L were lower than(39±10)mg/L]in the malnutrition group,the difference was statistically significant(P<0.05).Except for the visceral fat area and body fat percentages,there was no significant difference in body composition indexes and bone mineral density T-value between the malnutrition-risk and malnutrition groups(P<0.05).Compared with the well-nourished group,the body fat[(16±6)kg vs(20±6)kg],the percentage of body fat[(26±9)%vs(29±7)%],the waist-hip ratio[(0.86±0.05)vs(0.89±0.05)],and the upper arm circumference[(29.00±2.59)cm vs(30.74±2.75)cm]in the malnutrition risk group were lower,and the difference was statistically significant(P<0.05).There were statistically significant differences in all body composition indicators and T-values of bone density between the malnourished and well nourished groups(all P<0.05).The MNA score of PD patients was negatively correlated with UPDRSⅠ,UPDRSⅡ,and UPDRSⅣscores(r=-0.347,-0.364,-0.303,all P<0.05);Body composition indicators:total body water and inorganic salts were negatively correlated with UPDRS-I(r=-0.206,-0.223,all P<0.05),and body fat was negatively correlated with levodopa Equivalent dose(LED)(r=-0.209,P<0.05)Conclusions The malnutrition risk and incidence of malnutrition in PD patients are high;lymphocyte,uric acid,hemoglobin,Retinol binding protein,body composition and bone mineral density were low in malnutrition group.MNA score of PD patients was negatively correlated with Parkinson′s disease symptoms.