帕金森病运动前期的概念、定义、临床表现及预警筛查策略

Pre-motor Parkinson's disease: concepts,definition,clinical manifestation and predictable screening strategies

帕金森病(PD)可能存在一个前驱阶段,即运动前期。PD运动前期是由一系列相续阶段组成的,在此阶段即可出现例如嗅觉障碍、自主神经功能异常、情感障碍和快速动眼期睡眠障碍(RBD)等非运动的临床特征及生理异常。探索敏感而特异的检测方法对PD运动前期患者进行筛选,是当前PD研究领域的新热点问题。在PD高危人群中建立效价比高的PD运动前期筛查策略(也指特异性和敏感性高的生物标记物),有助于突破当前PD一旦确诊即已处于中晚期的困境,为实现PD的早期诊断和治疗带来新的希望。鉴于此,本文就PD运动前期的概念、定义、临床表现及其可能的病理基础、PD运动前期预警筛查策略等相关问题进行了总结、解读与分析。

Parkinson＇ s disease （PD）may have a prodromal phase without non-motor clinical features, viz. pre-motor phase of PD, which is consist of a series of successive stages. During this phase, other non-motor clinical characteristics and physiological abnormalities such as olfactory dysfunction, autonomic dysfunction, affective disorders, rapid eye movement sleep disorder（RBD） may emerge. Exploring the sensitive and specific detection methods for pre-motor phase of PD has become new focus in the PD research field. Establishing high value-cost screening strategies （also referred to as high specificity and sensitivity biomarkers） for pre-motor phase of PD in high-risk would contribute to break through the current dilemma that PD has always been in the middle-late stages once diagnosed. It can also bring new hope to achieve early diagnosis and treatment for PD. In view of this, the concept and definition of pre-motor phase, its clinical manifestations and possible pathological mechanism as well as the predictable screening strategies for premotor phase of PD were summarized,interpretated and analyzed.