幽门螺杆菌感染与帕金森病运动并发症的关系研究

Relationship between Helicobacter pylori infection and motor complications in Parkinson's disease

目的 研究幽门螺杆菌感染与帕金森病运动并发症的关系。方法 选择2015年1月至2016年12月病程≥5年的帕金森病患者100例,使用帕金森病统一评分量表(UPDRSIV)评估患者运动并发症(异动症、症状波动及其他治疗并发症),采用UPDRSIV第41条评估患者的睡眠障碍情况,采用剂末现象症状量表(WOQ9量表)评定患者的剂末现象,继而评估患者的症状波动情况。采用^(14)C呼气试验测定患者幽门螺杆菌感染情况,同时测定患者血浆叶酸、维生素B_(12)、同型半胱氨酸水平。结果 32例(32%)帕金森病患者合并有幽门螺杆菌感染,倾向性匹配分析示幽门螺杆菌感染组UPDRSIV低于非感染组(4.7±3.2 vs 7.7±3.6),症状波动及睡眠障碍发生率低于非感染组(71.9%vs 100%、15.6%vs 56.3%),两组左旋多巴等效用量、血浆叶酸、维生素B_(12)、同型半胱氨酸水平无差异(均P>0.05)。结论 幽门螺杆菌感染的帕金森病患者运动并发症较少,其原因可能是幽门螺杆菌感染影响左旋多巴在胃肠道的吸收。

Objective To investigate the relationship between Helicobacter pylori（HP） infection and motor complications in Parkinson＇s disease（PD）. Methods One hundred PD patients with disease duration ≥ 5 years were enrolled in the study. The presence and pattern of dyskinesias, clinical fluctuations and other complications of therapy were assessed by using the Unified PD Rating Scale, section IV（UPDRSIV）, and sleep disorders were assessed by UPDRSIV-41. The occurrence of wearing-off symptoms were assessed by the Wearing-Off-Questionnaire-9（WOQ-9）, HP infection was detected with [^（14）C] urea breath test. Blood folic acid, vitamin B12 and homocysteine were measured. Results Of the 100 included patients, 32 were HP infected. The propensity-matched analysis showed that the total UPDRS-IV score of HP infected patients was significantly lower than that of non-infected patients（4.7 ±3.2 vs. 7.7 ±3.6, P=0.02）, the incidence of wearing-off and sleep disturbance was also significantly lower in the HP infected patients（71.9% vs. 100.0%, 15.6% vs. 56.3%,P〈0.05）. There were no significant differences in folic acid, vitamin B12, or homocysteine levels between two groups of patients（P〉0.05）.Conclusion HP infection in patients with PD may result in a decreased occurrence of motor complications, which may be due to the altered absorption of levodopa in the gastrointestinal tract by HP infection.