早发型与晚发型帕金森病非运动症状与血生化指标水平分析

Non-motor symptoms and serum biochemical markers of patients with early-onset and late-onset Parkinson’s disease

目的比较早发型帕金森病(Early-onset Parkinson’s disease,EOPD)和晚发型帕金森病(Late onset Parkinson’s disease, LOPD)患者非运动症状和血生化指标水平的差异,并分析2组患者非运动症状与血生化指标水平的相关性。方法纳入2018年9月-2020年1月于华中科技大学同济医学院附属同济医院就诊的281例诊断为帕金森病(Parkinson’s disease, PD)的患者,按照发病年龄是否>50岁分为EOPD组和LOPD组;采用改良H&Y分级和国际运动障碍协会帕金森病统一评定量表第三部分(MDS-UPDRS-Ⅲ)用于评估关期运动功能;PD自主神经功能量表(SCOPA-AUT)用于评估自主神经功能障碍;帕金森病睡眠量表(Parkinson disease sleeping scale, PDSS)用于评估睡眠质量;汉密尔顿抑郁量表(HAMD)、汉密尔顿焦虑量表(HAMA)用于评估焦虑抑郁状态;简易智能精神状态检查量表(MMSE)和蒙特利尔认知评估量表(MoCA)用于评估认知功能障碍,其中MoCA经教育程度校正(受教育年限<12年,总分加1分);同时测定血生化指标包括血清总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、同型半胱氨酸(HCY)、叶酸、维生素B12(VitB12)、铁(Fe)、铜(Cu)、铜蓝蛋白(CP)水平。结果 (1)LOPD组的SCOPA-AUT得分高于EOPD组,MMSE和MOCA得分低于EOPD组(P<0.05),而2组PDSS,HAMD,HAMA得分无明显差异(P>0.05);(2)LOPD组血清同型半胱氨酸(HCY)、铜(Cu)、铜蓝蛋白(CP)水平均高于EOPD组(P<0.05);(3)EOPD组血清TG水平与MMSE,MOCA评分呈负相关(-0.4<r<-0.2,P<0.05);血清VitB12水平与MOCA评分呈正相关(r=0.275,P<0.05),与HAMA评分呈负相关(r=-0.264,P<0.05);血清Fe水平与SCOPA-AUT评分呈负相关(r=-0.314,P<0.05);LOPD组血清HCY水平与SCOPA-AUT评分呈正相关(r=0.174,P<0.05),血清TC,LDL-C水平与MOCA评分呈正相关(0.1<r<0.3,P<0.05)。结论 LOPD患者非运动症状中的自主神经功能障碍及认知功能障碍较EOPD患者重;LOPD患者血清HCY水平较EOPD患者高,而EOPD患者血清Cu及CP水平较LOPD患者低;2组患者的血清生化指标水平与非运动症状具有相关性,但存在差异。

Objective To compare the differences of non-motor symptoms and blood biochemical markers between patients with early onset Parkinson's disease(EOPD)and late onset Parkinson's disease(LOPD),and to explore the correlation between non-motor symptoms and blood biochemical marker levels in the two groups.Methods A total of 281 patients with a diagnosis of Parkinson's disease(PD)admitted to Tongji Hospital from September 2018 to January 2020 were divided into two groups,EOPD group(onset age≤50years)and LOPD group(onset age>50years).PD-autonomic questionnaire(SCOPA-AUT),montreal cognitive assessment scale(MoCA),mini-mental state examination(MMSE),PD sleep scale(PDSS),hamilton depression scale(HAMD),hamilton anxiety scale(HAMA)were used to evaluate non-motor symptoms in two groups.Some serum biochemical markers including total cholesterol(TC),triglyceride(TG),high-density lipoprotein cholesterol(HDL-C),low-density lipoprotein cholesterol(LDL-C),homocysteine(HCY),folic acid vitamin B12(VitB12),serum iron,serum copper,ceruloplasmin(CP)were measured.Results(1)The SCOPA-AUT score of LOPD group was higher than that of EOPD group,while MMSE and MOCA scores of LOPD group were lower than those of EOPD group(P<0.05).However,there were no significant differences in PDSS,HAMD and HAMA scores of the two groups(P>0.05).(2)The serum HCY,copper and CP levels in LOPD group were higher than those in EOPD group(P<0.05).(3)In EOPD group serum TG levels were negatively correlated with MMSE and MOCA scores(-0.4<r<-0.2,P<0.05).Serum VitB12 level was positively correlated with MOCA score(r=0.275,P<0.05),and was negatively correlated with HAMA score(r=-0.264,P<0.05).Serum iron level was negatively correlated with SCOPA-AUT score(r=-0.314,P<0.05).In LOPD group serum HCY level was positively correlated with SCOPA-AUT score(r=0.174,P<0.05),and serum TC,LDL-C levels were positively correlated with MOCA score(0.1<r<0.3,P<0.05).Conclusion The autonomic symptoms and cognitive impairment in patients with LOPD were more serious than those in patients with EOPD.Serum HCY level was higher in LOPD group,while serum copper and CP levels were lower in EOPD group.Serum biochemical markers were correlated with non-motor symptoms in both groups but there were differences between the two groups.