帕金森病不同亚型与血清维生素D及其他指标的相关性分析

Correlation between Different Subtypes of Parkinson′s Disease and Serum VitD and Other Indicators

目的 探讨血清维生素D(vitaminD,VitD)、尿酸(uric acid, UA)、总胆固醇(cholesterol, TC)、甘油三酯(triglyceride, TG)、红细胞压积(hematokrit, HCT)与帕金森病(Parkinson′s disease, PD)不同运动亚型及疾病严重程度的关系。方法 选取2019年9月~2022年9月于淮安市第一人民医院就诊的原发性PD患者83例,另选取同期健康查体的35例志愿者作为对照组,根据国际运动障碍协会统一帕金森病评定量表评分中的震颤部分和非震颤部分评分平均值之比将PD患者分为震颤为主(tremor dominant, TD)组、姿势步态障碍(postural instability and gait difficult, PIGD)组和混合(indeterminate, IT)组,比较不同运动亚型患者和对照组的血清VitD、HCT、UA、TC及TG水平,分析上述指标与疾病严重程度之间的相关性,采用Logistic回归分析评价不同疾病亚型的危险因素。结果 TD组、PIGD组、IT组和对照组之间的性别、病程、HCT、UA、TC和TG差异均无统计学意义(P>0.05);4组间的年龄、H-Y分期、VitD水平比较,差异均有统计学意义(P<0.05),4组间的等效剂量(levodopa equivalent doses, LED)具有微小的显著性(P=0.051)。组间两两比较可知,对照组的年龄显著低于PIGD组(P=0.0172)和IT组(P=0.0035);TD组的H-Y分期显著低于PIGD组(P=0.0024);TD组的LED显著低于PIGD组(P=0.0471);对照组的VitD水平显著高于PIGD组(P=0.0002)和IT组(P=0.0125)。VitD水平与总PD患者疾病严重程度呈负相关,且差异有统计学意义(r=-0.241,P=0.028);年龄的增加是发生PIGD和IT型PD的危险因素[相对危险度(relative risk, RR)=1.09,95%CI:1.03~1.16]和(RR=1.12,95%CI:1.05~1.19),VitD水平的降低是发生PIGD型(RR=0.85,95%CI:0.78~0.93)和IT型(RR=0.89,95%CI:0.82~0.97)PD的危险因素和。结论 血清VitD可能参与不同亚型PD的发病机制,血清VitD水平降低可能是特定亚型PD患者的危险因素。

Objective To investigate the relationship between serum vitamin D(VitD),uric acid(UA),total cholesterol(TC),triglyceride(TG),hematocrit(HCT)and different motor subtypes of Parkinson′s disease(PD)and disease severity.Methods A total of 83 patients with primary PD who were treated in the First People′s Hospital of Huai′an City from September 2019 to September 2022 were selected;meanwhile,35 volunteers who underwent physical examination during the same period were selected as the control group.The PD patients were divided into tremor dominant(TD)group,postural instability and gait difficulty(PIGD)group and indeterminate(IT)group according to the ratio of the mean scores of the tremor and non-tremor components in the International Movement Disorders Association Unified Parkinson′s Disease Rating Scale.The serum VitD,HCT,UA,TC and TG levels of patients with different motor subtypes and patients in the control group were compared.Also,the correlation between above indexes and disease severity was analyzed,and the Logistic regression was used to analyze the risk factors of different disease subtypes.Results The differences in gender,disease duration,HCT,UA,TC and TG between the TD,PIGD,IT and control groups were not statistically significant(P>0.05);the differences in age,H-Y stage and VitD levels between the four groups were statistically significant(P<0.05),and the levodopa equivalent doses(LED)between the four groups was marginally significant(P=0.051).The pairwise comparisons between groups showed that the age of the control group was significantly lower than that of the PIGD group(P=0.0172)and the IT group(P=0.0035);the H-Y staging of TD group was significantly lower than that of the PIGD group(P=0.0024);the LED of TD group was significantly lower than that of the PIGD group(P=0.0471);and the VitD levels of control group was significantly higher than that of the PIGD group(P=0.0002)and IT group(P=0.0125).VitD levels were negatively associated with disease severity in total PD patients,and the difference was statistical significance(r=-0.241,P=0.028).The increase of age was a risk factor for the development of PIGD and IT-type PD(RR=1.09,95%CI:1.03-1.16)and(RR=1.12,95%CI:1.05-1.19);the reduction of VitD level was a risk factor for the development of PIGD and IT-type PD(RR=0.85,95%CI:0.78-0.93)and(RR=0.89,95%CI:0.82-0.97).Conclusion Serum VitD may be involved in the pathogenesis of different subtypes of PD,and the decreased serum VitD level may be a risk factor for patients with specific subtypes of PD.