The PRIAMO study: urinary dysfunction as a marker of disease progression in early Parkinson's disease
The PRIAMO study: urinary dysfunction as a marker of disease progression in early Parkinson's disease
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DOI：
10.1111/ene.13290
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发表时间：
2017-06-01
影响因子：
5.1
通讯作者：
Antonini, A.
中科院分区：
文献类型：
--
作者：
Picillo, M.;Palladino, R.;Antonini, A.
背景和目的：目前正在探索新的场所来预测帕金森病(PD)的疾病进展，例如非运动亚型和合并运动和非运动症状(NMS)的模型。方法和结果：控制人口学和临床变量的多变量混合效应Logistic回归模型显示胃肠道[优势比(OR)2.57，95%可信区间(CI)1.67~3.97，P<]；0.001]、心血管(OR2.22，95%CI1.18~4.17，P=0.013)、皮肤(OR1.81，95%CI1.06~3.08，P=0.029)、睡眠(OR2.06，95%CI1.34~3.16，P=0.001)、疼痛(OR1.85，95%CI1.21~2.83，P=0.004)、疲劳(OR2.40，95%CI1.56~3.68，P<；0.001)、冷漠(OR2.79，95%CI1.72~4.52，P<；0.001)和呼吸(OR1.82，95%CI1.02~3.23，P=0.039)。分析还表明，排尿功能障碍与较高的运动功能障碍(系数1.73，95%CI 0.68~2.78，P=0.001)和较低的健康相关生活质量(系数-0.001，95%CI-0.08~-0.02，P<；0.001)，但与更严重的认知功能障碍无关(系数-0.34，95%CI-0.92~0.24，P=0.251)。结论：这是第一项涉及大量PD患者的前瞻性纵向研究，表明尿路功能障碍是较高的运动和非运动功能障碍以及较低的健康相关生活质量的早期标志。这些发现支持尿功能障碍作为更严重疾病进展的早期标志的作用。
Background and purpose: New venues are currently being explored to predict disease progression in Parkinson's disease (PD), such as non-motor subtypes and models merging motor and non-motor symptoms (NMS). By involving a subgroup of 585 patients from the PRIAMO (Parkinson Disease Non-motor Symptoms) study, the present 24-month longitudinal prospective analysis aimed to demonstrate that urinary dysfunction is an early marker of higher motor and non-motor burden as well as lower health-related quality of life.Methods and results: Multivariable mixed-effect logistic regression models controlling for demographic and clinical variables showed that the following NMS domains were associated with urinary dysfunction: gastrointestinal [odds ratio (OR) 2.57, 95% confidence interval (CI) 1.67-3.97, P < 0.001], cardiovascular (OR 2.22, 95% CI 1.18-4.17, P = 0.013), skin (OR 1.81, 95% CI 1.06-3.08, P = 0.029), sleep (OR 2.06, 95% CI 1.34-3.16, P = 0.001), pain (OR 1.85, 95% CI 1.21-2.83, P = 0.004), fatigue (OR 2.40, 95% CI 1.56-3.68, P < 0.001), apathy (OR 2.79, 95% CI 1.72-4.52, P < 0.001) and respiratory (OR 1.82, 95% CI 1.02-3.23, P = 0.039). Analysis also demonstrated that urinary dysfunction was associated with higher motor disability (coefficient 1.73, 95% CI 0.68-2.78, P = 0.001) and lower health-related quality of life (coefficient -0.05, 95% CI -0.08 to -0.02, P < 0.001, and coefficient -3.49, 95% CI -5.21 to -1.77, P < 0.001) but not with more severe cognitive disability (coefficient -0.34, 95% CI -0.92 to 0.24, P = 0.251).Conclusions: This is the first prospective longitudinal study involving a large cohort of PD patients demonstrating the relevance of urinary dysfunction as an early marker of higher motor and non-motor disability as well as lower health-related quality of life. These findings support a role for urinary dysfunction as an early marker of more severe disease progression.