Bile acid abnormality induced by intestinal dysbiosis might explain lipid metabolism in Parkinson's disease
Bile acid abnormality induced by intestinal dysbiosis might explain lipid metabolism in Parkinson's disease
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DOI：
10.1016/j.mehy.2019.109436
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发表时间：
2020-01-01
影响因子：
4.7
通讯作者：
Sakoda, Saburo
中科院分区：
文献类型：
--
作者：
Hasuike, Yuhei;Endo, Takuyuki;Sakoda, Saburo
肠道生态失调是指肠道植物群失衡。小肠细菌过度生长（SIBO）是小肠微生物群异常增殖的一种情况，已被提出为小肠生态失调的一种形式。在帕金森病患者中，经常遇到体重减轻和代谢紊乱如脂质异常。这是一项使用乳果糖呼气试验、帕金森病症状、药物、腹部症状和血液数据对SIBO存在的前瞻性研究，涉及39名帕金森病患者。39例患者中，19例SIBO阳性，16例阴性，4例可疑。SIBO阳性患者的多巴胺能药物负荷（多巴胺替代帕金森病药物效力）显著较小（P = 0.009），血清甘油三酯（TG）（P = 0.024）和总胆红素（P = 0.019）水平显著较低。SIBO的存在或不存在与运动或腹部症状之间没有关系。以下假设是关于肠道细菌过度生长具有通过帕金森病患者的胆汁酸代谢表现出的各种影响的可能性而提出的。血清胆红素水平变得更高，因为胆红素代谢随着肠道细菌的减少而下降。同时，由于肠道细菌增加，胆汁酸被分解，脂质吸收减少。这会导致低血清TG水平，并导致体重减轻。通过类似的机制，随着胆汁酸水平的降低，维生素D的吸收减少，导致骨质疏松症和骨折。一些伴随帕金森病的非运动表现是由肠道生态失调引起的可能性需要考虑。
Intestinal dysbiosis refers to an imbalance in the intestinal flora. The concept of small intestinal bacterial overgrowth (SIBO), a condition of abnormal proliferation of the small intestine microbiota, has been proposed as a form of small intestine dysbiosis. In Parkinsons disease patients, weight loss and metabolic disorders such as lipid abnormalities are frequently encountered. This was a prospective investigation of the presence of SIBO using the lactulose breath test, Parkinson's disease symptoms, medications, abdominal symptoms, and blood data involving 39 Parkinson's disease patients. Of the 39 patients, 19 were positive for SIBO, 16 were negative, and 4 were equivocal. SIBO-positive patients had a significantly smaller dopaminergic drug load (dopamine replacement of Parkinson's disease drug potency) (P = 0.009) and significantly lower serum triglyceride (TG) (P = 0.024) and total bilirubin (P = 0.019) levels. No relationship was seen between the presence or absence of SIBO and motor or abdominal symptoms. The following hypothesis was developed with regard to the possibility that intestinal bacterial overgrowth has various effects that are exhibited via bile acid metabolism in Parkinsons disease patients. Serum bilirubin levels become higher as bilirubin metabolism declines with decreases in the intestinal bacteria. At the same time, bile acid is broken down due to increased intestinal bacteria, and lipid absorption decreases. This induces low serum TG levels and leads to weight loss. By a similar mechanism, there is less absorption of vitamin D as bile acid levels decrease, leading to osteoporosis and fractures. The possibility that some of the non-motor manifestations accompanying Parkinsons disease are caused by intestinal dysbiosis needs to be considered.