Diabetes mellitus and Parkinson disease
Diabetes mellitus and Parkinson disease
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DOI：
10.1212/wnl.0000000000005475
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发表时间：
2018-05-08
期刊：
影响因子：
9.9
通讯作者：
Politis, Marios
中科院分区：
文献类型：
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作者：
Pagano, Gennaro;Polychronis, Sotirios;Politis, Marios
目的探讨糖尿病是否与非帕金森病患者的帕金森样病理学相关，并评估糖尿病对未用药的早期帕金森病患者的帕金森病理学标志物和临床进展的影响。14例无帕金森病的糖尿病患者和14例无糖尿病或帕金森病的健康对照者。糖尿病的临床诊断通过连续2次空腹测量血清葡萄糖水平> 126 mL/dL来证实。在36个月的随访期内，我们调查了帕金森病患者是否存在糖尿病与更快的运动进展或认知能力下降有关。（p < 0.01），纹状体多巴胺转运蛋白结合降低（p < 0.05），tau CSF水平升高（p < 0.05）。在患有糖尿病但没有帕金森病的患者中，与健康对照相比，糖尿病的存在与纹状体多巴胺转运蛋白结合降低（p <0.05）和tau（p < 0.05）和α-突触核蛋白（p < 0.05）CSF水平升高相关。在帕金森病患者人群的考克斯生存分析中，糖尿病的存在与更快的运动进展相关（风险比= 4.521，95%置信区间= 1.468-13.926; p < 0.01）和认知能力下降（危险比= 9.314，95%可信区间= 1.164-74.519; p < 0.05）.结论糖尿病可能倾向于帕金森样病理，当存在于帕金森病患者时，可以诱导更积极的表型。
ObjectiveTo investigate whether diabetes mellitus is associated with Parkinson-like pathology in people without Parkinson disease and to evaluate the effect of diabetes mellitus on markers of Parkinson pathology and clinical progression in drug-naive patients with early-stage Parkinson disease.MethodsWe compared 25 patients with Parkinson disease and diabetes mellitus to 25 without diabetes mellitus, and 14 patients with diabetes mellitus and no Parkinson disease to 14 healthy controls (people with no diabetes mellitus or Parkinson disease). The clinical diagnosis of diabetes mellitus was confirmed by 2 consecutive fasting measurements of serum glucose levels > 126 mL/dL. Over a 36-month follow-up period, we then investigated in the population with Parkinson disease whether the presence of diabetes mellitus was associated with faster motor progression or cognitive decline.ResultsThe presence of diabetes mellitus was associated with higher motor scores (p < 0.01), lower striatal dopamine transporter binding (p < 0.05), and higher tau CSF levels (p < 0.05) in patients with Parkinson disease. In patients with diabetes but without Parkinson disease, the presence of diabetes mellitus was associated with lower striatal dopamine transporter binding (p < 0.05) and higher tau (p < 0.05) and a-synuclein (p < 0.05) CSF levels compared to healthy controls. At the Cox survival analysis in the population of patients with Parkinson disease, the presence of diabetes mellitus was associated with faster motor progression (hazard ratio = 4.521, 95% confidence interval = 1.468-13.926; p < 0.01) and cognitive decline (hazard ratio = 9.314, 95% confidence interval = 1.164-74.519; p < 0.05).ConclusionsDiabetes mellitus may predispose toward a Parkinson-like pathology, and when present in patients with Parkinson disease, can induce a more aggressive phenotype.