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JAMA Neuro:帕金森病早期出现体重下降可能预示更严重的病情

来源:生物谷 2016-01-19 17:12

                                

2016年1月19日讯 /生物谷BIOON/ --最近,来自麻省总医院的研究人员领导的一项研究发现病人在帕金森病早期出现的体重下降与该病进展情况存在相关性。虽然体重下降在帕金森病病人中是一种比较常见的现象,但这项研究表明在疾病早期出现体重下降预示着这种神经退行性紊乱会变得更加严重。相关研究结果发表在国际学术期刊JAMA Neurology上。

文章通讯作者Marie Wills这样说道:“出现早期体重下降的病人其病情往往更加严重,这可能是由于神经内分泌系统或者胃肠道神经系统参与疾病进展所导致,而那些体重增加的病人患病情况相对较轻。”

之前一些研究发现更高的体质指数(BMI)与亨廷顿氏病和肌萎缩侧索硬化症病人的存活时间改善存在相关性,但没有研究检测体重与帕金森病疾病进展情况和病人生存时间之间是否也存在相关。

该项研究利用了NIH支持的一项使用肌酸治疗早期帕金森病的临床试验的数据,这项临床试验共包含1,700名早期帕金森病病人,但最终发现肌酸对帕金森病没有显著治疗效果。Wills等人对其中1673名参与研究的病人每年的身高和体重结果与疾病进展情况进行了分析,结果发现77%的病人其BMI在临床试验期间保持稳定,而有大约9%的病人出现体重下降,另有14%的病人出现体重增长。那些在试验期间出现体重下降的病人UPDRS评分相比于体重没有出现明显变化的病人上升幅度更大,这表明帕金森病症状更加严重,而体重增加的病人每年的UPDRS评分上升幅度最小。这三组病人在存活时间方面没有显著差异,这也反映了这些病人仍然处于疾病发展的早期阶段。

作者表示现在还无法确定维持或增加体重是否能够帮助延缓疾病进展,这项研究也只是对这两者之间的关联性进行初步观察,因此无法对如何改变现在的标准治疗方法给出任何建议。(生物谷Bioon.com)

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doi:10.1001/jamaneurol.2015.4265 

Association Between Change in Body Mass Index, Unified Parkinson’s Disease Rating Scale Scores, and Survival Among Persons With Parkinson Disease

Anne-Marie A. Wills, MD, MPH1; Adriana Pérez, PhD2; Jue Wang, MS3; Xiao Su, BSc3; John Morgan, MD4; Suja S. Rajan, PhD5; Maureen A. Leehey, MD6; Gregory M. Pontone, MD7; Kelvin L. Chou, MD8; Chizoba Umeh, MD9; Zoltan Mari, MD10; James Boyd, MD11 ; for the NINDS Exploratory Trials in Parkinson Disease (NET-PD) Investigators

Main Outcomes and Measures  Change across time in motor UPDRS score, change across time in total UPDRS score, and time to death. Generalized linear mixed models were used to estimate the effect of BMI on the change in motor and total UPDRS scores after controlling for covariates. Survival was analyzed using Cox proportional hazards models of time to death. A participant’s BMI was measured at randomization, and BMI trajectory groups were classified according to whether participants experienced weight loss (“decreasing BMI”), weight stability (“stable BMI”), or weight gain (“increasing BMI”) during the study.

Results  Of the 1673 participants (mean [SD] age, 61.7 [9.6] years; 1074 [64.2%] were male), 158 (9.4%) experienced weight loss (decreasing BMI), whereas 233 (13.9%) experienced weight gain (increasing BMI). After adjusting for covariates, we found that the weight-loss group’s mean (SE) motor UPDRS score increased by 1.48 (0.28) (P < .001) more points per visit than the weight-stable group’s mean (SE) motor UPDRS score. The weight-gain group’s mean (SE) motor UPDRS score decreased by −0.51 (0.24) (P = .03) points per visit, relative to the weight-stable group. While there was an unadjusted difference in survival between the 3 BMI trajectory groups (log-rank P < .001), this was not significant after adjusting for covariates.

Conclusions and Relevance  Change in BMI was inversely associated with change in motor and total UPDRS scores in the NET-PD LS-1. Change in BMI was not associated with survival; however, these results were limited by the low number of deaths in the NET-PD LS-1.

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