MOVEMENT DISORDERS:2型糖尿病与帕金森病更快进展有关

2022-06-19 影像小生 MedSci原创

T2DM与帕金森病更快的疾病进展有关,它可能是缓解帕金森症状和减缓残疾和痴呆进展的目标。

2型糖尿病(T2DM)是帕金森病(PD)发生的危险因素,但其对疾病进展的影响尚不清楚。有研究评估了T2DM对疾病进展的影响,并提示与无T2DM的PD患者相比,共患T2DM可能与运动速度更快和认知能力下降有关。

Dilan Athauda等在MOVEMENT DISORDERS发表题为The Impact of Type 2 Diabetes in Parkinson's Disease的研究文章,探了T2DM对帕金森病各方面疾病进展的影响。

该研究通过比较一系列运动和非运动症状的症状严重程度评分,来检查共病T2DM对PD进展和生活质量的影响。

与非T2DM患者相比,T2DM患者更容易出现抑郁、严重步态障碍和独立性丧失,而多巴胺失调的可能性也更小。

Kaplan Meier曲线显示,T2DM患者发生轻度认知障碍(MCI)和严重步态障碍的时间明显缩短。

167例(8.7%)患者有PD和T2DM (PD + T2DM), 1763例(91.3%)患者有PD(无T2DM)。

1.      控制混杂因素后,合并T2DM的PD患者有更严重的运动症状(运动障碍社会统一帕金森病评定量表第三部分) (25.8 [0.9]vs. 22.5 [0.3] P = 0.002)和非运动症状(非运动症状评定量表总分)(38.4 [2.5]vs. 31.8 [0.7] P < 0.001),

2.      合并T2DM的PD患者更有可能报告丧失独立性(优势比,2.08;95%置信区间[CI]: 1.34 3.25;P = 0.001)和抑郁(优势比,1.62;置信区间:1.10—2.39;P = 0.015)。

3.      随着时间的推移,合并T2DM的PD患者的运动症状进展明显更快(P = 0.012),出现更糟糕的情绪症状(P = 0.041),更有可能出现实质性的步态损害(风险比,1.55;置信区间:1.07—2.23;P = 0.020)和轻度认知障碍(风险比,1.7;置信区间:1.24—2.51;P = 0.002)。

该研究确定T2DM是一个独立的危险因素,与最近被诊断为PD的患者更严重的运动症状、非运动症状和较差的生活质量评分相关。此外,T2DM的存在对PD的临床进程有不利影响,有助于加快运动和非运动症状的进展,并增加MCI和步态障碍的风险。这一点的重要性在于,胰岛素抵抗是一种潜在的可改变的代谢状态,有多个外围和中心的干预目标。因此,靶向胰岛素抵抗可能是缓解帕金森症状、改善神经退行性变、减缓残疾和痴呆进展的一个新靶点

 

原文出处

The Impact of Type 2 Diabetes in Parkinson's Disease

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