Montaurier C, Morio B, Bannier S, Derost P, Arnaud P, Brandolini-Bunlon M, Giraudet C, Boirie Y, Durif F
INRA, Centre Clermont-Ferrand-Theix, UMR 1019, Unité de Nutrition Humaine, CRNH Auvergne, Clermont-Ferrand, F-63009 France.
Brain. 2007 Jul;130(Pt 7):1808-18. doi: 10.1093/brain/awm113. Epub 2007 May 29.
Chronic bilateral subthalamic stimulation leads to a spectacular clinical improvement in patients with motor complications. However, the post-operative body weight gain involved may limit the benefits of surgery and induce critical metabolic disorders. Twenty-four Parkinsonians (61.1 +/- 1.4 years) were examined 1 month before (M - 1) and 3 months after (M + 3) surgery. Body composition and energy expenditure (EE) were measured (1) over 36 h in calorimetric chambers (CC) with rigorous control of food intakes and activities [sleep metabolic rate, resting activities, meals, 3 or 4 sessions of 20 min on a training bicycle at 13 km/h and daily EE] and (2) in resting conditions (basal metabolic rate) during an acute L-dopa challenge (M - 1) or according to acute 'off' and 'on' stimulation (M + 3). Before surgery, EE was compared between the Parkinsonian patients and healthy subjects matched for height and body composition (metabolic rate during sleep, daily EE) or matched to predicted values (basal metabolic rate). Before surgery, in Parkinsonian men but not women, (1) daily EE was higher while sleep metabolic rate was lower compared to healthy matched men (+9.2 +/- 3.9 and -8.2 +/- 2.3%, respectively, P < 0.05) and (2) basal metabolic rate (L-dopa 'on') was higher than predicted basal metabolic rate (+11.5 +/- 4.0%, P < 0.05) but was further increased without L-dopa (+8.4 +/- 3.2% vs L-dopa 'on', P < 0.05). EE during daily activities was higher during 'off' periods compared to 'on' periods for both men (+19.3 +/- 3.3%, P < 0.0001) and women (+16.1 +/- 4.7%, P < 0.01). After surgery, there was a 3.4 +/- 0.6 kg (P < 0.0001) body weight increase together with fat mass (P < 0.0001) and fat-free mass (P < 0.05) in Parkinsonian men and a 2.6 +/- 0.8 kg (P < 0.05) body weight increase together with fat mass (P < 0.05) in Parkinsonian women. Sleep metabolic rate increased in men (+7.5 +/- 2.0%, P < 0.01) to reach control values but remained unchanged in women. Daily EE decreased significantly in both men and women (-7.3 +/- 2.2% and -13.1 +/- 1.7%, respectively, P < 0.01) but there was no correlation between daily EE changes and body weight gain. Parkinson's disease is associated with profound alterations in the central control of energy metabolism. Normalization of energy metabolism after DBS-STN implantation may favour body weight gain, of which quality was gender specific. As men gained primarily fat-free mass, a reasonable weight gain may be tolerated, in contrast with women who gained only fat. Other factors such as changes in free-living physical activity may help to limit body weight gain in some patients.
慢性双侧丘脑底核刺激可使运动并发症患者的临床症状显著改善。然而，术后出现的体重增加可能会限制手术的益处，并引发严重的代谢紊乱。对24名帕金森病患者（61.1±1.4岁）在手术前1个月（M - 1）和术后3个月（M + 3）进行了检查。测量了身体成分和能量消耗（EE）：（1）在热量测定室（CC）中进行36小时测量，严格控制食物摄入量和活动量[睡眠代谢率、静息活动、进餐、以13公里/小时的速度在训练自行车上进行3或4次20分钟的锻炼以及每日EE]；（2）在急性左旋多巴激发试验期间（M - 1）或根据急性“关”和“开”刺激状态（M + 3）在静息条件下（基础代谢率）进行测量。手术前，将帕金森病患者的EE与身高和身体成分相匹配的健康受试者（睡眠期间的代谢率、每日EE）或与预测值相匹配的健康受试者（基础代谢率）进行比较。手术前，在帕金森病男性患者而非女性患者中，（1）与匹配的健康男性相比，每日EE较高，而睡眠代谢率较低（分别为+9.2±3.9%和 - 8.2±2.3%，P < 0.05）；（2）基础代谢率（左旋多巴“开”时）高于预测的基础代谢率（+11.5±4.0%，P < 0.05），但在无左旋多巴时进一步升高（与左旋多巴“开”时相比为+8.4±3.2%，P < 0.05）。男性和女性在“关”期的日常活动期间的EE均高于“开”期（男性为+19.3±3.3%，P < 0.0001；女性为+16.1±4.7%，P < 0.01）。手术后，帕金森病男性患者体重增加3.4±0.6千克（P < 0.0001），同时脂肪量（P < 0.0001）和去脂体重（P < 0.05）增加；帕金森病女性患者体重增加2.6±0.8千克（P < 0.05），同时脂肪量增加（P < 0.05）。男性的睡眠代谢率增加（+7.5±2.0%，P < 0.01）至对照值，但女性保持不变。男性和女性的每日EE均显著下降（分别为 - 7.3±2.2%和 - 13.1±1.7%，P < 0.01），但每日EE变化与体重增加之间无相关性。帕金森病与能量代谢的中枢控制发生深刻改变有关。脑深部电刺激丘脑底核（DBS - STN）植入术后能量代谢的正常化可能有利于体重增加，但增加的性质存在性别差异。由于男性主要增加的是去脂体重，因此可能可以耐受合理的体重增加，而女性增加的只是脂肪。其他因素，如自由生活状态下身体活动的变化，可能有助于某些患者限制体重增加。
