Savica R, Carlin J M, Grossardt B R, Bower J H, Ahlskog J E, Maraganore D M, Bharucha A E, Rocca W A
Department of Neurology, Mayo Clinic, Rochester, MN 55905, USA.
Neurology. 2009 Nov 24;73(21):1752-8. doi: 10.1212/WNL.0b013e3181c34af5.
Parkinson disease (PD) may affect the autonomic nervous system and may cause constipation; however, few studies have explored constipation preceding the motor onset of PD. We investigated constipation preceding PD using a case-control study design in a population-based sample.
Using the medical records-linkage system of the Rochester Epidemiology Project, we identified 196 subjects who developed PD in Olmsted County, MN, from 1976 through 1995. Each incident case was matched by age (+/-1 year) and sex to a general population control. We reviewed the complete medical records of cases and controls in the medical records-linkage system to ascertain the occurrence of constipation preceding the onset of PD (or index year).
Constipation preceding PD or the index year was more common in cases than in controls (odds ratio [OR] 2.48; 95% confidence interval [CI] 1.49 to 4.11; p = 0.0005). This association remained significant after adjusting for smoking and coffee consumption (ever vs never), and after excluding constipation possibly induced by drugs. In addition, the association remained significant in analyses restricted to constipation documented 20 or more years before the onset of motor symptoms of PD. Although the association was stronger in women than in men and in patients with PD with rest tremor compared with patients with PD without rest tremor, these differences were not significant.
Our findings suggest that constipation occurring as early as 20 or more years before the onset of motor symptoms is associated with an increased risk of Parkinson disease.
帕金森病（PD）可能影响自主神经系统并可能导致便秘；然而，很少有研究探讨PD运动症状出现之前的便秘情况。我们采用基于人群的病例对照研究设计，调查了PD之前的便秘情况。
利用罗切斯特流行病学项目的医疗记录链接系统，我们确定了1976年至1995年在明尼苏达州奥尔姆斯特德县患PD的196名受试者。每个新发病例按年龄（±1岁）和性别与一名普通人群对照进行匹配。我们查阅了医疗记录链接系统中病例和对照的完整医疗记录，以确定PD发病（或索引年份）之前便秘的发生情况。
PD或索引年份之前出现便秘的情况在病例组中比对照组更常见（优势比[OR]2.48；95%置信区间[CI]1.49至4.11；p = 0.0005）。在调整吸烟和咖啡摄入量（曾经吸烟或喝咖啡与从不吸烟或喝咖啡）后以及排除可能由药物引起的便秘后，这种关联仍然显著。此外，在仅限于记录在PD运动症状出现前20年或更久之前的便秘的分析中，这种关联仍然显著。尽管女性中的关联比男性更强，并且与无静止性震颤的PD患者相比，有静止性震颤的PD患者中的关联更强，但这些差异并不显著。
我们的研究结果表明，早在运动症状出现前20年或更久之前出现的便秘与帕金森病风险增加有关。
