Pouclet Hélène, Lebouvier Thibaud, Flamant Mathurin, Coron Emmanuel, Neunlist Michel, Derkinderen Pascal, Rouaud Tiphaine
INSERM U913, University Nantes, Nantes, France.
Presse Med. 2012 Jul;41(7-8):695-701. doi: 10.1016/j.lpm.2011.11.018. Epub 2012 Jan 28.
No validated biomarker is yet available for Parkinson's disease (PD). Clinical PD symptoms include dopa-responsive motor symptoms and dopa-resistant non motor symptoms. Some of the non motor symptoms begin during the premotor stage, like constipation, hyposmia or REM-sleep disorders. Dementia, gait disorders and dysarthria occur in later stages of the disease. PD pathology extends well beyond the substantia nigra. It affects autonomic and non autonomic nuclei in the brainstem and in the medulla, the olfactory bulb and the peripheral autonomic nervous system. Alpha-synuclein aggregates, called Lewy bodies and Lewy neurites, are detectable in these structures at early stages. The study of the enteric nervous system (ENS) displays the Lewy pathology in living patients through the digestive biopsies. Minor salivary glands analysis could be a good marker as well, but this needs confirmation. An anatomopathologic PD biomarker would be interesting at different stages of PD: for the positive diagnosis, to follow the progression and to develop neuroprotective treatments.
目前尚无经过验证的帕金森病（PD）生物标志物。临床PD症状包括对多巴有反应的运动症状和对多巴无反应的非运动症状。一些非运动症状在运动前阶段就开始出现，如便秘、嗅觉减退或快速眼动睡眠障碍。痴呆、步态障碍和构音障碍出现在疾病的后期。PD病理变化远远超出黑质。它影响脑干和延髓中的自主和非自主神经核、嗅球以及外周自主神经系统。在这些结构的早期阶段可检测到α-突触核蛋白聚集体，即路易小体和路易神经突。通过消化活检，对肠神经系统（ENS）的研究显示了活体患者中的路易病理变化。小唾液腺分析也可能是一个很好的标志物，但这需要进一步证实。一种解剖病理学的PD生物标志物在PD的不同阶段都将很有意义：用于阳性诊断、跟踪疾病进展以及开发神经保护治疗方法。
