Department of Neurology, General Cathay Hospital, Sijhih Branch, Taipei, Taiwan.
Int J Clin Pract. 2012 May;66(5):499-503. doi: 10.1111/j.1742-1241.2012.02896.x. Epub 2012 Mar 27.
Movement disorders are one of the central nervous system complications in uremic patients. Asterixis, multifocal myoclonus, and restless leg syndrome are well-documented in this category. Acute parkinsonism, however, is only reported in rare series with a small number of cases. In this study, we investigated the risk for parkinsonism during a 3-year follow-up period after a diagnosis of uremia.
The Longitudinal Health Insurance Database in Taiwan was utilised. We identified a total of 2862 patients who had visited ambulatory care centers with a diagnosis of chronic renal failure between 1999 and 2001 as the study cohort. We further randomly selected 14,310 enrollees matched with the study cohort in terms of gender, age, and year of their index visit for comparison. Each patient was individually tracked for 3 years to identify the occurrence of parkinsonism. Stratified Cox proportional hazard regressions (stratified by age and gender) were performed for analyses.
We found the annual incidence rates of parkinsonism to be 1.2% and 0.6% in the uremic and non-uremic groups, respectively. Furthermore, uremic patients were more vulnerable to developing parkinsonism with a 1.81-fold higher risk [95%CI = (1.21-2.71)] than the non-uremic group after adjusting for diabetes mellitus, which did not augment the risk.
The importance of raising awareness regarding the early symptoms of parkinsonism among patients with uremia is tied to its early identification, with timely aggressive dialysis being able to apply to slow the progression of the disease and its symptoms. Further study is warranted to elucidate the pathophysiology of uremic parkinsonism.
运动障碍是尿毒症患者中枢神经系统并发症之一。在该类别中，已经有文献详细记载了震颤、多灶性肌阵挛和不安腿综合征。然而，急性帕金森病仅在少数病例的罕见系列中报道。在这项研究中，我们在尿毒症诊断后的 3 年随访期间调查了帕金森病的发病风险。
我们使用了台湾的纵向健康保险数据库。我们共确定了 2862 名患者，他们在 1999 年至 2001 年期间因慢性肾衰竭就诊于门诊护理中心，作为研究队列。我们进一步随机选择了 14310 名与研究队列在性别、年龄和就诊年份相匹配的参保人作为对照。对每位患者进行单独跟踪 3 年，以确定帕金森病的发生情况。采用分层 Cox 比例风险回归（按年龄和性别分层）进行分析。
我们发现尿毒症组和非尿毒症组的帕金森病年发生率分别为 1.2%和 0.6%。此外，尿毒症患者发生帕金森病的风险更高，调整糖尿病后风险比为 1.81（95%CI=1.21-2.71）。
提高尿毒症患者对帕金森病早期症状的认识非常重要，因为这有助于早期发现，及时进行积极的透析可以减缓疾病及其症状的进展。需要进一步研究以阐明尿毒症性帕金森病的病理生理学。
