Lin Chin-Hsien, Lin Jou-Wei, Liu Ying-Chun, Chang Chia-Hsuin, Wu Ruey-Meei
Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan.
Department of Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan; Cardiovascular Center, National Taiwan University Hospital Yun-Lin Branch, Dou-Liou City, Yun-Lin County, Taiwan.
Parkinsonism Relat Disord. 2014 Dec;20(12):1371-5. doi: 10.1016/j.parkreldis.2014.09.026. Epub 2014 Sep 28.
Constipation is a non-motor symptom of Parkinson's disease (PD). We investigated the association between the severity of constipation and subsequent risk of PD in a population-based sample.
551,324 participants free of PD, dementia, and stroke were retrospectively ascertained between January 1, 2005 and December 31, 2005 using the Taiwan National Health Insurance Research Database. The association between constipation at the beginning of the study and the incidence of PD was examined using a Cox regression model. Information regarding comorbidities and concomitant medications use was adjusted in the proportional hazards models.
After an average follow-up of 5.5 years, 2336 incident PD cases were diagnosed. The crude incidence rate of PD per 1,000,000 person-days was 1.57 for subjects without constipation and 4.04, 5.28, and 12.67 for mild, moderate, and severe constipation, respectively. After adjusting for age, sex, comorbidities, and concomitant medication use, patients with constipation were more likely to develop PD than subjects without constipation; the adjusted hazard ratio (aHR) was 3.28 (95% CI: 2.14-5.03), 3.83 (2.51-5.84), and 4.22 (2.95-6.05) for individual constipation severity categories. Constipation severity was also associated with an increased likelihood of PD in the time-varying analysis; the aHR was 2.84 (2.43-3.33), 5.22 (4.61-5.92), and 10.47 (9.46-11.58) for mild, moderate, and severe constipation, respectively (P < 0.0001). After excluding PD patients diagnosed within 3 years of constipation, the association remained significant.
Our study suggests that the severity of constipation is associated with a future diagnosis of PD in a dose-dependent manner.
便秘是帕金森病（PD）的一种非运动症状。我们在一个基于人群的样本中研究了便秘严重程度与后续患PD风险之间的关联。
利用台湾国民健康保险研究数据库，对2005年1月1日至2005年12月31日期间551324名无PD、痴呆和中风的参与者进行回顾性确定。使用Cox回归模型检查研究开始时的便秘与PD发病率之间的关联。在比例风险模型中对合并症和伴随用药信息进行了调整。
平均随访5.5年后，诊断出2336例新发PD病例。每1000000人日中，无便秘受试者的PD粗发病率为1.57，轻度、中度和重度便秘受试者的PD粗发病率分别为4.04、5.28和12.67。在调整年龄、性别、合并症和伴随用药后，便秘患者比无便秘受试者更易患PD；各便秘严重程度类别的调整后风险比（aHR）分别为3.28（95%CI：2.14 - 5.03）、3.83（2.51 - 5.84）和4.22（2.95 - 6.05）。在时变分析中，便秘严重程度也与患PD的可能性增加相关；轻度、中度和重度便秘的aHR分别为2.84（2.43 - 3.33）、5.22（4.61 - 5.92）和10.47（9.46 - 11.58）（P < 0.0001）。排除在便秘3年内诊断出的PD患者后，该关联仍然显著。
我们的研究表明，便秘严重程度与未来PD诊断呈剂量依赖性关联。
