Nagaoka Utako, Shimizu Toshio, Uchihara Toshiki
Department of Neurology, Tokyo Metropolitan Neurological Hospital, 2-6-1 Musashidai, Fuchu, Tokyo, 183-0042, Japan,
Neurol Sci. 2015 Aug;36(8):1471-7. doi: 10.1007/s10072-015-2189-y. Epub 2015 Mar 26.
Advanced multiple system atrophy (MSA) patients exhibit malnutrition with hypocholesterolemia and hypoalbuminemia, similar to patients with other neurodegenerative disorders, but also display unexpected fat accumulation. To understand this paradox, we herein examined the relationship between fat accumulation, measured by triceps skinfold thickness (TSF), and plasma leptin in 29 MSA patients at three clinical stages: activities of daily living (ADL) 1: ambulatory with/without wheelchair; ADL2: bedridden/communicable; and ADL3: bedridden/non-communicable. TSF and leptin were higher while cholesterol and albumin were lower in advanced stage ADL3 than in ADL1 or ADL2. Although a correlation was observed between leptin and TSF, a stepwise regression analysis identified the first significant positive predictor of leptin as the duration of autonomic symptoms (p < 0.005) rather than TSF. Leptin/TSF strongly correlated with the duration of autonomic symptoms (p < 0.001). These results implicate leptin resistance through autonomic dysfunction in the paradoxical fat accumulation observed in patients with advanced MSA, but not to be seen in the cholesterol metabolism.
晚期多系统萎缩（MSA）患者表现出营养不良，伴有低胆固醇血症和低白蛋白血症，这与其他神经退行性疾病患者相似，但也出现了意想不到的脂肪堆积。为了解这一矛盾现象，我们在此研究了29例处于三个临床阶段的MSA患者的脂肪堆积（通过肱三头肌皮褶厚度（TSF）测量）与血浆瘦素之间的关系：日常生活活动（ADL）1：可独立行走（无论是否使用轮椅）；ADL2：卧床/可交流；ADL3：卧床/不可交流。与ADL1或ADL2相比，晚期ADL3阶段的TSF和瘦素水平较高，而胆固醇和白蛋白水平较低。虽然观察到瘦素与TSF之间存在相关性，但逐步回归分析确定瘦素的首个显著正预测因子是自主神经症状的持续时间（p < 0.005），而非TSF。瘦素/TSF与自主神经症状的持续时间密切相关（p < 0.001）。这些结果表明，晚期MSA患者出现的矛盾性脂肪堆积是通过自主神经功能障碍导致瘦素抵抗引起的，而在胆固醇代谢中未观察到这种情况。
