甲状旁腺激素、认知功能与痴呆：一项系统综述
Parathyroid hormone, cognitive function and dementia: a systematic review.
作者信息
Lourida Ilianna, Thompson-Coon Jo, Dickens Chris M, Soni Maya, Kuźma Elżbieta, Kos Katarina, Llewellyn David J
机构信息
The National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care South West Peninsula (PenCLAHRC), University of Exeter Medical School, University of Exeter, Exeter, United Kingdom; University of Exeter Medical School, University of Exeter, Exeter, United Kingdom.
University of Exeter Medical School, University of Exeter, Exeter, United Kingdom.
出版信息
PLoS One. 2015 May 26;10(5):e0127574. doi: 10.1371/journal.pone.0127574. eCollection 2015.
BACKGROUND
Metabolic factors are increasingly recognized to play an important role in the pathogenesis of Alzheimer's disease and dementia. Abnormal parathyroid hormone (PTH) levels play a role in neuronal calcium dysregulation, hypoperfusion and disrupted neuronal signaling. Some studies support a significant link between PTH levels and dementia whereas others do not.
METHODS
We conducted a systematic review through January 2014 to evaluate the association between PTH and parathyroid conditions, cognitive function and dementia. Eleven electronic databases and citation indexes were searched including Medline, Embase and the Cochrane Library. Hand searches of selected journals, reference lists of primary studies and reviews were also conducted along with websites of key organizations. Two reviewers independently screened titles and abstracts of identified studies. Data extraction and study quality were performed by one and checked by a second reviewer using predefined criteria. A narrative synthesis was performed due to the heterogeneity of included studies.
RESULTS
The twenty-seven studies identified were of low and moderate quality, and challenging to synthesize due to inadequate reporting. Findings from six observational studies were mixed but suggest a link between higher serum PTH levels and increased odds of poor cognition or dementia. Two case-control studies of hypoparathyroidism provide limited evidence for a link with poorer cognitive function. Thirteen pre-post surgery studies for primary hyperparathyroidism show mixed evidence for improvements in memory though limited agreement in other cognitive domains. There was some degree of cognitive impairment and improvement postoperatively in observational studies of secondary hyperparathyroidism but no evident pattern of associations with specific cognitive domains.
CONCLUSIONS
Mixed evidence offers weak support for a link between PTH, cognition and dementia due to the paucity of high quality research in this area.
背景
代谢因素在阿尔茨海默病和痴呆症的发病机制中所起的重要作用日益受到认可。甲状旁腺激素（PTH）水平异常在神经元钙调节异常、灌注不足和神经元信号传导中断中发挥作用。一些研究支持PTH水平与痴呆症之间存在显著关联，而另一些研究则不然。
方法
我们进行了一项截至2014年1月的系统评价，以评估PTH与甲状旁腺疾病、认知功能和痴呆症之间的关联。检索了11个电子数据库和引文索引，包括医学期刊数据库（Medline）、荷兰医学文摘数据库（Embase）和考科蓝图书馆。还对手选期刊进行了手工检索，对主要研究和综述的参考文献列表以及关键组织的网站进行了检索。两名评审员独立筛选已识别研究的标题和摘要。由一名评审员进行数据提取和研究质量评估，并由另一名评审员使用预定义标准进行检查。由于纳入研究的异质性，进行了叙述性综合分析。
结果
所识别的27项研究质量较低或中等，且由于报告不充分而难以进行综合分析。六项观察性研究的结果不一，但表明血清PTH水平较高与认知能力差或患痴呆症的几率增加之间存在联系。两项甲状旁腺功能减退症的病例对照研究为与较差认知功能之间的联系提供了有限的证据。13项原发性甲状旁腺功能亢进症的手术前后研究显示，记忆改善的证据不一，尽管在其他认知领域的一致性有限。在继发性甲状旁腺功能亢进症的观察性研究中，术后存在一定程度的认知障碍和改善，但与特定认知领域的关联没有明显模式。
结论
由于该领域高质量研究匮乏，证据不一，因此对PTH、认知和痴呆症之间的联系提供了微弱支持。
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