Adler Charles H, Dugger Brittany N, Hentz Joseph G, Hinni Michael L, Lott David G, Driver-Dunckley Erika, Mehta Shyamal, Serrano Geidy, Sue Lucia I, Duffy Amy, Intorcia Anthony, Filon Jessica, Pullen Joel, Walker Douglas G, Beach Thomas G
Parkinson's Disease and Movement Disorders Center, Department of Neurology, Mayo Clinic College of Medicine, Mayo Clinic, Scottsdale, Arizona, USA.
Banner Sun Health Research Institute, Sun City, Arizona, USA.
Mov Disord. 2016 Feb;31(2):250-6. doi: 10.1002/mds.26476. Epub 2016 Jan 22.
Finding a peripheral tissue biopsy site to diagnose early PD would be of value for clinical care, biomarker validation, and as research enrollment criteria. Whereas autopsy and advanced PD studies suggest that the submandibular gland is an important biopsy site, there are no studies in early PD. The aim of this study was to determine whether needle biopsy of the submandibular gland reveals Lewy type alpha-synucleinopathy in early PD.
Twenty-five early PD (duration < 5 years) and 10 controls underwent transcutaneous needle core biopsies of the submandibular gland. Tissue was stained for phosphorylated alpha-synuclein, reviewed blind to clinical diagnosis, and only nerve element staining was considered positive.
Mean (standard deviation) age was 69.5 (8.3) for the PD group, 64.8 (8.0) years for controls, and disease duration 2.6 (1.1) years. Six PD and 1 control subject had inadequate glandular tissue. Positive staining was found in 14 of 19 (74%) PD and 2 of 9 (22%) control subjects. PD-positive and -negative cases did not differ clinically. Adverse events (mainly swelling and bruising) were common (77% of cases), but were minor and transient.
Submandibular gland needle biopsies identified phosphorylated alpha-synuclein staining in 74% of early PD subjects. False positives may be true false positives or may represent prodromal PD. If confirmed in larger studies with eventual autopsy confirmation, the potential value of submandibular gland biopsies for early PD may be to aid in clinical trial inclusion/exclusion and eventually serve as a gold standard for biomarker studies short of autopsy confirmation.
找到一个外周组织活检部位以诊断早期帕金森病对于临床护理、生物标志物验证以及作为研究纳入标准具有重要价值。尽管尸检和晚期帕金森病研究表明下颌下腺是一个重要的活检部位，但早期帕金森病方面尚无相关研究。本研究的目的是确定下颌下腺针吸活检是否能揭示早期帕金森病中路易体样α-突触核蛋白病变。
25例早期帕金森病患者（病程<5年）和10例对照者接受了下颌下腺经皮针芯活检。组织进行磷酸化α-突触核蛋白染色，在对临床诊断不知情的情况下进行阅片，仅神经元染色被视为阳性。
帕金森病组的平均（标准差）年龄为69.5（8.3）岁，对照组为64.8（8.0）岁，病程为2.6（1.1）年。6例帕金森病患者和1例对照者的腺体组织不足。19例帕金森病患者中有14例（74%）呈阳性染色，9例对照者中有2例（22%）呈阳性染色。帕金森病阳性和阴性病例在临床上无差异。不良事件（主要是肿胀和瘀斑）很常见（77%的病例），但症状轻微且为一过性。
下颌下腺针吸活检在74%的早期帕金森病患者中发现了磷酸化α-突触核蛋白染色。假阳性可能是真正的假阳性，也可能代表前驱期帕金森病。如果在更大规模的研究中得到证实，并最终通过尸检确认，下颌下腺活检对早期帕金森病的潜在价值可能在于辅助临床试验的纳入/排除，最终成为尸检确认之外生物标志物研究的金标准。
