Farhadi Farzaneh, Vosoughi Kia, Shahidi Gholam Ali, Delbari Ahmad, Lökk Johan, Fereshtehnejad Seyed-Mohammad
Medical Student Research Committee.
Movement Disorders Clinic, Department of Neurology, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran.
Neuropsychiatr Dis Treat. 2017 Feb 1;13:329-338. doi: 10.2147/NDT.S124984. eCollection 2017.
Sex-related differences in clinical manifestations and consequences of Parkinson's disease (PD) have been poorly explored. Better understanding of sexual dimorphism in neurologic diseases such as PD has been announced as a research priority. The aim of our study was to determine independent sex differences in clinical manifestations and subtypes, psychosocial functioning, quality of life (QoL) and its domains between male and female individuals with PD.
A comprehensive list of demographics, motor symptoms and subtypes, nonmotor features, health-related quality of life (HRQoL), psychosocial functioning and general aspects of daily life was assessed in 157 individuals (108 males and 49 females) with idiopathic PD. In order to control for potential confounding variables, we applied Orthogonal Partial Least Squares - Discriminant Analysis (OPLS-DA) to explore the strength of each feature to discriminate male and female patients with PD.
While no sex difference was found in the total Unified Parkinson's Disease Rating Scale (UPDRS) score and cumulative daily dose of levodopa, females had significantly more severe anxiety (mean difference =2.2 [95% confidence interval, CI: 0.5-4.0], =0.011), worse nutritional status (23.8 [standard deviation, SD =4.2] vs 25.8 [SD =2.6], =0.003) and poorer QoL (28.3 [SD =15.7] vs 17.9 [SD =14.2], <0.001). Based on multivariate discriminant analysis, emotional well-being, bodily discomfort, social support, mobility and communication domains of HRQoL, together with anxiety, depression and psychosocial functioning, were the strongest features with more severe/worse status in females after adjustment for potential statistical confounders.
Our study provides a comprehensive understanding of sexual dimorphism in PD. Anxiety, depression, specific domains of HRQoL (mobility, emotional well-being, social support and bodily discomfort) and psychosocial functioning were significantly worse in female individuals with PD. Sexual dimorphism in PD highlights the features that are more likely to be affected in each sex and should be specifically targeted when managing male and female individuals with PD.
帕金森病（PD）临床表现及后果中的性别差异尚未得到充分研究。更好地理解诸如PD等神经疾病中的性别二态性已被宣布为一项研究重点。我们研究的目的是确定患有PD的男性和女性个体在临床表现和亚型、心理社会功能、生活质量（QoL）及其领域方面的独立性别差异。
对157名特发性PD患者（108名男性和49名女性）进行了人口统计学、运动症状和亚型、非运动特征、健康相关生活质量（HRQoL）、心理社会功能以及日常生活一般方面的综合评估。为了控制潜在的混杂变量，我们应用正交偏最小二乘判别分析（OPLS-DA）来探究每个特征区分男性和女性PD患者的强度。
虽然在帕金森病统一评分量表（UPDRS）总分和左旋多巴累计日剂量方面未发现性别差异，但女性的焦虑症状明显更严重（平均差异=2.2 [95%置信区间，CI：0.5 - 4.0]，P = 0.011），营养状况更差（23.8 [标准差，SD = 4.2] 对 25.8 [SD = 2.6]，P = 0.003），生活质量更差（28.3 [SD = 15.7] 对 17.9 [SD = 14.2]，P < 0.001）。基于多变量判别分析，在对潜在统计混杂因素进行调整后，HRQoL的情绪幸福感、身体不适、社会支持、活动能力和沟通领域，以及焦虑、抑郁和心理社会功能，是女性中状况更严重/更差的最强特征。
我们的研究提供了对PD中性别二态性的全面理解。患有PD的女性在焦虑、抑郁、HRQoL的特定领域（活动能力、情绪幸福感、社会支持和身体不适）以及心理社会功能方面明显更差。PD中的性别二态性突出了每种性别中更易受影响的特征，在管理患有PD的男性和女性个体时应予以特别关注。
