Pakpoor Julia, Noyce Alastair, Goldacre Raph, Selkihova Marianna, Mullin Stephen, Schrag Anette, Lees Andrew, Goldacre Michael
From the Unit of Health-Care Epidemiology (J.P., R.G., M.G.), Nuffield Department of Population Health, University of Oxford; and UCL Institute of Neurology (A.N., M.S., S.M., A.S., A.L.), Queen Square, London, UK.
Neurology. 2017 Apr 25;88(17):1630-1633. doi: 10.1212/WNL.0000000000003848. Epub 2017 Mar 29.
To study associations between viral hepatitis and Parkinson disease (PD).
A retrospective cohort study was done by analyzing linked English National Hospital Episode Statistics and mortality data (1999-2011). Cohorts of individuals with hepatitis B, hepatitis C, autoimmune hepatitis, chronic active hepatitis, and HIV were constructed, and compared to a reference cohort for subsequent rates of PD.
The standardized rate ratio (RR) of PD following hepatitis B was 1.76 (95% confidence interval [CI] 1.28-2.37) ( < 0.001), based on 44 observed compared with 25 expected cases. The RR of PD following hepatitis C was 1.51 (95% CI, 1.18-1.9) ( < 0.001), based on 48.5 expected and 73 observed cases. There was no significant association between autoimmune hepatitis, chronic active hepatitis or HIV, and subsequent PD. When including only those episodes of care for PD that occurred first at least 1 year following each exposure condition, the RR for hepatitis B and hepatitis C were 1.82 (1.29-2.5) and 1.43 (1.09-1.84), respectively.
We report strong evidence in favor of an elevation of rates of subsequent PD in patients with hepatitis B and hepatitis C. These findings may be explained by factors peculiar to viral hepatitis, but whether it reflects consequences of infection, shared disease mechanisms, or the result of antiviral treatment remains to be elucidated. Further work is needed to confirm this association and to investigate pathophysiologic pathways, potentially advancing etiologic understanding of PD more broadly.
研究病毒性肝炎与帕金森病（PD）之间的关联。
通过分析英国国家医院事件统计数据与死亡率数据的关联（1999 - 2011年）进行一项回顾性队列研究。构建了乙型肝炎、丙型肝炎、自身免疫性肝炎、慢性活动性肝炎和HIV感染者队列，并与一个对照队列比较后续的PD发病率。
基于44例观察到的病例与25例预期病例，乙型肝炎后发生PD的标准化发病率比（RR）为1.76（95%置信区间[CI] 1.28 - 2.37）（P < 0.001）。基于48.5例预期病例和73例观察到的病例，丙型肝炎后发生PD的RR为1.51（95% CI，1.18 - 1.9）（P < 0.001）。自身免疫性肝炎、慢性活动性肝炎或HIV与后续的PD之间无显著关联。当仅纳入每种暴露情况后至少1年首次发生的PD护理事件时，乙型肝炎和丙型肝炎的RR分别为1.82（1.29 - 2.5）和1.43（1.09 - 1.84）。
我们报告了有力证据支持乙型肝炎和丙型肝炎患者后续PD发病率升高。这些发现可能由病毒性肝炎特有的因素解释，但这是否反映感染的后果、共同的疾病机制或抗病毒治疗的结果仍有待阐明。需要进一步的研究来证实这种关联并调查病理生理途径，这可能更广泛地推进对PD病因的理解。
