Frentzel Dominik, Judanin Grigorij, Borozdina Olga, Klucken Jochen, Winkler Jürgen, Schlachetzki Johannes C M
Department of Molecular Neurology, University Hospital Erlangen, Friedrich-Alexander Universität (FAU) Erlangen-Nürnberg, Erlangen, Germany.
Department of Applied Econometrics and International Political Economy, Goethe University Frankfurt, Frankfurt, Germany.
Front Neurol. 2017 Aug 21;8:397. doi: 10.3389/fneur.2017.00397. eCollection 2017.
One striking observation in Parkinson's disease (PD) is the remarkable gender difference in incidence and prevalence of the disease. Data on gender differences with regard to disease onset, motor and non-motor symptoms, and dopaminergic medication are limited. Furthermore, whether estrogen status affects disease onset and progression of PD is controversially discussed. In this retrospective single center study, we extracted clinical data of 226 ambulatory PD patients and compared age of disease onset, disease stage, motor impairment, non-motor symptoms, and dopaminergic medication between genders. We applied a matched-pairs design to adjust for age and disease duration. To determine the effect of estrogen-related reproductive factors including number of children, age at menarche, and menopause on the age of onset, we applied a standardized questionnaire and performed a regression analysis. The male to female ratio in the present PD cohort was 1.9:1 (147 men vs. 79 women). Male patients showed increased motor impairment than female patients. The levodopa equivalent daily dose was increased by 18.9% in male patients compared to female patients. Matched-pairs analysis confirmed the increased dose of dopaminergic medication in male patients. No differences were observed in age of onset, type of medication, and non-motor symptoms between both groups. Female reproductive factors including number of children, age at menarche, and age at menopause were positively associated with a delay of disease onset up to 30 months. The disease-modifying role of estrogen-related outcome measures warrants further clinical and experimental studies targeting gender differences, specifically hormone-dependent pathways in PD.
帕金森病（PD）一个显著的观察结果是，该疾病在发病率和患病率上存在明显的性别差异。关于疾病发病、运动和非运动症状以及多巴胺能药物治疗方面的性别差异数据有限。此外，雌激素状态是否影响PD的发病和进展仍存在争议。在这项回顾性单中心研究中，我们提取了226例门诊PD患者的临床数据，并比较了不同性别之间的疾病发病年龄、疾病阶段、运动障碍、非运动症状以及多巴胺能药物治疗情况。我们采用配对设计来调整年龄和病程。为了确定包括子女数量、初潮年龄和绝经年龄在内的雌激素相关生殖因素对发病年龄的影响，我们使用了标准化问卷并进行了回归分析。在目前的PD队列中，男女比例为1.9:1（147名男性对79名女性）。男性患者比女性患者表现出更严重的运动障碍。与女性患者相比，男性患者的左旋多巴等效日剂量增加了18.9%。配对分析证实了男性患者多巴胺能药物剂量增加。两组在发病年龄、药物类型和非运动症状方面未观察到差异。包括子女数量、初潮年龄和绝经年龄在内的女性生殖因素与疾病发病延迟长达30个月呈正相关。雌激素相关结果指标对疾病的修饰作用值得针对性别差异，特别是PD中激素依赖途径开展进一步的临床和实验研究。
