Department of Neurology, UCSF, San Francisco, California, USA.
Center for Human Experimental Therapeutics, University of Rochester, Rochester, New York, USA.
Mov Disord. 2018 May;33(5):762-770. doi: 10.1002/mds.27301. Epub 2018 Mar 6.
In moderately advanced Parkinson's disease (PD), low serum vitamin B12 levels are common and are associated with neuropathy and cognitive impairment. However, little is known about B12 in early PD.
To determine the prevalence of low vitamin B12 status in early PD and whether it is associated with clinical progression.
We measured vitamin B12 and other B12 status determinants (methylmalonic acid, homocysteine, and holotranscobalamin) in 680 baseline and 456 follow-up serum samples collected from DATATOP participants with early, untreated PD. Borderline low B12 status was defined as serum B12 <184 pmol/L (250 pg/mL), and elevated homocysteine was defined as >15 µmol/L. Outcomes included the UPDRS, ambulatory capacity score (sum of UPDRS items 13-15, 29&30), and MMSE, calculated as annualized rates of change.
At baseline, 13% had borderline low B12 levels, 7% had elevated homocysteine, whereas 2% had both. Elevated homocysteine at baseline was associated with worse scores on the baseline MMSE. Analysis of study outcomes showed that compared with the other tertiles, participants in the low B12 tertile (<234 pmol/L; 317 pg/mL) developed greater morbidity as assessed by greater annualized worsening of the ambulatory capacity score. Elevated homocysteine was associated with greater annualized decline in MMSE (-1.96 vs. 0.06; P = 0001). Blood count indices were not associated with B12 or homocysteine status.
In this study of early PD, low B12 status was common. Low B12 at baseline predicted greater worsening of mobility whereas elevated homocysteine predicted greater cognitive decline. Given that low B12 and elevated homocysteine can improve with vitamin supplementation, future studies should test whether prevention or early correction of these nutritionally modifiable conditions slows development of disability. © 2018 International Parkinson and Movement Disorder Society.
在中度进展的帕金森病（PD）中，血清维生素 B12 水平较低较为常见，并且与神经病变和认知障碍有关。然而，关于早期 PD 中的 B12 知之甚少。
确定早期 PD 中低维生素 B12 状态的患病率，以及它是否与临床进展有关。
我们在 DATATOP 参与者的 680 份基线和 456 份随访血清样本中测量了维生素 B12 和其他 B12 状态决定因素（甲基丙二酸、同型半胱氨酸和全钴胺素），这些参与者患有早期未经治疗的 PD。边缘低 B12 状态定义为血清 B12<184pmol/L（250pg/mL），高同型半胱氨酸定义为>15μmol/L。结果包括 UPDRS、活动能力评分（UPDRS 项目 13-15、29&30 的总和）和 MMSE，计算为年化变化率。
基线时，13%的患者存在边缘低 B12 水平，7%的患者存在高同型半胱氨酸，而 2%的患者同时存在这两种情况。基线时的高同型半胱氨酸与基线 MMSE 的评分较差有关。对研究结果的分析表明，与其他两个三分位组相比，低 B12 三分位组（<234pmol/L；317pg/mL）患者的活动能力评分恶化程度更大，评估为年度恶化程度更大。高同型半胱氨酸与 MMSE 的年化下降有关（-1.96 对 0.06；P=0.0001）。血细胞计数指数与 B12 或同型半胱氨酸状态无关。
在这项早期 PD 的研究中，低 B12 状态较为常见。基线时的低 B12 预测运动能力恶化程度更大，而高同型半胱氨酸预测认知能力下降程度更大。鉴于低 B12 和高同型半胱氨酸可以通过维生素补充来改善，未来的研究应测试这些可通过营养干预来改善的情况是否可以预防或早期纠正，以减缓残疾的发展。
