Gan Jing, Wan Ying, Shi Junjie, Zhou Mingzhu, Lou Zhiyin, Liu Zhenguo
Department of Neurology, Xinhua Hospital Shanghai JiaoTong University, School of Medicine, 1665 Kongjiang Road, Shanghai, 20092, China.
BMC Neurol. 2018 Mar 15;18(1):29. doi: 10.1186/s12883-018-1034-3.
Constipation is one of the most frequent non-motor symptoms (NMS) in Parkinson's disease (PD) and the prevalence of constipation in PD patients varies among different studies. We designed this study to survey the prevalence and clinical characteristics of subjective constipation and the appearance chronology between the emergence of constipation and onset of motor symptoms in PD patients from Shanghai, China.
268 PD patients were continuously recruited into this study. Parkinson's related clinical information of the participants was collected. A spectrum of motor and nonmotor features was assessed with scales and questionnaires. Subjective constipation was defined by ROME III criteria.
54.10% PD patients suffer from constipation. Among them, there was 47.59% having constipation before onset of motor symptoms. Compared with patients without constipation, patients with constipation reported lower daily water intake and less exercise, and were dominated by bradykinetic-rigid motor phenotype at onset and were prone to have anxiety, depression and insomnia. The time span between constipation and the onset of motor symptoms was (6.62 ± 9.32) years. Constipation occurred more frequently between 2 and 10 years before onset of motor symptoms. Patients suffering with constipation were then divided into two groups according to the time sequence of constipation and motor onset: 'constipation pre-motor sign' group and 'constipation post-motor sign' group. Total timespan from earliest initial symptoms to present was similar. Compared with 'constipation post-motor sign' group, the patients in 'constipation pre-motor sign' group experienced an older motor symptoms onset age, less serious motor symptoms, more serious constipation and less daily levodopa dosage.
Our results supported that constipation could be a pre-motor symptom of PD. Different clinical characteristics were found in different constipation-loading time relative to motor symptoms. Research of constipation may be useful to better understand the early stages of PD and assessment of constipation with validated criteria may have utility as a risk factor for predicting PD in the prodromal phase.
便秘是帕金森病（PD）最常见的非运动症状（NMS）之一，不同研究中PD患者便秘的患病率有所不同。我们开展本研究旨在调查中国上海PD患者主观便秘的患病率及临床特征，以及便秘出现与运动症状发作之间的时间顺序。
连续纳入268例PD患者。收集参与者的帕金森病相关临床信息。使用量表和问卷评估一系列运动和非运动特征。主观便秘根据罗马III标准定义。
54.10%的PD患者患有便秘。其中，47.59%在运动症状发作前出现便秘。与无便秘的患者相比，便秘患者报告每日饮水量较低且运动较少，起病时以运动迟缓-强直运动表型为主，且易出现焦虑、抑郁和失眠。便秘与运动症状发作之间的时间跨度为（6.62±9.32）年。便秘在运动症状发作前2至10年更为频繁地出现。然后根据便秘和运动发作的时间顺序将便秘患者分为两组：“便秘先于运动体征”组和“便秘后于运动体征”组。从最早的初始症状到目前的总时间跨度相似。与“便秘后于运动体征”组相比，“便秘先于运动体征”组患者的运动症状起病年龄较大，运动症状较轻，便秘较严重，每日左旋多巴剂量较少。
我们的结果支持便秘可能是PD的运动前症状。相对于运动症状，在不同的便秘发生时间发现了不同的临床特征。对便秘的研究可能有助于更好地理解PD的早期阶段，使用经过验证的标准评估便秘可能作为前驱期预测PD的危险因素具有实用价值。
