帕金森病非糖尿病患者中胰岛素抵抗的高患病率。

High Prevalence of Undiagnosed Insulin Resistance in Non-Diabetic Subjects with Parkinson's Disease.

机构信息

Department of Neurology, Cedar-Sinai Medical Center, Los Angeles, CA, USA.

Department of Neurosurgery, Cedar-Sinai Medical Center, Los Angeles, CA, USA.

出版信息

J Parkinsons Dis. 2018;8(2):259-265. doi: 10.3233/JPD-181305.

DOI:10.3233/JPD-181305

PMID:29614702

Abstract

BACKGROUND

Reduced glucose tolerance has been long recognized as a potential risk factor for Parkinson's disease (PD), and increasing scrutiny is currently being placed on insulin resistance (IR) as a pathologic driver of neurodegeneration. However, the prevalence of IR in PD is unknown.

OBJECTIVE

To determine IR prevalence in non-diabetic patients with PD and to correlate IR with other metabolic indicators, motor and non-motor symptoms (NMS) of PD, and quality of life (QoL).

METHODS

Non-diabetic patients with a diagnosis of PD were identified and tested for fasting insulin, fasting glucose, and HbA1c. Patients were also offered to take a battery of clinical tests (MoCA, NMSQ, and PDQ-39) and had their PD medications, height, weight, and other demographic features recorded. IR was defined as HOMA-IR≥2.0 and/or HbA1c≥5.7. IR abnormalities were correlated with BMI and demographic features, in addition to motor and NMS.

RESULTS

154 subjects (109 M, 45F, mean age 67.7±10.5) were included in this study. Mean HOMA-IR was 2.3±1.8. Ninety out of 154 (58.4%) subjects had abnormal IR. IR was more frequent in overweight and obese subjects (61.1% and 82.8% respectively) than normal weight subjects (41.5%). Multivariate analysis showed that BMI was the only significant predictor of IR (p < 0.0001). There was no significant correlation between HOMA-IR and MoCA, PDQ-39, and NMSQ scores.

CONCLUSIONS

IR is prevalent in PD and it correlates with BMI. A correlation between IR with cognitive and QoL measures cannot be determined on the basis of this sample.

摘要

背景

葡萄糖耐量降低早已被认为是帕金森病（PD）的潜在风险因素，目前人们越来越关注胰岛素抵抗（IR）作为神经退行性变的病理驱动因素。然而，PD 患者的 IR 患病率尚不清楚。

目的

确定非糖尿病 PD 患者的 IR 患病率，并将 IR 与其他代谢指标、PD 的运动和非运动症状（NMS）以及生活质量（QoL）相关联。

方法

确定诊断为 PD 的非糖尿病患者，并对其进行空腹胰岛素、空腹血糖和 HbA1c 检测。还向患者提供了一系列临床测试（MoCA、NMSQ 和 PDQ-39），并记录了他们的 PD 药物、身高、体重和其他人口统计学特征。IR 定义为 HOMA-IR≥2.0 和/或 HbA1c≥5.7。IR 异常与 BMI 和人口统计学特征以及运动和 NMS 相关。

结果

本研究共纳入 154 名受试者（109 名男性，45 名女性，平均年龄 67.7±10.5）。平均 HOMA-IR 为 2.3±1.8。154 名受试者中有 90 名（58.4%）存在异常 IR。超重和肥胖受试者（分别为 61.1%和 82.8%）的 IR 发生率高于正常体重受试者（41.5%）。多变量分析显示，BMI 是 IR 的唯一显著预测因素（p < 0.0001）。HOMA-IR 与 MoCA、PDQ-39 和 NMSQ 评分之间无显著相关性。