Vanta Oana Maria, Tohanean Nicoleta, Pintea Sebastian, Perju-Dumbrava Lacramioara
Anatomy Department, University of Medicine and Pharmacy "Iuliu Hatieganu", 400006 Cluj-Napoca, Romania.
Neurology Department, University of Medicine and Pharmacy "Iuliu Hatieganu", 400012 Cluj-Napoca, Romania.
J Clin Med. 2019 Sep 24;8(10):1533. doi: 10.3390/jcm8101533.
(1) Background: Increased attention has lately been given to polyneuropathy in Parkinson's Disease (PD). Several papers postulated that large-fiber neuropathy (PNP) in PD is related to vitamin B12 deficiency and L-Dopa exposure. (2) Methods: Using a cross-sectional, observational study, we evaluated 73 PD patients without a previously known cause of PNP using clinical scores (UPDRS II and III and Toronto Clinical Scoring System), biological evaluation of vitamin B12 and folic acid, and nerve conduction studies to assess the prevalence and features of PNP. (3) Results: The prevalence of PNP was 49.3% in the study group. In the L-Dopa group, the frequency of PNP was 67.3% as compared to PNP in the non-L-Dopa group, where one subject had PNP (χ = 23.41, < 0.01). PNP was predominantly sensory with mild to moderate axonal loss. Cyanocobalamin correlated with L-Dopa daily dose ( = -0.287, < 0.05) and L-Dopa duration of administration ( = -0.316, < 0.05). L-Dopa daily dose correlated with the amplitudes of sensory nerve action potentials of the superficial peroneal and radial nerves ( = -0.312, < 0.05) ( = -0.336, < 0.05), respectively. (4) Conclusions: PNP is more frequent in L-Dopa-treated patients than in L-Dopa-naïve patients. The results imply that longer exposure to high doses of L-Dopa may cause vitamin B12 and folate imbalance and PNP, secondarily.
（1）背景：帕金森病（PD）中的多发性神经病近来受到了更多关注。几篇论文推测，PD中的大纤维神经病（PNP）与维生素B12缺乏和左旋多巴暴露有关。（2）方法：采用横断面观察性研究，我们使用临床评分（统一帕金森病评定量表II和III以及多伦多临床评分系统）、维生素B12和叶酸的生物学评估以及神经传导研究，对73例此前无已知PNP病因的PD患者进行评估，以评估PNP的患病率和特征。（3）结果：研究组中PNP的患病率为49.3%。在左旋多巴组中，PNP的发生率为67.3%，相比之下，非左旋多巴组中只有1例患者患有PNP（χ = 23.41，P < 0.01）。PNP主要为感觉性，伴有轻度至中度轴突损失。氰钴胺与左旋多巴每日剂量（r = -0.287，P < 0.05）和左旋多巴给药持续时间（r = -0.316，P < 0.05）相关。左旋多巴每日剂量分别与腓浅神经和桡神经感觉神经动作电位的波幅相关（r = -0.312，P < 0.05）（r = -0.336，P < 0.05）。（4）结论：接受左旋多巴治疗的患者比未接受左旋多巴治疗的患者中PNP更为常见。结果表明，长期高剂量暴露于左旋多巴可能会继发导致维生素B12和叶酸失衡以及PNP。
