帕金森病中多巴胺激动剂与体重的纵向关联。

Longitudinal association between dopamine agonists and weight in Parkinson's disease.

机构信息

Université Paris-Saclay, UVSQ, Univ. Paris-Sud, Inserm, Équipe « Exposome, Hérédité, Cancer et Santé », CESP, 94807, Villejuif, France.

Department of Health Care Management, College of Health Technology, National Taipei University of Nursing and Health Sciences, Taiwan.

出版信息

Parkinsonism Relat Disord. 2020 Nov;80:158-164. doi: 10.1016/j.parkreldis.2020.09.037. Epub 2020 Sep 24.

DOI:10.1016/j.parkreldis.2020.09.037

PMID:33011605

Abstract

OBJECTIVE

To examine the longitudinal relation of dopamine agonists (DA) use with body mass index (BMI) change and weight gain in Parkinson's disease (PD).

METHODS

In a cohort of 356 patients with PD annually followed up to 6 years, BMI, antiparkinsonian drugs use, and impulse control disorders (ICDs) were assessed at each visit. DA dose trajectories were estimated using latent class mixed models. The association of DA use with BMI change and weight gain was examined using latent-process mixed models and time-dependent Cox models respectively, while adjusting for disease severity and levodopa (LD) use.

RESULTS

In the mixed model, BMI (kg/m) increased over the follow-up in DA users (beta = 0.13, 95% CI = 0.02, 0.24) compared to non-users, while it decreased in LD users (beta = -0.26, 95% CI = -0.38, -0.13). We identified three trajectories of average daily DA dose over the follow-up. Patients in the high trajectory gained more weight than patients who never used DA (P = .001) and in the low (P = .02) or moderate (P = .04) trajectories. The incidence of weight gain of ≥6 kg was 2.10-fold (95% CI = 1.03, 4.28) higher in DA users compared to non-users, while LD users were less likely to gain weight (HR = 0.60, 95% CI = 0.33, 1.11). Associations decreased in analyses adjusted for compulsive eating or ICDs.

CONCLUSION

Weight increased in DA users over 6 years, and DA use was associated with increased incidence of weight gain. These associations were partially explained by compulsive eating. Alternatively, weight decreased in LD users. These findings warrant careful monitoring of compulsive eating and weight in PD patients.

摘要

目的

探讨多巴胺激动剂（DA）的使用与帕金森病（PD）患者体重指数（BMI）变化和体重增加的纵向关系。

方法

在一项对 356 例 PD 患者进行的队列研究中，每年随访 6 年，每次就诊时评估 BMI、抗帕金森病药物使用情况和冲动控制障碍（ICD）。使用潜在类别混合模型估计 DA 剂量轨迹。使用潜在过程混合模型和时间依赖性 Cox 模型分别检查 DA 使用与 BMI 变化和体重增加的关系，同时调整疾病严重程度和左旋多巴（LD）的使用。

结果

在混合模型中，与非使用者相比，DA 使用者的 BMI（kg/m）在随访过程中增加（β=0.13，95%CI=0.02，0.24），而 LD 使用者的 BMI 则下降（β=-0.26，95%CI=-0.38，-0.13）。我们发现了三种随访期间平均每日 DA 剂量的轨迹。与从未使用过 DA 的患者相比，高剂量轨迹的患者体重增加更多（P=0.001），而低剂量（P=0.02）或中剂量（P=0.04）轨迹的患者体重增加较少。与非使用者相比，DA 使用者体重增加≥6kg 的发生率高 2.10 倍（95%CI=1.03，4.28），而 LD 使用者体重增加的可能性较小（HR=0.60，95%CI=0.33，1.11）。在调整强迫性进食或 ICD 后，这些关联有所减弱。