Choi Yoon Jin, Choi In Young, Jang Wooyoung, Jeong Su-Min, Park Sanghyun, Han Kyungdo, Lee Yoontaek, Lee Dong Ho, Shin Dong Wook
Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea.
Department of Family Medicine & International Healthcare Center, Samsung Medical Center, Seoul, Republic of Korea.
Parkinsonism Relat Disord. 2021 Feb;83:15-21. doi: 10.1016/j.parkreldis.2020.12.026. Epub 2021 Jan 12.
Previous evidence has suggested roles for α-synuclein propagation and vitamin B12 (VitB12) deficiency in the pathogenesis of Parkinson's disease (PD). We investigated whether gastric cancer (GC) patients who underwent gastrectomy had a lower risk of PD and whether VitB12 supplementation modified the risk.
GC patients aged ≥50 years who underwent curative gastrectomy between 2007 and 2012 (n = 72,216) and matched comparison groups (n = 211,389) were identified from the Korean National Health Insurance database. The risks of PD were analyzed by Cox regression.
Compared to their matched comparison groups, GC patients who underwent gastrectomy showed a decreased risk of PD (adjusted HR [aHR] 0.86; 95% confidence interval [CI] 0.75-0.98), but the significance disappeared after further adjustment with smoking and body mass index (BMI). To elaborate, subtotal gastrectomy (STG) was associated with decreased risk of PD (aHR 0.85; 95% CI 0.74-0.99) while total gastrectomy (TG) was not (aHR 0.89; 95% CI 0.66-1.19), although the risk reduction was not significant when further adjusted for smoking and BMI. Among the patients who underwent TG, their risk of PD was markedly lower when they had VitB12 supplementation after surgery (aHR 0.36; 95% CI 0.17-0.76), while the risk was higher when they did not have any (aHR 1.55; 95% CI 1.03-2.32).
GC patients who underwent gastrectomy and received uninterrupted VitB12 supplementation had a decreased incidence of PD. This study provides indirect epidemiological evidence for the potential roles of gastrectomy and VitB12 in the pathogenesis of PD.
先前的证据表明α-突触核蛋白传播和维生素B12（VitB12）缺乏在帕金森病（PD）发病机制中起作用。我们调查了接受胃切除术的胃癌（GC）患者患PD的风险是否较低，以及补充VitB12是否会改变这一风险。
从韩国国民健康保险数据库中识别出2007年至2012年间接受根治性胃切除术的年龄≥50岁的GC患者（n = 72,216）以及匹配的对照组（n = 211,389）。通过Cox回归分析PD的风险。
与匹配的对照组相比，接受胃切除术的GC患者患PD的风险降低（调整后风险比[aHR] 0.86；95%置信区间[CI] 0.75 - 0.98），但在进一步根据吸烟和体重指数（BMI）进行调整后，这种显著性消失。具体而言，胃次全切除术（STG）与PD风险降低相关（aHR 0.85；95% CI 0.74 - 0.99），而全胃切除术（TG）则不然（aHR 0.89；95% CI 0.66 - 1.19），尽管在进一步根据吸烟和BMI进行调整后，风险降低并不显著。在接受TG的患者中，术后补充VitB12时患PD的风险显著降低（aHR 0.36；95% CI 0.17 - 0.76），而未补充任何VitB12时风险则较高（aHR 1.55；95% CI 1.03 - 2.32）。
接受胃切除术并持续补充VitB12的GC患者PD发病率降低。本研究为胃切除术和VitB12在PD发病机制中的潜在作用提供了间接的流行病学证据。
