Department of Neurology, Helsinki University Hospital and Department of Clinical Neurosciences (Neurology), University of Helsinki, Helsinki, Finland.
Biostatistics consulting, Department of Public Health, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
J Parkinsons Dis. 2021;11(2):641-651. doi: 10.3233/JPD-202330.
The gastrointestinal tract is considered as a potential origin of Parkinson's disease (PD) pathology. Besides constipation, appendectomy and inflammatory bowel disease have also been associated with a higher PD-risk, but findings have been inconsistent. To date, there is only one previous study suggesting that irritable bowel syndrome (IBS) is associated with an increased risk of PD.
To evaluate whether IBS is associated with a higher risk of PD.
In this retrospective registry-based cohort study, we identified 28,150 patients that were diagnosed with IBS (IBS+) during the years 1998-2014, using data from the Finnish Care Register for Health Care. In addition, 98,789 IBS-free reference subjects (IBS-) of same age and gender and living in the same municipality were included. The study subjects were followed until the end of the year 2014 to analyze the incidence of PD. The association between IBS and PD was assessed by a Cox proportional hazards model.
Diagnosis of IBS was associated with a higher hazard of PD with an adjusted hazard ratio (aHR) of 1.70 (95% CI 1.27-2.26). However, the ratio of hazard rates for PD between IBS+ and IBS- subjects was not constant over time. The Cox model with time-varying coefficient for IBS status showed that the hazard of PD was significantly higher in IBS patients only during the first two years of follow-up (aHR 2.96, 95% CI 1.78-4.92).
Our findings indicate that the association between IBS and PD is likely explained by reverse causation and detection bias. It remains open whether IBS is an actual risk factor or a prodromal symptom of PD.
胃肠道被认为是帕金森病（PD）病理的潜在起源。除了便秘，阑尾切除术和炎症性肠病也与更高的 PD 风险相关，但研究结果并不一致。迄今为止，只有一项先前的研究表明肠易激综合征（IBS）与 PD 风险增加相关。
评估 IBS 是否与更高的 PD 风险相关。
在这项基于回顾性登记的队列研究中，我们使用芬兰医疗保健注册中心的数据，确定了 1998-2014 年间诊断为 IBS（IBS+）的 28150 名患者。此外，还纳入了年龄和性别相同且居住在同一市的 98789 名无 IBS 对照受试者（IBS-）。研究对象随访至 2014 年底，以分析 PD 的发病率。采用 Cox 比例风险模型评估 IBS 与 PD 之间的关联。
IBS 的诊断与 PD 的发病风险增加相关，调整后的风险比（aHR）为 1.70（95%CI 1.27-2.26）。然而，IBS+和 IBS-受试者之间 PD 的风险比随时间变化并不稳定。IBS 状态的时变系数 Cox 模型显示，IBS 患者在随访的前两年 PD 的发病风险显著更高（aHR 2.96，95%CI 1.78-4.92）。
我们的研究结果表明，IBS 与 PD 之间的关联可能是由反向因果关系和检测偏倚引起的。IBS 是否是 PD 的实际危险因素或前驱症状仍有待探讨。
