Wang Chunyi, Chen Fangzheng, Li Yuanyuan, Liu Jun
Department of Neurology & Institute of Neurology, Ruijin Hospital affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Department of Neurology & Institute of Neurology, Ruijin Hospital affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
J Neurol Neurosurg Psychiatry. 2022 Apr;93(4):395-403. doi: 10.1136/jnnp-2021-328062. Epub 2021 Dec 22.
A number of promising biomarkers for predicting imminent α-synucleinopathies have been suggested in isolated rapid eye movement sleep behaviour disorder (iRBD). However, existing evidence is conflicting without quantitative evaluation.
PubMed, Web of Science and ClinicalTrials.gov were searched through June 2021 to identify possible predictors of phenoconversion from iRBD to Parkinson's disease (PD). The pooled HRs and standardised mean differences (SMDs) with 95% CIs were calculated using fixed-effects or random-effects model.
A total of 123 studies were included in the meta-analysis. Significant motor dysfunction (HR 1.83, 95% CI 1.33 to 2.51, I=86.8%, p<0.001), constipation (HR 1.52, 95% CI 1.26 to 1.84, I=8.3%, p=0.365), orthostatic hypotension (HR 1.93, 95% CI 1.05 to 3.53, I=54.9%, p=0.084), hyposmia (HR 2.78, 95% CI 1.83 to 4.23, I=23.9%, p=0.255), mild cognitive impairment (HR 2.27, 95% CI 1.58 to 3.27, I=0%, p=0.681) and abnormal colour vision (SMD -0.34, 95% CI -0.63 to -0.05, I=45.6%, p=0.087) correlated with susceptibility to PD. The process can also be traced by putaminal dopamine transporter imaging (HR 2.60, 95% CI 1.94 to 3.48, I=0%, p=0.781) and tonic electromyographic activity (HR 1.50, 95% CI 1.04 to 2.15, I=70%, p=0.018).
The predictive value of each biomarker was initially highlighted with comprehensive evaluation. Combining specific predictors with high sensitivity is promising for detecting phenoconversion in the prodromal stage. Large-scale and multicentre studies are pivotal to extend our findings.
在孤立性快速眼动睡眠行为障碍（iRBD）中，已提出多种有望预测即将发生的α-突触核蛋白病的生物标志物。然而，现有证据相互矛盾，且缺乏定量评估。
检索截至2021年6月的PubMed、Web of Science和ClinicalTrials.gov，以确定从iRBD向帕金森病（PD）表型转化的可能预测因素。使用固定效应或随机效应模型计算合并风险比（HRs）和标准化均数差（SMDs）及其95%置信区间（CIs）。
荟萃分析共纳入123项研究。显著的运动功能障碍（HR 1.83，95%CI 1.33至2.51，I=86.8%，p<0.001）、便秘（HR 1.52，95%CI 1.26至1.84，I=8.3%，p=0.365）、体位性低血压（HR 1.93，95%CI 1.05至3.53，I=54.9%，p=0.084）、嗅觉减退（HR 2.78，95%CI 1.83至4.23，I=23.9%，p=0.255）、轻度认知障碍（HR 2.27，95%CI 1.58至3.27，I=0%，p=0.681）和色觉异常（SMD -0.34，95%CI -0.63至-0.05，I=45.6%，p=0.087）与患PD的易感性相关。该过程也可通过壳核多巴胺转运体成像（HR 2.60，95%CI 1.94至3.48，I=0%，p=0.781）和紧张性肌电图活动（HR 1.50，95%CI 1.04至2.15，I=70%，p=0.018）进行追踪。
通过综合评估初步突出了每种生物标志物的预测价值。结合具有高敏感性的特定预测因素有望在前驱期检测到表型转化。大规模多中心研究对于扩展我们的发现至关重要。
