Marano Massimo, Pozzilli Valeria, Magliozzi Alessandro, Tabacco Gaia, Naciu Anda Mihaela, Palermo Andrea, Di Lazzaro Vincenzo
Unit of Neurology, Neurophysiology, Neurobiology and Psichiatry, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Rome, Italy.
Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy.
Front Neurol. 2023 Feb 16;14:1113913. doi: 10.3389/fneur.2023.1113913. eCollection 2023.
Non-motor manifestations are the main features of Parkinson's disease (PD). These have been associated with vitamin D abnormalities, but the role of parathormone (PTH) is still obscure. Among the non-motor symptoms of PD, the pathogenesis of restless leg syndrome (RLS) is still debated, but it has been associated with the vitamin D/PTH axis in other disease models. Our study deepens the association between vitamin D and PTH with the prevalence of non-motor symptoms of PD and explores such a relationship in patients reporting leg restlessness.
Fifty patients with PD were extensively investigated with motor and non-motor scales. Data on serum levels of vitamin D, PTH, and related metabolites were obtained, and patients were stratified as having vitamin D deficiency or hyperparathyroidism according to standardized criteria.
Overall, 80% of patients with PD exhibited low vitamin D levels, and hyperparathyroidism was diagnosed in 45%. The analysis of the non-motor symptoms profile using the non-motor symptom questionnaire (NMSQ) revealed 36% of leg restlessness, a main feature of RLS. This was significantly associated with worse motor symptoms, quality of sleep, and quality of life. Moreover, it was associated with hyperparathyroidism (OR: 3.48) and with PTH levels, independent of vitamin D, calcium/phosphate levels, and motor status.
Our results suggest a significant association between the vitamin D/PTH axis and leg restlessness in PD. PTH has a putative role in nociceptive modulation, and previous evidence on hyperparathyroidism has suggested a possible interrelation with RLS. Further investigations are necessary to add PTH to the non-dopaminergic non-motor landscape of PD.
非运动症状是帕金森病（PD）的主要特征。这些症状与维生素D异常有关，但甲状旁腺激素（PTH）的作用仍不明确。在PD的非运动症状中，不安腿综合征（RLS）的发病机制仍存在争议，但在其他疾病模型中，它与维生素D/PTH轴有关。我们的研究深化了维生素D和PTH与PD非运动症状患病率之间的关联，并在报告腿部不安的患者中探索了这种关系。
对50例PD患者进行了广泛的运动和非运动量表调查。获取了血清维生素D、PTH及相关代谢产物水平的数据，并根据标准化标准将患者分为维生素D缺乏或甲状旁腺功能亢进组。
总体而言，80%的PD患者维生素D水平较低，45%被诊断为甲状旁腺功能亢进。使用非运动症状问卷（NMSQ）对非运动症状特征进行分析，发现36%的患者有腿部不安，这是RLS的主要特征。这与更严重的运动症状、睡眠质量和生活质量显著相关。此外，它与甲状旁腺功能亢进（比值比：3.48）和PTH水平相关，独立于维生素D、钙/磷水平和运动状态。
我们的结果表明，维生素D/PTH轴与PD患者的腿部不安之间存在显著关联。PTH在伤害性调制中可能起作用，先前关于甲状旁腺功能亢进的证据表明它与RLS可能存在相互关系。有必要进一步研究，将PTH纳入PD的非多巴胺能非运动领域。
