Department of Neurology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, No. 1 Da HuaRoad, DongDan, Beijing, 100730, P.R. China.
Ann Clin Transl Neurol. 2023 Dec;10(12):2276-2284. doi: 10.1002/acn3.51913. Epub 2023 Sep 26.
Our study aimed to investigate the glucose levels in PD and controls. We also examine whether glucose control is associated with PD severity regardless of diabetic status, and test whether the correlation is mediated by cerebral small vessel disease (CSVD) burden.
A total of 100 patients with idiopathic PD and 100 age- and sex-matched controls who underwent brain magnetic resonance imaging (MRI) were enrolled in this study. We collected the clinical data and blood parameters, including fasting blood glucose (FBG), glycated hemoglobin A1c (HbA1c), and blood lipid. Patients with PD were divided into early (n = 61) and advanced (n = 39) subgroups, based on Hoehn and Yahr (H&Y) stages. Differences between the PD and controls, PD with and without diabetes, and between two PD subgroups were compared. CSVD markers were assessed, including lacunes, white matter hyperintensities, enlarged perivascular spaces, and cerebral microbleeds. Multivariable logistic regressions were used to test the association between HbA1c and H&Y stages. Interaction between HbA1c and CSVD burden in relation to H&Y stages was also analyzed.
PD group exhibited higher HbA1c (p < 0.001), lower high-density lipoprotein cholesterol (p < 0.001) and triglyceride (p = 0.049) than controls. Advanced PD patients showed higher HbA1c than early PD group (p = 0.022). Increasing HbA1c (OR = 1.54, 95% CI 1.03-2.32, p = 0.036) along with longer disease duration (OR = 1.14, 95% CI 1.01-1.27, p = 0.028) and higher UPDRS III score (OR = 1.07, 95% CI 1.02-1.11, p = 0.002) increased the risk of belonging to the higher H&Y stage. However, interaction between HbA1c and CSVD burden in relation to H&Y stages was not significant.
HbA1c is independently associated with H&Y stages in PD, and this correlation may not be mediated by CSVD burden.
本研究旨在调查 PD 患者和对照组的血糖水平。我们还检查了血糖控制是否与 PD 严重程度有关，而与糖尿病状态无关，并测试这种相关性是否由脑小血管疾病（CSVD）负担介导。
本研究共纳入 100 例特发性 PD 患者和 100 例年龄和性别匹配的对照组，他们均接受了脑部磁共振成像（MRI）检查。我们收集了临床数据和血液参数，包括空腹血糖（FBG）、糖化血红蛋白 A1c（HbA1c）和血脂。根据 Hoehn 和 Yahr（H&Y）分期，将 PD 患者分为早期（n=61）和晚期（n=39）亚组。比较 PD 组和对照组、PD 伴或不伴糖尿病组以及两组 PD 亚组之间的差异。评估 CSVD 标志物，包括腔隙、脑白质高信号、扩大的血管周围间隙和脑微出血。采用多变量逻辑回归检验 HbA1c 与 H&Y 分期之间的关系。还分析了 HbA1c 和 CSVD 负担与 H&Y 分期之间的交互作用。
PD 组的 HbA1c 水平较高（p<0.001），高密度脂蛋白胆固醇（p<0.001）和甘油三酯（p=0.049）水平较低。晚期 PD 患者的 HbA1c 水平高于早期 PD 患者（p=0.022）。HbA1c 水平升高（OR=1.54，95%CI 1.03-2.32，p=0.036）、病程延长（OR=1.14，95%CI 1.01-1.27，p=0.028）和 UPDRS III 评分升高（OR=1.07，95%CI 1.02-1.11，p=0.002）都会增加 H&Y 分期较高的风险。然而，HbA1c 和 CSVD 负担与 H&Y 分期之间的交互作用不显著。
HbA1c 与 PD 患者的 H&Y 分期独立相关，这种相关性可能不受 CSVD 负担的影响。
