Kim Min Seung, Park Don Gueu, Shin In Ja, An Young Sil, Yoon Jung Han
Department of Neurology, Ajou University School of Medicine, Suwon, Republic of Korea.
Department of Neurology, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Republic of Korea.
J Neurol. 2024 Dec 12;272(1):28. doi: 10.1007/s00415-024-12783-6.
Recently, "body-first" and "brain-first" subtype in Parkinson's disease (PD) was proposed based on the propagation of α-synuclein. In isolated RBD considered as a premotor stage of body-first PD, α-synuclein was supposed to originate in the enteric nervous system and spreads via autonomic nervous system. Therefore, we hypothesized that body-first PD is more likely to have a delayed gastric emptying time and reduced cardiac sympathetic denervation. In this study, we aimed to assess gastric motility and its correlation with cardiac sympathetic denervation, dopamine transporter uptake in PD with the body-first PD in comparison with brain-first PD.
We investigated gastric scintigraphy, dual-phase 18F-FP-CIT PET, and cardiac MIBG scintigraphy in patients with PD. Based on the presence of RBD and delayed H/M ratio in MIBG scintigraphy, we classified patients into the body-first PD and brain-first PD groups. Gastric emptying time (GET) was assessed by dynamic gastric scintigraphy, and half-emptying time (T) was measured.
A total of 18 PD patients (mean age 68.8) were classified into body-first PD group (n = 10) and brain-first PD group (n = 8). Delayed GET was more prevalent in body-first PD group compared to brain-first PD (T > 110 min, 90.0 vs 37.5%, p = 0.043). Striatal dopamine depletion was similar between groups and no significant correlation with T. Washout rate of cardiac MIBG showed a tendency of correlation with T (r = 0.454, p = 0.077).
This study showed that body-first PD may be associated with a higher prevalence of delayed gastric emptying time compared to the brain-first PD, suggesting higher burden of gastrointestinal dysmotility in brain-first PD.
最近，基于α-突触核蛋白的传播，帕金森病（PD）中提出了“身体优先”和“大脑优先”亚型。在被认为是身体优先型PD运动前期的孤立性快速眼动睡眠行为障碍（RBD）中，α-突触核蛋白被认为起源于肠神经系统，并通过自主神经系统传播。因此，我们假设身体优先型PD更有可能出现胃排空时间延迟和心脏交感神经去神经支配减少。在本研究中，我们旨在评估身体优先型PD与大脑优先型PD相比，PD患者的胃动力及其与心脏交感神经去神经支配、多巴胺转运体摄取的相关性。
我们对PD患者进行了胃闪烁显像、双相18F-FP-CIT PET和心脏MIBG闪烁显像。根据MIBG闪烁显像中RBD的存在和延迟的H/M比值，我们将患者分为身体优先型PD组和大脑优先型PD组。通过动态胃闪烁显像评估胃排空时间（GET），并测量半排空时间（T）。
总共18例PD患者（平均年龄68.8岁）被分为身体优先型PD组（n = 10）和大脑优先型PD组（n = 8）。与大脑优先型PD相比，身体优先型PD组中GET延迟更为普遍（T>110分钟，90.0%对37.5%，p = 0.043）。两组之间纹状体多巴胺耗竭情况相似，且与T无显著相关性。心脏MIBG的洗脱率与T呈相关趋势（r = 0.454，p = 0.077）。
本研究表明，与大脑优先型PD相比，身体优先型PD可能与胃排空时间延迟的更高患病率相关，提示大脑优先型PD中胃肠动力障碍的负担更重。
