Wu Zhuang, Hong Ronghua, Zhang Zhuoyu, Zhu Sha, Peng Yanzi, Zhang Jingxing, Guan Qiang, Pan Lizhen, Chen Yuhui, Jin Lingjing
Department of Neurology and Neurological Rehabilitation, Shanghai Disabled Persons' Federation Key Laboratory of Intelligent Rehabilitation Assistive Devices and Technologies, Shanghai Sunshine Rehabilitation Center), School of Medicine, Yangzhi Rehabilitation Hospital, Tongji University, Shanghai, China.
Neurotoxin Research Center, Key Laboratory of Spine and Spinal Cord Injury Repair and Regeneration of Ministry of Education, Department of Neurology, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China.
Neurol Sci. 2025 Aug 21. doi: 10.1007/s10072-025-08375-5.
Axial postural abnormality (APA) contains various forms and the progression patterns and clinical predictors for each APA remain unknown. We aimed to investigate the evolution of APA and elucidate its relationships to clinical picture in Parkinson's disease (PD).
151 PD patients underwent anterior neck flexion (ANF), anterior trunk flexion (ATF) at thoracic and lumbar fulcrum, and lateral trunk flexion (LTF) assessments for 3 years. APA was assessed using a linear mixed-effects model. The cumulative incidence of APA progression was displayed using Kaplan-Meier curves with log-rank test to compare differences. Univariate and multivariate Cox proportional hazards analyses were performed to investigate risk factors for different types of APA progression.
ANF and ATF (thoracic fulcrum) began to increase significantly at 1-year follow-up. Lumbar fulcrum (ATF) and LTF began increasing at the 2-year and 3-year follow-ups, respectively. The overall cumulative progression risks for four APAs were different, with ANF having a significantly higher risk than thoracic fulcrum (ATF) and lumbar fulcrum (ATF), followed by LTF. We identified predictors for ANF progression were disease duration and bradykinesia symptoms. Exercise status and bradykinesia symptoms were associated with progression of ATF (thoracic fulcrum), and Hoehn-Yahr stage was associated with progression of ATF (lumbar fulcrum). LTF progression was associated with levodopa equivalent daily dose and MDS-UPDRS III posture subitem.
The APA of PD patients follow a "top to down, sagittal to coronal plane" pattern. An increased APA is associated with motor symptoms. Regular physical activity can slow the deterioration of APA in PD.
轴性姿势异常（APA）包含多种形式，每种APA的进展模式和临床预测因素仍不明确。我们旨在研究帕金森病（PD）中APA的演变，并阐明其与临床症状的关系。
151例PD患者接受了为期3年的前颈部屈曲（ANF）、胸腰椎支点处的前躯干屈曲（ATF）和侧躯干屈曲（LTF）评估。使用线性混合效应模型评估APA。使用Kaplan-Meier曲线显示APA进展的累积发生率，并进行对数秩检验以比较差异。进行单因素和多因素Cox比例风险分析以研究不同类型APA进展的危险因素。
在1年随访时，ANF和胸腰椎支点处的ATF开始显著增加。腰椎支点处的ATF和LTF分别在2年和3年随访时开始增加。四种APA的总体累积进展风险不同，ANF的风险显著高于胸腰椎支点处的ATF和腰椎支点处的ATF，其次是LTF。我们确定ANF进展的预测因素为疾病持续时间和运动迟缓症状。运动状态和运动迟缓症状与胸腰椎支点处的ATF进展相关，Hoehn-Yahr分期与腰椎支点处的ATF进展相关。LTF进展与左旋多巴等效日剂量和MDS-UPDRS III姿势子项相关。
PD患者的APA遵循“自上而下，矢状面到冠状面”的模式。APA增加与运动症状相关。规律的体育活动可减缓PD患者APA的恶化。
