The Relationship between Co-occurrence of Categorical Non-motor Symptoms and Subsequent Parkinson's Disease: A Population-based Retrospective Case-control Study

非運動型障礙類型之數量與帕金森氏症的關係：一個以族群為基礎的回溯性病例對照研究

王馨範(Hsin-Fan Wang) ； 張祐剛(Yu-Kang Chang) ； 周哲毅(Che-Yi Chou) ； 范洪春(Hueng-Chuen Fan)

《童綜合醫學雜誌》 15卷2期 (2021/12) Pp. 71-78

https://doi.org/10.3966/207135922021121502004

摘要

Background: Non-motor symptoms predict the risk of Parkinson's disease (PD), but the association between the number of symptom categories and the subsequent development of PD is unknown. This study assessed the effect of the co-occurrence of non-motor symptoms on PD development. Methods: Patients with PD (ICD9-CM code 332 and receipt of anti-Parkinson treatments) treated between January 1, 2007 and December 31, 2012 and propensity score-matched controls were extracted from a Longitudinal Health Insurance Database. The propensity score was calculated according to individuals' age, sex, Charlson's comorbidity index, and geographic region, and a 1:1 ratio was used. Codes for non-motor symptoms were searched in the database 7 days before the date of the PD diagnosis. The associations of six categories of non-motor symptoms with PD risk were analyzed using logistic regression. Results: In total, 2648 patients with PD and 2648 controls were analyzed. Gastrointestinal, sleep, psychiatry, genitourinary and other specific symptoms predicted the risk of PD with adjusted odds ratios (aORs) of 1.79, 1.96, 2.52, 1.55, and 1.98, respectively, (all p ＜ 0.001). Smell/taste disorders were excluded from the analysis because only two patients exhibited these signs. The risk of PD increased from 40.6% in patients with no symptoms to 81.8% in patients with five categories of symptoms (p ＜ 0.001). The aOR of PD was 1.28 (95% confidence intervals (CI) = 1.13-1.45, p ＜ 0.0001) in patients with one category of non-motor symptoms, versus 3.16 (95% CI = 2.20-4.53, p ＜ 0.0001) in patients with more than four categories of non-motor symptoms (p-trend = 0.030). Conclusion: Non-motor symptoms are associated with PD, and the co-occurrence of high numbers of categories of non-motor symptoms is related to an increased risk of subsequent PD.

關鍵字

Parkinson's disease ； non-motor ； pre-motor ； autonomic disorder ； alpha-synuclein ； disease modifying

並列摘要

研究背景：非運動型障礙與帕金森氏症有關，但是這些非運動型障礙類型的數量和帕金森氏症的相關性仍然未知。本研究目的就是要評估不同類型的非運動型障礙同時發生時與疾病的關係。研究方法：本研究的樣本是來自2000年台灣健保資料庫百萬抽樣檔，選取2007年1月1日到2012年12月31日診斷碼為ICD9為332並有服用巴金森氏症藥物的病患。利用傾向因子分數納入年齡、性別、查爾森共病症指數及投保地區，以1比1的比例選取年齡、性別、共病症及投保地區相似的對照組。病患有無非運動型障礙只計算於從巴金森氏症的診斷日之前7天往回溯至資料庫起始日。本研究使用邏輯式迴歸分析六類非運動型障礙與巴金森氏症的關係。研究結果：各有2648名巴金森氏症及非巴金森氏病患納入分析。除了嗅味覺異常因案例數極少而排除分析之外；和非巴金森氏症病患相比，巴金森氏症病患在腸胃道類障礙、睡眠類障礙、心理類障礙、泌尿生殖類障礙及其他類非運動型障礙的勝算比，分別為1.79、1.96、2.52、1.55及1.98，皆達統計顯著差異。有巴金森氏症病患的勝算比會隨著有非運動型障礙類型數目的增加而增加，從有一類的勝算比1.28增加到有四類為3.16，且都達到統計顯著差異。結論：研究結果顯示非運動型障礙和巴金森氏症的發生風險有關，伴隨非運動型障礙類型的數量可以作為預測巴金森氏症風險的參考。

並列關鍵字

巴金森氏症 ； 非運動型障礙 ； 前運動期障礙 ； 自律神經異常 ； 阿爾發突觸核蛋白 ； 改變病程因素