Dysphagia is a common non-motor symptom of Parkinson's disease (PD), which may cause pneumonia, malnutrition, and declined quality of life. However, risk factors of dysphagia in PD are still unclear.

To explore the risk factors of dysphagiain PD.

One hundred and seven consecutive PD patients were recruited in Henan Provincial People's Hospital from June 2018 to December 2019, and general demographic data, incidence of dysphagia and sialorrhea, disease stage and illness severity, severity of anxiety and depression, cognitive function, as well as uric acid and homocsteine were retrospectively analyzed. Risk factors of dysphagia in PD were explored using multivariate Logistic regression analysis. ROC curve analysis was used for evaluating the predictive value of independent risk factors for dysphagia in PD.

Of the 107 PD patients, 45 with dysphagia and 62 without were assigned to an observation group and a control group, respectively, with an incidence of dysphagia of 42.1% (45/107). There were significant difference in terms of age, Hoehn-Yahr classification, Unified Parkinson's Disease Rating Scale (UPDRS) Ⅰ, Ⅱ and Ⅲ scores, incidence of sialorrhea, the 14-item Hamilton Anxiety Scale (HAMA-14) score, the 24-item Hamilton Depression Scale (HAMD-24) score, Mini-mental State Examination (MMSE) score and uric acid between these two groups (P≤0.05). Multivariate Logistic regression analysis showed that, UPDRSⅢ score≥35〔OR=7.639, 95%CI (2.750, 21.219) 〕, sialorrhea〔OR=3.336, 95%CI (1.178, 9.447) 〕, HAMA-14 score≥13〔OR=2.847, 95%CI (1.027, 7.894) 〕and uric acid <251 μmol/L〔OR=0.354, 95%CI (0.129, 0.971) 〕were independent risk factors of dysphagia in PD (P<0.05). ROC curve analysis showed that, AUC of UPDRS Ⅲ score, sialorrhea, HAMA-14 score and uric acid was 0.750, 0.682, 0.638 and 0.670 in predicting dysphagia in PD, with sensitivity of 69.4%, 56.5%, 59.7% and 64.5%, specificity of 80.0%, 80.0%, 71.1% and 66.7%, Youden index of 0.494, 0.365, 0.308 and 0.312, respectively.

UPDRSⅢ score≥35, HAMA-14 score≥13, sialorrhea and uric acid <251 μmol/L are independent risk factors of dysphagia in PD, and the above four risk factors has certain predictive value for dysphagia in PD.

Congenital absence of the internal carotid artery (ICA) is a rare congenital developmental anomaly, which is often associated with carotid canal atresia and structural abnormalities of the ICA. It may be asymptomatic, or shows noticeable symptoms such as Horner syndrome, loss of visual field, trigeminal neuralgia, pulsing tinnitus, memory dysfunction/dementia, transient ischemic attack, intracranial aneurysm, subarachnoid hemorrhage, pituitary dysfunction, and developmental malformations in multiple organs. We reported a case of congenital absence of the left ICA with Horner syndrome, aneurysm, and secondary Parkinson's syndrome. Along with the retrospective analysis of diagnosis, treatment and disease progression of this case, a review of relevant literature was conducted, to improve the recognition of this rare complication.

Hypomimia is one prominent clinical symptom of Parkinson's disease (PD) , which is mainly characterized by a loss or reduction of voluntary, emotional and other facial expressions, and usually appears bilaterally and symmetrically. Factors associated with hypomimia in PD have been extensively studied recently, including basal ganglia dysfunction, facial emotion recognition deficit, and cognitive impairment, but the specific pathophysiological mechanism is still unclear. Hypomimia strongly correlates with the progression of PD, so scientific quantification and evaluation of hypomimia will be of great significance to the diagnosis and treatment of PD. Besides that, there is still controversy over its treatment plan. We reviewed the latest developments in clinical presentations, pathogenesis and treatment of hypomimia in PD.

帕金森病（PD）是一种常见的神经系统退行性疾病，主要的病理改变是脑黑质致密部α突触核蛋白的异常聚集，近年来越来越多的研究认为在大脑之外（包括肠神经系统）也有α突触核蛋白异常聚集。微生物-肠-脑轴是将大脑和肠道功能整合的双向信息交流系统，肠道与大脑之间主要依靠神经通路、内分泌途径以及免疫途径进行信息交流。肠神经系统可能作为α突触核蛋白播散的渠道，通过迷走神经播散至中枢神经系统，因此有学者认为PD发病最初可能起源于肠道。本文就近年来针对肠脑轴在PD发病机制中作用的研究现状做一简要综述，将有助于进一步阐明PD的可能发病机制以及解释部分临床表现，并可能为PD的诊断和治疗提供新的方向。

Background　Rapid eye movement（REM） sleep behavior disorder（RBD） is important not only as a preclinical symptom but also an aggravating symptom of Parkinson's disease（PD）.However，it is not known whether the onset of RBD in relation to PD affects the clinical characteristics of PD.Objective　To study the clinical characteristics of PD between patients with RBD occurring before and after the onset of PD.Methods　Participants were recruited from Dalian Friendship Hospital between October 2013 and May 2018，including 136 PD patients from Department of Neurology，and 30 volunteered health examinees with normal cognitive function（control group） from the Physical Examination Center.Descriptive variables including age，sex ratio，dose of dopaminergic agents〔levodopa dose equivalents（LEDs）〕，duration of PD morbidity，Hoehn and Yahr stage，prevalence of tremor，laterality of PD symptoms，Mini-Mental State Examination（MMSE） score，prevalence of OH，self-reported hallucinations，and dementia were compared across PD patients with and without RBD and controls，and across PD patients with RBD before and after the onset of PD and controls.Results　PD patients included 47 with RBD（consisting of 9 with RBD before the onset of PD，and 38 with RBD after the onset of PD） and 89 without RBD.Those with RBD had longer mean duration of PD morbidity，higher prevalence of advanced Hoehn-Yahr stages，using greater dosage of LEDs，hallucinations，OH，and dementia，and lower mean MMSE score than those without RBD（P<0.05）.PD patients with RBD had higher prevalence of hallucination，OH and dementia than the controls，and so did PD patients without RBD（P<0.05）.PD patients with RBD before the onset of PD had lower mean MMSE score and higher prevalence of dementia than those with RBD after the onset of PD（P<0.05）.The mean MMSE score was lower and the prevalence of dementia was greater in PD patients with RBD before or after the onset of PD compared to controls（P<0.05）.Conclusion　The occurrence of RBD after the onset of PD might be an important factor aggravating cognitive function.

Constipation is a common clinical symptom.Because of the characteristics of age of onset，constipation due to Parkinson's disease is very common in outpatient clinics of general practice and grassroots health institutions.Through reviewing relevant literature，this paper summarized the etiologg and mechanism，characteristics and prevention of constipation due to Parkinson's disease and fully understood the needs of patients to emphasize that individualized treatment was the fundamental principle.Constipation due to Parkinson's disease belongs to the category of comorbidities.General practitioners should pay attention to the respective conditions of Parkinson's disease and constipation as well as their mutual connection in clinical work，develop personalized intervention and treatment plans following the concept of holistic and whole-process concept，timely carry out the targeted education，and be intend to do a good job in regular follow-up.

Parkinson's disease （PD） is a common neurodegenerative disorder of the central nervous system.PD patients frequently complain about Parkinson's disease-associated pain（PDAP），a non-motor symptom，which has not received enough attention.Moreover，those in the moderate and advanced stages of PD are more likely to suffer from impaired quality of life by chronic PDAP，a manifestation with complex pathogenesis.For the control and treatment of PDAP，increasing the dose of levodopa increases the risk of dyskinesia and risks to health can be brought by the use of analgesics.We used fire needle acupuncture combined with the normal acupuncture to treat 3 cases suffering from different types of PDAP，and good results have been achieved，indicating that the combination therapy is effective.

Background　Parkinson's disease（PD） is a common neurodegenerative disease in the elderly with high incidence，prevalence and morbidity.Patients with PD have variable clinical presentations，including motor and non-motor symptoms.According to motor symptoms，PD can be divided into different subtypes，with subtype-specific pathogenic factors and pathophysiological processes.However，only a few studies have focused on non-motor symptoms of PD，especially early PD.Objective　To explore the relationship between non-motor symptoms and motor subtypes of early PD by analyzing non-motor symptoms such as cognitive function，frontal lobe function，mood and sleep status，and autonomic function by motor subtypes in early PD patients.Methods　One hundred and sixteen neurology outpatients and inpatients with early PD from Zhejiang Hospital were included between January 2017 to March 2020 and divided into tremor-dominant（TD），postural instability/gait disorder（PIGD），and mixed（IT） groups according to the Movement Disorder Society-Unified Parkinson's Disease Rating Scale.The clinical data，and Motor disorders society-the unified Parkinson's disease rating scale，measurement results of Non-Motor Symptom Scale，Mini-Mental State Examination，Frontal Assessment Battery，Geriatric Depression Scale，Apathy Evaluation Scale，Parkinson's Disease Sleep Scale and Scales for Outcomes in Parkinson's Disease-Autonomic were compared between the three groups.Results　There were 76 cases in TD group, 32 cases in PIGD group and 8 cases in IT group.There were significant differences in frequency and severity of non-motor symptoms among three groups（P<0.05）.The assessed frontal lobe function，depression，apathy and cardiovascular autonomic function of patients between the three groups showed significant differences（P<0.05）.Conclusion　Non-motor symptoms are common in PD，which can appear in the early stage.The non-motor symptoms of PIGD and IT subtypes are more severe than those of TD subtype.The precise motor classification of early PD may facilitate effective assessment of the patient's status and prognosis in clinical practice，as well as the formulation of an appropriate treatment regimen.

Background　Previous studies have showed that the rapid eye movement sleep behavior disorder（RBD） and autonomic dysfunction are associated with the severity of the Parkinson's disease（PD），but there is a lack of studies on whether autonomic dysfunction plays a role in the relationship between RBD and PD severity. Objective　To examine whether autonomic dysfunction plays an intermediary role in the relationship between RBD and PD severity，and whether the role is influenced by age. Methods　A total of 669 PD patients meeting the inclusion criteria were selected from the Parkinson's Progression Markers Initiative database from January to December 2018. General socio-demographics，RBD prevalence（assessed by the REM Sleep Behaviour Disorder Screening Questionnaire），autonomic dysfunction prevalence（assessed by the Scales for Outcomes in Parkinson's Disease-Autonomic questionnaire），and PD severity 〔assessed by the modified Hoehn and Hahr （H-Y） staging〕 were collected. Using the RBD as the independent variable，severity of PD as the dependent variable，the autonomic dysfunction as the intermediate variable，and age as the subgroup variable（less than 56 years，56-65 years and greater than 65 years），a model for investigating the intermediating effect size of autonomic dysfunction between RBD and PD severity was constructed. Results　Those aged above 65 years had a higher mean modified H-Y staging than those aged less than 56 or 56-65 years（P<0.05）. Pearson correlation analysis showed that the severity of PD was positively correlated with RBD and autonomic dysfunction（r=0.200，0.299，P<0.01），and RBD was positively correlated with autonomic dysfunction（r=0.384，P<0.01）. In all participants，autonomic dysfunction partially played an intermediary role between RBD and PD severity，with an effect size of 0.031 with Bootstrap 95%CI（0.022，0.041），accounting for 50.00% （0.031/0.062） of the total effect.For those aged less than 56 years，autonomic dysfunction fully played an intermediary role between RBD and PD severity，with an effect size of 0.034 with Bootstrap 95%CI（0.016，0.056）. For those aged between 56-65 years，autonomic dysfunction partially played an intermediary role between RBD and PD severity，with an effect size of 0.028 with Bootstrap 95%CI（0.014，0.046），accounting for 39.43% （0.028/0.071） of the total effect. For those older than 65 years，autonomic dysfunction fully played an intermediary role between RBD and PD severity，with an effect size of 0.027 with Bootstrap 95%CI（0.012，0.046）. Conclusion　Autonomic dysfunction may produce intermediating effect on the relationship between RBD and PD severity，and the effect size may be impacted by age.

Sex-specific Correlations of Fracture Risk with Nutritional Status，Body Composition and Balance Condition in Parkinson's Disease Patients
XU Xiaohui1，TIAN Junmei2，CAI Weiwei1，ZHAO Yongfei2，WANG Yupeng1，LIU Chao1，
DUAN Zhihui1*
1.Department of Neurology，Luoyang Central Hospital Affiliated to Zhengzhou University，Luoyang 471000，China
2.Department of Nutrition，Luoyang Central Hospital Affiliated to Zhengzhou University，Luoyang 471000，China
*Corresponding author：DUAN Zhihui，Chief physician；E-mail：duanzhihui76@126.com
【Abstract】 Background Sufficient attention has not been paid to malnutrition，one of the non-motor symptoms of Parkinson's disease （PD），for a long time. Malnutrition，sarcopenia and balance disorders increase fracture risk in PD patients. Currently，the research in this field is relatively rare in China. Objective To examine sex-specific correlations of nutritional status，bodycomposition and balance condition with fracture risk in PD patients.Methods A total of 68 PD patients （37 males and 31 females）treated in Luoyang Central Hospital Affiliated to Zhengzhou University from December 2018 to December 2020 were enrolled，and their general data were collected. Then，the 10-year risks for major osteoporotic fractures （MOF） and hip fractures （HF） were predicted using the Fracture Risk Assessment Tool. Motor and balance functions were assessed using the Unified Parkinson Disease Rating Scale-part Ⅲ （UPDRS Ⅲ ）. Nutrition status was assessed using the Mini-Nutritional Assessment （MNA）. Balance ability was measured by the Berg Balance Scale （BBS）. Balance confidence for performing activities was rated by the Activities-specific Balance Confidence（ABC） Scale. The T-score of femoral neck bone mineral density（BMD） was calculated and body composition was measured. The correlations of fracture risk with various factors were analyzed. And fracture risk and various factors were subjected to partial correlation analysis after controlling for age，gender and T-score of femoral neck BMD. Results Compared to women PD patients，men had lower the 10-year risk for MOF，UPDRS Ⅲ score，and body fat rate （BFR），as well as greater mean triceps skin fold thickness，but higher mean T-score of femoral neck BMD，mean trunk muscle mass，upper limb muscle mass，lower limb muscle mass and BBS score （P<0.05）. In men PD patients，the 10-year risks for MOF and HF were negatively correlated with the MNA score，lower limbs muscle mass，BBS score and ABC score （P<0.05），but were positively correlated with the UPDRS Ⅲ score （P<0.05）；the T-score of femoral neck BMD was positively correlated with lower limbs muscle mass （P<0.05），while negatively correlated with BFR （P<0.05）. In women PD patients，the 10-year risk for MOF was positively correlated with the UPDRS Ⅲ score and age，while negatively correlated with the MNA score，muscle mass of lower limbs，BBS score and ABC score （P<0.05）；the 10-year risk for HF was positively correlated with the UPDRS Ⅲ score，while negatively correlated with MNA score，muscle mass of upper limbs and lower limbs，BBS score and ABC score （P<0.05）. Besides，the T-score of femoral neck BMD was positively correlated with muscle mass of lower limbs （P<0.05），while negatively correlated with age and waist-to-hip ratio （P<0.05）. The results of partial correlation analysis revealed that the 10-year risks for MOF and HF had negative correlations with MNA score，muscle mass of lower limbs，BBS score and ABC score （P<0.05），and a positive association was found between the 10-year
risk for MOF and UPDRS Ⅲ score （P<0.05）. Conclusion The body composition and T-score of femoral neck BMD in males are different from those in females. Malnutrition，decreased muscle mass of lower limbs，reduced balance capacity and severity of PD are important predictors of the risk of MOF in PD patients. In view of this，to prevent and treat osteoporosis and fractures in PD patients，it is essential to pay attention to nutritional status and muscle mass of them，especially female patients.
【Key words】 Parkinson disease；Fracture risk；Nutritional status；Body composition；Balance scale
Patients with Parkinson's disease (PD) often experience weight loss and malnutrition, which may continue throughout the entire disease process, even prior to the onset of symptoms.However, compared with other non-motor symptoms, there have been few clinical studies on the nutritional status of PD patients. As reported in foreign studies, a remarkably higher risk of malnutrition is found in PD population than healthy individuals, while malnutrition is present in 0-24% of patients and those with malnutrition riskconstitute 3-60%[1] of all cases. Poor nutrition may cause reduction in muscle quantity and induce other diseases, and relevant fractures may result in disability or even death.There exist certain differences in body composition between females and males. At present, the research that investigates the relations betweenskeletal muscle index and osteoporotic fracture in postmenopausal females and elderly males has been reported in China [2-3], whereas there are few publications on the associations of nutritional status and body composition with fracture risk in PD patients.Fracture Risk Assessment Tool (FRAX) as an available means of screening the risk of osteoporotic fracture is commonly used in clinic, so as to prevent the occurrence of fracture[4].This study aimed to analyze the correlations between fracture risk predicted by FRAX and nutritional status score, body composition and balance scale score, thus providingnovel perspectives and references for the prevention and treatment of osteoporotic fracture in PD patients.
1 Subjects and Methods
1.1 Research subjectsPD patients treated in Luoyang Central Hospital Affiliated to Zhengzhou University from December 2018 to December 2020 were enrolled，and their general data were collected.Inclusion criteria were as follows: patients who met the diagnostic criteria for primary PD[5], those in stage 1-3 according to
Hoehn-Yahr(H-Y)staging, and those who signed the informed consent.Exclusion criteria involved: long-term bedridden patients, those who could not cooperate in questionnairesurvey, those with severe cardiovascular or cerebrovascular diseases, or those with severe osteoporosis.Finally, 68 patients were enrolled in this study, including 37 males and 31 females aged 62-78 years old, averagely (65.5±9.8) years old. This study was conducted by the medical ethics Committee of Luoyang Central Hospital affiliated to Zhengzhou UniversityApproval will be reviewed (Approval No: LWLL-2021-06-04).
1.2 Data collection （1）the general data, including age, gender, living alone or not, fracture history, and wearing-off, gait freezing and on-off phenomena or not, were gathered. （2）in terms of fracture risk, FRAX (http://www.shef.ac.uk/FRAX/) was utilized to predict the 10-year risks for major osteoporotic fracture (MOF) risk and hip fracture (HF), and the individuals who had HF risk ≥3% or MOF risk ≥20% were identified as patients at high risk of osteoporotic fracture.（3） the Unified Parkinson's Disease Rating Scale-motor score (UPDRS-III) with 16 items (0-4 points each, 56 points in total) was adopted, and the higher the score, the worse the motor and balance function[6]. In addition, the Mini Nutritional Assessment (MNA) scale (30 points in total) was used to measure the nutritional status of patients, MNA score ≥24 points indicated good nutritional status, MNA score ranged 17-23.5 points denoted malnutrition risk, and MNA score <17 points represented malnutrition[7].（4）femoral neckbone mineral density (BMD) T-value was tested using a Lexxos dual-energy X-ray bone densitometer purchased from DMS. In addition, body composition indexes including body fat ratio (BFR), body mass index (BMI), triceps skinfold thickness, arm circumference (AC), waist-to-hip ratio (WHR) and limb muscle quantity were measured using Inbody 720 (a body composition analyzer) under fasting state and 2-3 h after eating. （5） the balance scale score was evaluated bythe Berg Balance Scale (BBS) (0-4 points) with respect to the balance ability of patients from sitting to standing, and a lower score meant poorer balance control[8]. In addition, the Activities-specific Balance Confidence (ABC) scale was employed to assess the patients' confidence in their own balance ability during activities, with a total of 0-100
points, and the higher the score, the better the confidence in the balance ability[9].
1.3 Statistical analysisSPSS 23.0 software was adopted for statistical analysis. Normally-distributed measurement data were expressed by mean ± standard deviation (χ±s), and independent-samplest-test was used for comparison between groups. If the data did not conform to normal distribution, they were expressed as median (interquartile range) [M (P25, P75)], and non-parametric Mann-Whitney U test was utilized for comparison between groups. Enumeration data were expressed by ratio (%) and analyzed using χ2test. Pearson correlation analysis and Spearman rank correlation analysis were adopted to analyze correlations. Besides, after controlling age, gender and femoral neck BMD T-value, partial correlation analysis was employed to investigate the correlations between the main factors and fracture risk.p<0.05 represented statistically significant differences.
2 Results
2.1 Comparison of general data between different genders of PD patients
No statistically significant differences were found in age, living alone, fracture history,wearing-off, gait freezing and on-off phenomena, the 10-year risks for HF, MNA score, BMI, AC, WHR and ABC score between different genders of PD patients(p>0.05).The 10-year risks for MOF, UPDRS-III score, BFR and triceps skinfold thickness were lower, while femoral neck BMD T-value, trunk muscle quantity, double upper and lower limb muscle quantity and BBS score were higher in males than those in females (p<0.05) (Table 1).
2.2 Analysis of correlations of fracture risk, femoral neck BMD T-value with other indexes in PD patients of different genders
In male PD patients,there were negative associations of MNA score, double lower limb muscle quantity, BBS score and ABC score with the 10-year risks for MOF and HF (p<0.05), positive relations between UPDRS-III score and the 10-year risks for MOF and HF (p<0.05) as well as between double lower limb muscle quantity and femoral neck BMD T-value (p<0.05), and negative correlations between BFR and femoral neck BMD T-value (p<0.05) (Table 2).In female PD patients, positive relations were found between UPDRS-III score and the 10-year risks for MOF and
HF(p<0.05), between age and the 10-year risks for MOF (p<0.05), and between double lower limb muscle quantity and femoral neck BMD T-value (p<0.05), while there were negative associations of MNA score, double lower limb muscle quantity, BBS score and ABC score with the 10-year risks for MOF (p<0.05), of MNA score, double upper and lower limb muscle quantity, BBS score and ABC score with the 10-year risks for HF (p<0.05), and of age and WHR with femoral neck BMD T-value (p<0.05) (Table 2).
2.3 Analysis of partial correlation of fracture risk with other indexes
After controlling gender, ageand femoral neck BMD T-value, partial correlation analysis revealed that MNA score, double lower limb muscle quantity, BBS score and ABC score were negatively associated with the 10-year risks for MOF and HF (p<0.05), and UPDRS-III score was positively correlated with the 10-year risks for MOF (p<0.05) (Table 3).
3 Discussion
PD patients tend to suffer from malnutrition and weight loss followed by aggravation of motor symptoms or even fractures.In this study, the results displayed the MNA score<24 points [7]in the majority of PD patients, lower than the good standard value, and MNA score was negatively associated with the 10-year risks for MOFand HF, confirming that malnutrition appears in PD patients, and is related to fracture risk. The following reasons are commonly implicated in malnutrition and weight loss in PD patients, i.e.poor appetite and nutrition intake reductionresulted from early hyposmia[10], levodopa-induced gastrointestinal symptoms[11], neuroendocrine abnormalities[12], energy metabolism disorder[13],and excessive energy consumption due to muscle rigidity and dyskinesia[14]. In addition, the excessive control of protein intake aiming to reduce the impact of levodopa drugs is also one of the reasons for malnutrition in some patients.In recent years, more attention has been paid to bodycomposition such as muscle loss and osteoporosis which may cause balance abilitydecline and increase the risk of falls and fragility fractures[15]. As reported in a multi-center study, for every 1 standard deviation increase in limb muscle quantity, the risk of osteoporosis declines by 37%, and BMD is positivelyrelated to muscle
quantity[16].Consistent with the above-mentioned conclusion, this study also revealed that in male and female PD patients,double lower limb muscle quantity was positively correlated with femoral neck BMD T-value[17-18].According to two other prospective studies, it can be seen that the reduction in muscle quantity is an independent risk factor for fractures. This study manifested thatin male and female PD patients, there were negative associations of double lower limb muscle quantity with the 10-year risks for MOF and HF. The findings demonstrated that the reduction in muscle quantity of the lower limbs increases the risk of osteoporotic fracture, which is consistent with foreign reports[19-20].The results of this study displayedthat double upper limb muscle quantity in female PD patients was also negatively associated with the 10-year risks for HF, and the reason is that the reduction in muscle quantity of the upper limbs may weakenupper limb strength and grip strength and influence physical function, indirectly increasing the risk of fracture.
VANDER MARCKet al[21]. reported that weight loss in PD patients is mainly attributed to adipose tissue reduction, while the reduction of muscle is notapparent.However, this study exhibited that the lower limb muscle quantity was lower than reference range in most PD patients, and 1 patient had an extremely low muscle quantity of the lower limbs and presented with obvious fatigue. Theresults of this study denoted male PD patients showed greater trunk muscle quantity, doubleupper and lower limb muscle quantity than female PD patients[22]. However, foreign studies have indicated that the detection rate of skeletal muscle reduction is remarkably higher in male PD patients than that in females and scholars consider that male testosterone has a significant influence on muscle quantity than female estrogen[23-24].Wang et al[25]. reported that increasing the testosterone level in young male patients with a low level of sex hormone contributes to musclequantity elevated by 20-60%. In this study, all male PD patients enrolled were elderly individuals, while the enhancement effect of testosterone on the muscle quantity is weaker in elderly males than that in young males[26]. Moreover, the female PD patients enrolled in this study were postmenopausal elderly women with obviously reduced estrogen levels. Consequently, the results appeared to be different.
In the present study, two scales were used for balance scale scoring, of which BBS is capable of evaluating the fall risk of PD patients, from static state to dynamic state, during posture changes, and ABC is able to assess the confidence of PD patients in their own balance ability during activities.The combination of the two scales can better reflect PD patients' balance conditions. In addition, the correlation analysis manifested that BBS score and ABC score in male and female PD patients were negatively related tothe 10-year risks for MOF and HF, indicating the reduction of balance ability and the increased risk of fracture. Thus, it is necessary to focus on the balance ability training in PD patients. UPDRS-III score in both male and female PD patients was positively correlated with the 10-year risks for MOF and HF, suggesting the relations between PDseverity and fracture risk. Positive correlations between age and the 10-year risks for MOF among females PD patients indicated the associations between age and osteoporotic fracture risk in female PD patients, which was similar to previous research[27]. PD mostly occurs in elderly people, leading to the gradual reduction in vitamin D and blood calcium levels, and postmenopausal women will have reduced estrogenlevels, which may cause bone loss and osteoporosis, increasing the risk of fracture.
To further explore the correlations of balance, nutritional status and body composition with fracture risk, partial correlation analysis following controlling gender, age and femoral neck BMD T-value was conducted, and the results revealed that the 10-year risks for MOF and HF were negatively associated with BBS score, ABC score, MNA score and double lower limb muscle quantity. Positive relations between the 10-year risks for MOF and UPDRS-III score further verified that the low muscle quantity of the lower limbs, poor balance function, poor nutritional status and severe PD are risk factors for osteoporotic fracture, significantlyincreasing the risk of fracture.In addition to nutritional assessment, balance evaluation and bone mineral density measurement, body composition also can be detected to measure limb muscle quantity in PD patients, especially the nutritional status and muscle quantity of elderly female PD patients, so as to recognize the patients at high risk of fracture in advance and provide corresponding nutritional interventions. Then through comprehensive
analysis on the body balance abilities in patients of different genders, personalized treatment protocols are administered to reduce the risk of falls and osteoporotic fractures in PD patients. In this study, manual questionnaire and instrument measurement may cause subjective or objective errors due to small sample sizes. Thus, it is of necessity to expand the sample size and further investigate relevant risk factors for fracture in PD patients.

Table 1 Comparison of general characteristics of PD patients by sex 

Note: arepresents Z value, brepresents χ 2 value, and the residual test statistic value represents t value. MOF= Major osteoporotic fractures, HF= Hip fractures, UPDRS III= Parkinson's Disease Unified Assessment Scale Part III Exercise, MNA= Simplified Nutrition Assessment Scale, BFR= Body Fat percentage, BMI= body Index, AC= Upper arm Circumference, WHR= Waist-to-hip fat ratio, BBS=Berg Balance Scale, ABC= Activity balance confidence Scale.

Table 2 Correlation analysis of fracture risk and T-score of femoral neck bone mineral density with other indicators in PD patients by sex

Table 3 Partial correlation analysis of fracture risk with other indicators after controlling for gender，age and T-score of femoral neck bone mineral density in PD patientsdensity in PD patients

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Background　Along with the increase of population aging，the incidence rate of Parkinson's disease（PD） is gradually increasing.PD is mainly characterized by motor dysfunctions caused by static tremor，increased muscle tone，and muscle rigidity.The gradually decreased motor capacity makes it difficult for the patients to take care of themselves.In recent years，in addition to drug therapy，the main treatment for PD，the study in non-drug therapies has also obtained achievements，such as repetitive transcranial magnetic stimulation（rTMS），acupuncture，hyperbaric oxygen therapy，and rehabilitation function training，but a therapy incorporated with multiple interventions has not been developed.Objective　To explore the effects of rTMS combined with hyperbaric oxygen-acupuncture-rehabilitation therapy on motor function，serum CRP and plasma dopamine（DA） in patients with PD.Methods　90 PD patients hospitalized in Zigong First People's Hospital from April 2017 to February 2019 were selected and equally divided into control group，observation group，and hyperbaric oxygen-acupuncture-rehabilitation group according to a table of randomly generated numbers，receiving routine western medicine treatment，western medicine in combination with rTMS and hyperbaric oxygen-acupuncture-rehabilitation therapy（five-element music therapy，acupuncture and rehabilitation training are performed during a 90-minute hyperbaric oxygen therapy），and hyperbaric oxygen-acupuncture-rehabilitation therapy，respectively.The treatment for three groups lasted for 8 weeks.The outcome was evaluated by the assessment results of Unified Parkinson's Disease Rating Scale-Ⅲ（UPDRS-Ⅲ），Barthel index，Berg Balance Scale（BBS），limit of stability（LOS），clinical response，serum C-reactive protein （CRP），and plasma DA.Results　After treatment，the observation group showed better improvements in UPDRS-Ⅲ，BBS，LOS，CRP，DA and clinical responses than other two groups （P<0.05）.The Barthel index in the observation group was higher than that of the control group（P<0.05），but was similar to that of the hyperbaric oxygen-acupuncture-rehabilitation group（P>0.05）.Conclusion　rTMS combined with hyperbaric oxygen-acupuncture-rehabilitation therapy remarkably improves motor and balance functions，and reduces the expression of inflammatory factors and the loss of DA.In addition，using the therapy，the patients can receive many efficient interventions at the same time，which is time-saving.

Background　Parkinson's disease （PD） is a progressive neurodegenerative disease，which is the third leading cause of death in the elderly.In recent years，an increasing number of studies have found that non-motor symptoms in PD especially pain seriously affect the quality of life，to which clinicians should pay more attention and then give reasonable treatment to relieve the psychological pressure of these patients and their families.Objective　To perform a comparative analysis of the relationships of pain with dyskinesia and quality of life in PD and vascular parkinsonism （VaP） patients.Methods　Participants receiving outpatient or inpatient treatment were recruited from Anhui Provincial Hospital Affiliated to Anhui Medical University were enrolled from January 2017 to January 2019，including 65 with PD and 65 with VaP.General data were collected.The King's Parkinson's Disease Pain Scale （KPPS），UPDRS-Ⅲ 〔Motor Examination，part 3 of the Unified Parkinson's Disease Rating Scale （UPDRS-Ⅲ）〕，Hospital Anxiety and Depression Scale （HADS），and 39-item Parkinson's Disease Questionnaire （PDQ-39） were used to measure the item of pain，level of dyskinesia，prevalence of anxiety and depression，and quality of life，respectively，in all patients.Hoehn and Yahr （HY） Scale was used to assess the stage of PD.Results　Compared with PD patients，VaP patients had greater mean age and BMI，higher prevalence of hypertension and diabetes，higher mean UPDRS-Ⅲ score，but shorter mean duration of disease，lower mean KPPS score and lower incidence of pain（P<0.05）.Compared with PD patients with pain，VaP patients with pain had greater mean age，lower mean duration of disease，and lower prevalence of pain occurring in the shoulder，back and neck （P<0.05），pain occured more freguently in shoulder back and lumbar in PD while lower limds and lumbar in VaP（P<0.05）.The motor symptoms were relieved by dopaminergic drugs （mainly levodopa） in all PD patients with pain，but only in 72.4% （n=21） of VaP patients with pain.Compared with PD patients without pain，PD patients with pain had higher mean disease severity level，UPDRS-Ⅲ score，anxiety score，depression score，and PDQ-39 score （P< 0.05）.VP patients with pain had lower mean BMI and higher mean PDQ-39 score than those without （P<0.05）.Conclusion　Patients with PD and VaP both are prone to pain.The more severe the motor symptoms and emotional disorders are，the more likely they will suffer from pain and the worse quality of life they will have.Clinicians should strengthen their understanding of pain in these diseases and standardize the pain management to improve patients' quality of life.

帕金森病是一种常见的神经退行性病变，研究表明，肠道微生物在肠道与大脑的双向调节过程中扮演了重要角色，因此提出了微生物-肠-脑轴。微生物-肠-脑轴的失调不仅与帕金森病患者的胃肠功能障碍密切相关，而且可能是帕金森病发生发展的重要机制。本文总结了有关微生物-肠-脑轴与帕金森病相互作用的相关文献，分析表明微生物-肠-脑轴的提出将有助于更好地理解帕金森病并为未来通过改变肠道微生物组成来治疗或降低帕金森病的患病风险提供了依据。

Background　Depression，anxiety and other symptoms are common psychiatric symptoms in patients with Parkinson's disease，ranking the top 5 among all the symptoms.Depression and anxiety not only cause different degrees of functional damage，but also seriously affect patients’ quality of life.However，traditional medicines have many side effects and are addictive，while psychotherapies have fewer adverse reactions and reduce economic costs.Cognitive behavioral therapy （CBT） is widely used，and a large number of studies have confirmed its effectiveness in patients with Parkinson's disease.Objective　To systematically evaluate the effect of CBT on the symptoms of depression and anxiety and the quality of life in patients with Parkinson's disease（PD）.Methods　We searched the databases of PubMed，EMBase，Web of Science，Cochrane Library，Science Direct，CNKI，VIP，Wanfang Data Knowledge Service Platform and CBM.And randomized controlled trials（RCT）related to using CBT to relieve depression and anxiety in patients with PD included since the inception to May 2018 were collected.RCT were screened，data extraction was performed and qualities of eligible RCT were assessed.Meta-analysis was implemented with RevMan 5.3.Results　Nine RCT with 401 patients were included.Meta-analyses of depression symptom score 〔SMD
=-1.15，95%CI（-2.18，-0.13），P=0.03〕，anxiety symptom score 〔SMD=-0.80，95%CI（-1.40，-0.21），P=0.008〕 and general psychological health 〔SMD=-1.27，95%CI（-1.96，-0.59），P=0.000 3〕 after treatment showed the superiority of the experimental group over the control group.However，there was no significant difference in post-treatment quality of life between the groups（P>0.05）.Subgroup analyses showed that CBT had a poor effect on depression and anxiety after treatment immediately（P>0.05）.However，follow-up results showed that it significantly relieved the symptoms of depression and anxiety （P<0.05）.Conclusion　CBT helps to relieve the symptoms of depression and anxiety in PD.And long-term use of it can bring significant effect.However，its short-term effect and its effect on improving the quality of life need to be verified by further clinical studies.

目的  探讨ATP13A2基因Thr12Met位点突变在新疆维吾尔族、汉族帕金森病（PD）患者中是否存在差异。方法  选取2012年8月-2015年3月新疆伊犁地区、和田地区、乌鲁木齐市流行病学调查中及就诊于新疆医科大学第一附属医院的原发性PD患者420例为病例组（包括维吾尔族200例、汉族220例），同时选取流行病学调查中及就诊于新疆医科大学第一附属医院的健康体检者400例为对照组（包括维吾尔族198例、汉族202例）。采用聚合酶链反应-限制性片段长度多态性（PCR-RELP）和基因测序方法对两组人群进行检测，分析ATP13A2基因Thr12Met位点突变情况。结果  在420例PD患者和400例健康体检者中，仅出现2例汉族PD患者发生Thr12Met位点杂合变异AG基因型，且2例PD患者均是早发型帕金森病（EOPD）患者，未发现有纯合变异AA基因型，维吾尔族病例组和对照组均未发现纯合变异AA基因型和杂合变异AG基因型。ATP13A2基因Thr12Met多态性在所有病例组与对照组、维吾尔族病例组与对照组、汉族病例组与对照组、维吾尔族病例组与汉族病例组、EOPD组与晚发型帕金森病（LOPD）组、男病例组与女病例组基因型及等位基因分布间差异均无统计学意义（P＞0.05）。结论  新疆维吾尔族与汉族ATP13A2基因Thr12Met位点突变率均极低，且Thr12Met位点基因型及等位基因分布间无明显差异；Thr12Met位点的基因型及等位基因与民族、发病年龄及性别均为无明显相关性。

帕金森病是中老年人群常见的神经系统变性疾病，临床表现包括运动症状和非运动症状，疾病呈现缓慢进展的趋势。目前尚无根治的方法，治疗目的主要在于改善患者生活质量，因此如何评价帕金森病患者的生活质量显得十分重要并受到越来越多的关注。对帕金森病患者生活质量的评估主要依靠量表，目前评价的量表可分为普适量表和特异性量表。本文就帕金森病的各种生活质量测评量表进行综述。

The mode of onset，clinical symptoms and signs of multiple system atrophy（MSA） are similar to those of idiopathic Parkinson's disease（IPD），so it is very difficult to differentiate them.In order to improve the clinicians' awareness level of MSA and to reduce the probability of misdiagnosis and mistreatment，we reported one case of MSA misdiagnosed as IPD and reviewed related literature，summarized the clinical features，diagnosis and treatment，the causes of misdiagnosis of MSA and proposed preventive measures.

Parkinson's disease（PD） is a common neurodegenerative disease.The development of neuroimaging promotes intensive study of the pathophysiological mechanisms of PD.To study PD，quantitative magnetic resonance techniques have been widely used，among which resting state functional MRI（rs-fMRI） has attracted substantial research attention.This article reviews the progress of PD neuroimaging and rs-fMRI，and the application of rs-fMRI in studying PD.

躯干前屈症（CC）是帕金森病（PD） 较少见的临床表现，临床易漏诊。本文报道了以CC为主要临床表现的PD患者10例，PD病程5～15年，PD起病至发生CC间隔2～12年，7例患者具有运动并发症，均服用多巴丝肼片治疗。结合相关文献，本文探讨了PD患者出现CC的机制，如椎旁肌肉病变、PD药物诱导、轴性或运动性肌张力障碍等。

Objective　To investigate the level of oxidative stress biomarkers in plasma and the severity of Parkinson's disease（PD）.Methods　The participants enrolled were all from Fujian Provincial Hospital between December 2016 and June 2017，including 40 outpatients and inpatients with idiopathic PD from Department of Neurology〔23 with mild PD （mild PD subgroup） and 17 with moderate-to-severe PD（moderate-to-severe PD subgroup）classified by Hoehn and Yahr Scale〕，and 40 health individuals without biological relatives with PD undergoing physical examination （control group）.The levels of malondialdehyd（MDA），8-hydroxy-2-deoxyguanosine（8-OHdG）and DJ-1 protein were compared between the mild，moderate-to-severe PD patients and controls.Results　（1）The average levels of MDA and 8-OHdG differed significantly between mild，moderate-to-severe PD patients and controls（P<0.05）.To be specific，compared with the controls，mild and moderate-to-severe PD patients demonstrated much higher average MDA levels，and mild PD patients presented significantly higher average 8-OHdG levels（P<0.05）.（2）The average DJ-1 protein levels were similar in the controls and the PD patients（P>0.05）.Conclusion　Elevated MDA can be found in PD patients.Moreover，increased 8-OHdG can also be found in mild PD patients.

Pain is a common non-motor symptom of Parkinson's disease（PD），with its prevalence ranging from 40% to 85%.PD patients with pain are more likely to complicated with other non-motor symptoms，which cause decrease in patients' quality of life.This article summarized the clinical reports of drug therapy for patients with Parkinson's pain and its possible mechanism of action.The aim of this paper was to provide clinicians with reference information for the treatment of patients in pain with Parkinson's disease and put forward new goals to improve the treatment standard for the disease pain.

目的　利用携带大鼠酪氨酸羟化酶（TH）基因的重组慢病毒，对大鼠帕金森病模型进行基因治疗，评估基因疗法对帕金森病症状缓解和黑质神经元恢复的影响。方法　2014年11月—2015年12月，分离、培养和鉴定胎鼠原代神经元，抽提胎鼠原代神经元RNA、反转录聚合酶链式反应（RT-PCR）克隆大鼠TH（rTH）基因，将rTH基因构建至慢病毒质粒，包装rTH重组慢病毒。采用实时荧光定量RT-PCR、免疫荧光实验和Western blotting法体外检测大鼠成纤维细胞REF中rTH基因表达。通过脑内立体定位注射6羟多巴胺（6-OHDA）建立大鼠帕金森病模型，给予Lv-rTH重组慢病毒（Lv-rTH治疗组）、未携带基因的慢病毒Lv-NC（Lv-NC治疗组）及0.9%氯化钠溶液（对照组）注射大鼠纹状体和黑质。通过阿扑吗啡诱发旋转实验进行行为学评分，免疫组化进行神经元恢复评分。结果　成功分离、培养了胎鼠原代神经元，成功克隆了rTH基因，并将rTH基因构建至慢病毒质粒，实时荧光定量RT-PCR、免疫荧光实验和Western blotting法检测大鼠成纤维细胞REF中均表达rTH基因。3组大鼠治疗前1周自发旋转速率比较，差异无统计学意义（P>0.05）；3组大鼠治疗0、1、2、3、4、5、6、7、8、9、10周自发旋转速率比较，差异均有统计学意义（P<0.05）；其中治疗0、1、2、3、4、5、6、7、8、9、10周，Lv-NC治疗组和Lv-rTH治疗组大鼠自发旋转速率较对照组增快（P<0.05）；治疗2、3、5、6、8、9、10周，Lv-rTH治疗组大鼠自发旋转速率较Lv-NC治疗组减慢（P<0.05）。Lv-NC治疗组和Lv-rTH治疗组大鼠中脑黑质TH阳性神经元所占比例较对照组降低，Lv-rTH治疗组大鼠中脑黑质TH阳性神经元所占比例较Lv-NC治疗组升高（P<0.05）。结论　通过脑内立体定位注射，将表达rTH基因的重组慢病毒递送至帕金森病大鼠纹状体和黑质能缓解帕金森病症状并恢复TH阳性神经元。

目的  探讨帕金森病患者焦虑及抑郁与运动障碍、生活质量、自主神经功能紊乱、认知功能障碍及睡眠障碍等的关系。方法  选取2013年1月-2015年1月大连医科大学附属第一医院神经内科住院的帕金森病患者180例，采用汉密尔顿焦虑量表（HAMA）14项和汉密尔顿抑郁量表（HAMD）24项评定患者的焦虑和抑郁情况，HAMA评分≥14分或HAMD评分≥20分，满足一项即可入选情绪障碍组，不满足者入选非情绪障碍组。记录患者一般资料，采用统一帕金森病评定量表第三部分（UPDRS-Ⅲ）和39项帕金森病生活质量量表（PDQ-39）评定运动能力和日常活动功能以及生活质量；采用帕金森病自主神经症状量表（SCOPA-AUT）评定自主神经功能紊乱程度；采用简易智能精神状态检查量表（MMSE）和蒙特利尔认知评估量表（MoCA）评定认知功能；采用爱泼沃斯思睡量表（ESS）、匹兹堡睡眠质量指数（PSQI）和不宁腿综合征评定量表（RLSRS）评定患者日间嗜睡、夜间睡眠情况及不宁腿综合征程度。结果  180例帕金森病患者中情绪障碍组81例（45.0%），非情绪障碍组99例（55.0%）。情绪障碍组患者左旋多巴等效日剂量高于非情绪障碍组（P＜0.05）。情绪障碍组与非情绪障碍组MMSE评分、MoCA评分、ESS评分比较，差异均无统计学意义（P＞0.05）；情绪障碍组UPDRS-Ⅲ评分、PDQ-39评分、SCOPA-AUT评分、PSQI、RLSRS评分均高于非情绪障碍组（P＜0.05）。帕金森病患者HAMA评分及HAMD评分与UPDRS-Ⅲ评分、PDQ-39评分、SCOPA-AUT评分、PSQI、RLSRS评分均呈正相关（P＜0.05）。结论  焦虑和抑郁情绪障碍在帕金森病患者中有较高的发病率，合并情绪障碍的患者更易出现运动障碍、自主神经功能紊乱、睡眠障碍，严重影响患者的生活质量。

目的  探讨幽门螺杆菌（helicobacter pylori，Hp）感染对帕金森病（parkinson′s disease，PD）患者运动症状的影响，了解清除Hp治疗对PD患者运动症状波动的作用。方法  选取2011年1月—2013年12月在浙江医院神经内科确诊的PD患者89例，据微量14C-尿素呼气试验（14C-UBT）检测Hp感染状况，将研究对象分为Hp组和非Hp组。非Hp组采用口服左旋多巴/苄丝肼片治疗，Hp组在口服左旋多巴/苄丝肼片治疗的基础上予以Hp根除治疗。采用帕金森病症状评分量表（UPDRS） Ⅲ评分、Hoehn-Yahr分级及“开关现象”的“开”、“关”期时间评价患者治疗前后运动症状的严重程度，用UPDRS Ⅳ评分评价患者治疗前后运动并发症的变化。结果  治疗前，两组UPDRS Ⅳ评分比较，差异有统计学意义（P＜0.05）|非Hp组治疗前后Hoehn-Yahr分级、UPDRS Ⅲ评分、UPDRS Ⅳ评分及“开”“关”期时间比较，差异无统计学意义（P＞0.05）|Hp组治疗前后UPDRS Ⅲ评分、UPDRS Ⅳ评分及“开”“关”期时间比较，差异有统计学意义（P＜0.05）|治疗后，两组“开”“关”期时间比较，差异有统计学意义（P＜0.05）。结论  Hp感染可以增加PD患者运动并发症的发生。对Hp感染的PD患者行Hp根除治疗可以改善其运动症状，减少运动并发症的发生。

Background　There are few reports regarding the initial pharmacotherapy for newly-diagnosed Parkinson's disease（PD） patients in China.Objective　To understand the current status of pharmacotherapy for PD patients by investigating the choice of initial drugs for PD patients.Methods　One hundred fifty-six patients who were initially hospitalized in Anhui Provincial Hospital Affiliated to Medical University of Anhui between September 2015 and April 2017 were selected as study subjects.Patient gender，age of disease onset，symptoms，time from disease onset to definite diagnosis，initial drugs，and drug types were collected and analyzed.Results　The initial drugs chosen by the patients included the following：levodopa（LD） alone（n=92）；LD plus dopamine agonist（DA）（LD+DA，n=30）；LD plus other anti-PD drugs（LD+X，n=3）；DA plus other anti-PD drugs（DA+X，n=23）；and non-LD/non-DA drugs（n=8）．Gender，age of disease onset，and disease symptoms did not affect patient choice for initial drugs（P>0.05），while time from disease onset to definite diagnosis did not significantly affect choice for initial drugs（P<0.05）．Conclusion　LD is a first-choice drug for most PD patients.Patients who initially use DA，monoamine oxidase inhibitors，and other anti-PD drugs are relatively fewer in number.

帕金森病轻度认知功能障碍（PD-MCI）是指由帕金森病（PD）所致的对日常生活功能影响很小且没有进展为痴呆的一组认知功能障碍综合征，对预测帕金森病痴呆（PDD）的风险有潜在价值。随着国际运动障碍协会（MDS）对PD-MCI诊断标准的提出，一系列研究应用此标准在PD-MCI发生、发展等方面提供新观点，并对此诊断标准的合理性进行初步评价。本文就PD-MCI的流行病学及危险因素、临床亚型特点、诊断、转归、治疗做一综述，提示PD-MCI发病率较高，有多种临床亚型，但目前尚缺乏有效的治疗手段，需要更深入的研究加以探索。

目的 探讨乌鸡黑色素对1-甲基-4-苯基-1,2,3,6-四氢吡啶（MPTP）致帕金森病（PD）模型小鼠的神经保护作用及其机制。方法 2013年3月-2014年5月，按照随机数字表法将60只雄性C57/B6小鼠分为对照组（n=10）、MPTP模型组（n=12）和乌鸡黑色素治疗组（n=38）；乌鸡黑色素治疗组又进一步分为10 mg/kg治疗组（n=13）、30 mg/kg治疗组（n=13）和100 mg/kg治疗组（n=12）。对照组小鼠采用0.9%氯化钠溶液灌胃。MPTP模型组和乌鸡黑色素治疗组小鼠腹腔注射MPTP（30 mg/kg，1次/d，共7 d），同时乌鸡黑色素治疗组小鼠分别灌胃给予不同剂量的乌鸡黑色素（10 mg/kg、30 mg/kg和100 mg/kg，1次/d，共7 d）。剔除建模不成功小鼠，最后实际入组小鼠分别为对照组10只、MPTP模型组10只、10 mg/kg治疗组10只、30 mg/kg治疗组9只、100 mg/kg治疗组9只。比较各组小鼠黑质酪氨酸羟化酶（TH）免疫阳性纤维的表达变化、黑质致密部TH免疫阳性神经元数及纹状体TH水平。结果 对照组可见大量呈束状、密集、排列规则有序TH免疫阳性神经纤维；MPTP模型组TH免疫阳性神经纤维稀疏、断裂且排列零散无序；乌鸡黑色素治疗组与模型组染色结果相比，仍可见呈束状、较密集、排列较有序的TH免疫阳性神经纤维，尤其以30 mg/kg治疗组最为明显。MPTP模型组、10 mg/kg治疗组、30 mg/kg治疗组、100 mg/kg治疗组黑质致密部TH免疫阳性神经元数低于对照组（P＜0.05）；30 mg/kg治疗组黑质致密部TH免疫阳性神经元数高于MPTP模型组（P＜0.05）。MPTP模型组、10 mg/kg治疗组、30 mg/kg治疗组、100 mg/kg治疗组纹状体TH水平低于对照组（P＜0.05）；30 mg/kg治疗组、100 mg/kg治疗组纹状体TH水平高于MPTP模型组（P＜0.05）。结论 乌鸡黑色素灌胃给药能减缓MPTP诱导的亚急性PD模型小鼠黑质多巴胺能神经元的死亡和纹状体TH免疫阳性神经纤维的丢失，提示口服乌鸡黑色素对于PD模型小鼠有潜在的神经保护作用。

目的  了解帕金森病（PD）患者的血清β-淀粉样蛋白1-42（Aβ1-42）水平，并探讨其与病情的关系。方法  选取2014年5月-2015年5月到新疆医科大学第一附属医院神经内科就诊的PD患者108例为病例组；另选取同时期在本院体检中心进行体检的健康成年人108例为对照组。收集两组的一般资料，并检测其血清Aβ1-42水平。以病程、统一帕金森病评定量表（UPDRS）评分及Hoehn-Yahr（H-Y）分级判断PD患者的病情严重程度，分析血清Aβ1-42水平与病情的相关关系。结果  两组血清Aβ1-42水平比较，差异有统计学意义（P＜0.05）。以性别分层，两组男性受试者的血清Aβ1-42水平比较，差异有统计学意义（P＜0.05）；而两组女性受试者的血清Aβ1-42水平比较，差异无统计学意义（P＞0.05）。以年龄分层，两组≤60岁受试者的血清Aβ1-42水平比较，差异无统计学意义（P＞0.05）；两组>60岁受试者的血清Aβ1-42水平比较，差异有统计学意义（P＜0.05）。以民族分层，两组汉族受试者的血清Aβ1-42水平比较，差异有统计学意义（P＜0.05）；两组维吾尔族受试者的血清Aβ1-42水平比较，差异无统计学意义（P＞0.05）。早期和中晚期患者的血清Aβ1-42水平比较，差异无统计学意义（P＞0.05）。Spearman秩相关分析显示，血清Aβ1-42水平与PD患者病程无相关性（rs=0.06，P＞0.05）；与UPDRS第Ⅰ部分评分（rs=-0.11，P＞0.05）、第Ⅱ部分评分（rs=-0.09，P＞0.05）、第Ⅲ部分评分（rs=0.10，P＞0.05）无相关性；与H-Y分级呈负相关（rs=-0.25，P＜0.05）。结论  PD患者血清Aβ1-42水平较低，血清Aβ1-42水平可能为PD临床诊断中的新型生物学指标，但尚不能作为病情严重程度的判断指标。

目的 探讨辅酶Q10（CoQ10）在不同给药时间窗干预1-甲基-4-苯基吡啶（MPP+）-帕金森病（PD）模型大鼠的作用及机制。方法 选取清洁级标准健康成年雄性Sprague-Dawley大鼠48只，体质量250~280 g。采用MPP+黑质内注射建立PD大鼠模型。按完全随机设计方法分为假手术组、模型组、CoQ10预防性给药组、CoQ10治疗性给药组，每组12只。比较4组大鼠行为学（阿朴吗啡诱导旋转试验、前肢跨步运动试验、触须引发不对称放置试验）情况，测定小胶质细胞特异表达补体C3受体（OX-42）免疫荧光强度、多巴胺（DA）神经元存活率、线粒体酶复合体Ⅰ（Complex Ⅰ）的活性。结果 4组大鼠不同时间点阿朴吗啡诱导旋转试验转数比较，差异有统计学意义（F交互=22.299，P＜0.01；F时间=132.494，P＜0.01；F组间=99.994，P＜0.01）；4组大鼠不同时间点前肢跨步运动试验得分比较，差异有统计学意义（F交互=10.622，P＜0.01；F时间=107.880，P＜0.01；F组间=45.621，P＜0.01）；4组大鼠不同时间点触须引发不对称放置试验得分比较，差异有统计学意义（F交互=8.281，P＜0.05；F时间=120.000，P＜0.01；F组间=40.200，P＜0.01）。4组大鼠OX-42免疫荧光强度比较，差异有统计学意义（F=7.460，P＜0.01）；模型组、CoQ10预防性给药组、CoQ10治疗性给药组OX-42免疫荧光强度高于假手术组（P＜0.01）。4组大鼠DA神经元存活率比较，差异有统计学意义（F=229.757，P＜0.01）；CoQ10预防性给药组大鼠DA神经元存活率高于模型组（q=9.136,P＜0.01）。假手术组、模型组、CoQ10预防性给药组、CoQ10治疗性给药组大鼠的Complex Ⅰ活性分别为（174.3±27.2）、（93.5±17.0）、（151.3±21.9）、（116.2±19.6），差异有统计学意义（F=16.395,P＜0.01）；CoQ10预防性给药组大鼠Complex Ⅰ活性高于模型组（q=6.507，P＜0.01）；CoQ10治疗性给药组大鼠与模型组Complex Ⅰ活性比较，差异无统计学意义（q=2.550，P＞0.05）。结论 CoQ10预防性给药对MPP+-PD模型大鼠黑质致密部DA神经元有保护作用，其机制可能与增强Complex Ⅰ活性有关。

维生素D为固醇类衍生物，在骨骼健康中具有重要作用，近年来的研究表明维生素D在肌肉、免疫、内分泌及中枢神经系统中也扮演着重要角色。帕金森病（PD）是一种中枢神经系统退行性病变。目前，关于维生素D与PD间的关系尚不明确，探讨维生素D的神经保护作用及其与PD间的关系，不仅有助于对PD患者病情严重程度进行评估，而且可以为其诊疗过程提供简单、有效的指导。本研究对维生素D的神经保护作用及其与PD关系的研究进展进行了综述，以期为临床研究提供依据。

目的 通过观察帕金森病痴呆（PDD）患者外周血血小板β淀粉样前体蛋白免疫反应片段之比（βAPPr）的变化，分析βAPPr与PDD的关系，为PDD诊断提供思路。方法 收集2011年4月-2014年4月在郑州大学附属洛阳中心医院神经内科就诊的帕金森病（PD）患者124例，按是否合并痴呆分为PDD组59例和对照组65例。评价简易智能量表（MMSE）评分、蒙特利尔认知评估量表（MoCA）评分、临床痴呆评定量表（CDR）评分、统一帕金森病评定量表（UPDRS）评分；采用Western blotting法检测外周血血小板βAPPr。结果 PDD组患者受教育年限、MMSE评分、MoCA评分低于对照组，CDR评分、UPDRSⅠ评分高于对照组（P＜0.05）。PDD组患者外周血血小板βAPPr（5.43±0.92）低于对照组的（7.88±1.32）（t=6.28，P＜0.001）。PDD组患者βAPPr与MoCA评分中视空间与执行能力、命名能力、注意能力、延迟回忆能力、定向力得分均呈正相关（P＜0.05）。结论 PDD患者血小板βAPPr较PD患者下降，血小板βAPPr有可能成为PDD诊断的外周血生物学指标之一，外周血血小板淀粉样前体蛋白（βAPP）表达水平有可能为研究PDD的发病机制和治疗提供线索。

目的  探讨新疆地区不同临床分型帕金森病（PD）患者的影响因素，为疾病的早期预防和治疗提供理论依据。方法  采用回顾性研究的方法，选取2004年1月—2013年12月新疆医科大学第一附属医院确诊的PD患者259例，调查患者的年龄、性别、民族、吸烟史、饮酒史、饮茶史、农药接触史、阳性家族史、高血压病史、糖尿病病史、文化程度、职业、体质指数（BMI）等。结果  震颤型142例、强直-少动型90例、混合型27例。震颤型、强直-少动型、混合型PD患者年龄比较，差异有统计学意义（P＜0.05）。不同民族、吸烟史、饮茶史、农药接触史、职业PD患者临床分型不同，差异有统计学意义（P＜0.05）。不同性别、饮酒、阳性家族史、高血压病史、糖尿病病史、文化程度、BMI PD患者临床分型比较，差异无统计学意义（P>0.05）。多因素Logistic回归分析结果显示，民族、饮茶史与震颤型有回归关系，年龄、吸烟史与强直-少动型有回归关系，民族与混合型有回归关系（P＜0.05）。结论  PD患者以震颤型和强直-少动型为主，不同临床分型PD患者年龄分布不同，汉族、饮茶者较少以震颤型起病，高龄、吸烟者主要以强直-少动型起病，汉族主要以混合型起病。