【作者】 王芳；

【导师】 崔群力；

【作者基本信息】 郑州大学 ， 神经病学（专业学位）， 2025， 硕士

【摘要】 背景和目的帕金森病(Parkinson’s Disease,PD)是一种以黑质多巴胺能神经元退化为核心的中枢神经系统变性疾病,主要临床表现为运动迟缓、肌强直、静止性震颤及姿势平衡障碍。PD患病率不断上升,已成为仅次于阿尔茨海默病的第二大神经退行性疾病。肌肉减少症(Sarcopenia)作为一种与衰老及慢性疾病(包括帕金森病)相关的全身性肌肉疾病,主要表现为肌肉质量下降、肌肉力量减退及功能受损。研究表明,约20%的帕金森病患者伴随肌肉减少症,且其严重程度与帕金森病的进展密切相关。然而,针对帕金森病患者中肌肉减少症的研究仍较为有限,因此,本研究旨在探讨帕金森病并发肌少症的影响因素,期望为相关临床研究提供理论和数据支持。方法本研究采用横断面研究法,纳入2022年12月至2024年12月于郑州大学第二附属医院住院且符合入组标准的帕金森病患者155例,根据2019年亚洲肌少症工作组(Asian Working Group for Sarcopenia,AWGS)诊断标准,肌肉减少症定义为肌肉量减少和肌肉力量下降或躯体功能下降。通过评估四肢骨骼肌质量指数(Appendicular Skeletal Muscle Index,ASMI)、握力、步速三个指标,将患者分为PD肌少症组(n=50例)和PD非肌少症组(n=105例)。收集所有患者的一般临床资料和实验室检查数据,进行两组间的差异性分析和变量筛选,并从性别、年龄、BMI、Hoehn-Yahr(H-Y)分期四个层面分别分析PD患者ASMI、握力、步速的差异;探究筛选出来的变量与ASMI、握力、步速的相关性;将筛选出来的变量进一步纳入多因素Logistic回归分析明确PD患者并发肌少症的独立影响因素,并构建列线图预测模型;通过绘制受试者工作特征曲线(Receiver Operating Characteristic Curve,ROC)、校准曲线(Calibration curve)、临床决策曲线(Decision Curve Analysis,DCA)分别对诊断预测模型的区分度、校准度、临床实用性进行评估。结果1.本研究共纳入155例PD患者(男性86人,女性69人),并发肌少症者50人(男性26人,女性24人),肌少症患病率为32.3%。2.比较PD肌少症组与PD非肌少症组的各项指标,其中年龄、BMI、H-Y分期、叶酸、同型半胱氨酸(Homocysteine,Hcy)、维生素B12、白细胞计数、中性粒细胞计数、高密度脂蛋白胆固醇、甘油三酯均在两组中具有统计学差异(P<0.05)。3.男性的握力、ASMI明显高于女性(P<0.05),步速未见明显差异(P>0.05);不同年龄、H-Y分期层面的ASMI和握力、步速均具有统计学差异(P<0.05);不同BMI层面的ASMI和握力具有统计学差异(P<0.05)。4.ASMI与维生素B12、BMI呈正相关,与年龄、H-Y分期、Hcy、白细胞计数、中性粒细胞计数呈负相关;握力与叶酸、维生素B12、BMI、高密度脂蛋白胆固醇、甘油三酯呈正相关,与年龄、H-Y分期、Hcy、白细胞计数、中性粒细胞计数呈负相关;步速与叶酸、维生素B12、BMI、甘油三酯呈正相关,与年龄、H-Y分期、Hcy、白细胞计数、中性粒细胞计数呈负相关(P<0.05)。5.多因素Logistic回归分析结果显示Hcy水平升高(OR=1.30)、H-Y分期进展(OR=2.41)是PD患者并发肌少症的独立危险因素(P<0.05),维生素B12水平升高(OR=0.99)、BMI增加(OR=0.78)是PD患者并发肌少症的保护因素(P<0.05)。6.根据独立影响因素构建列线图模型,ROC曲线分析示AUC值为0.86(95%CI:0.79～0.93),具有较高的准确性。校准曲线提示具有较好的拟合度(HL检验P>0.05)。DCA在大多数阈值下有显著的净获益。结论1.Hcy水平升高、H-Y分期进展是PD患者并发肌少症的独立危险因素,维生素B12水平升高、BMI增加是PD患者并发肌少症的保护因素。2.基于Hcy、维生素B12、H-Y分期、BMI构建的预测模型具有操作简便、实用性强的特点,可为临床医生早期识别PD患者并发肌少症风险提供量化工具,有助于临床医生尽早实行风险管理。更多还原

【Abstract】 Background and ObjectivesParkinson’s disease(PD)is a central nervous system degenerative disease with the degeneration of dopaminergic neurons in the substantia nigra as its core.The main clinical manifestations include bradykinesia,muscular rigidity,resting tremor,and postural balance disorders.The prevalence of PD is continuously increasing,and it has become the second most common neurodegenerative disease after Alzheimer’s disease.Sarcopenia,as a systemic muscle disease associated with aging and chronic diseases(including Parkinson’s disease),is mainly characterized by a decrease in muscle mass,a reduction in muscle strength,and impaired muscle function.Studies have shown that approximately 20%of Parkinson’s disease patients are accompanied by sarcopenia,and the severity of sarcopenia is closely related to the progression of Parkinson’s disease.However,research on sarcopenia in Parkinson’s disease patients remains relatively limited.Therefore,this study aims to explore the influencing factors of Parkinson’s disease complicated by sarcopenia,with the expectation of providing theoretical and data support for relevant clinical research.MethodsThis study adopted a cross-sectional research method.A total of 155 Parkinson’s disease patients who were hospitalized in The Second Clinical Medical School of Zhengzhou University from December 2022 to December 2024 and met the inclusion criteria were enrolled.According to the diagnostic criteria of the Asian Working Group for Sarcopenia(AWGS)in 2019,sarcopenia was defined as a decrease in muscle mass and a decline in muscle strength or physical function.By evaluating three indicators,namely the Appendicular Skeletal Muscle Index(ASMI),grip strength,and gait speed,the patients were divided into the PD with sarcopenia group(n=50 cases)and the PD without sarcopenia group(n=105 cases).The general clinical data and laboratory examination data of all patients were collected for differential analysis and variable screening between the two groups.Additionally,the differences in ASMI,grip strength,and gait speed among PD patients were analyzed from four aspects:gender,age,BMI,and Hoehn-Yahr(H-Y)stage.The correlations between the screened variables and ASMI,grip strength,and gait speed were explored.The screened variables were further included in a multivariate Logistic regression analysis to identify the independent influencing factors of sarcopenia in PD patients,and a nomogram diagnostic prediction model was constructed.The discrimination,calibration,and clinical practicality of the diagnostic prediction model were evaluated by drawing the Receiver Operating Characteristic Curve(ROC),Calibration curve,and Decision Curve Analysis(DCA)respectively.Results1.A total of 155 PD patients were included in this study(86 males and 69 females),among whom 50 patients(26 males and 24 females)had concurrent sarcopenia,and the prevalence rate of sarcopenia was 32.3%.2.Various indicators of the PD with sarcopenia group and the PD without sarcopenia group were compared.Age,BMI,H-Y stage,folic acid,Homocysteine(Hcy),vitamin B12,white blood cell count,neutrophil count,high-density lipoprotein cholesterol,and triglyceride showed statistically significant differences between the two groups(P<0.05).3.The grip strength and ASMI of males were significantly higher than those of females(P<0.05),while there was no significant difference in gait speed(P>0.05).ASMI,grip strength,and gait speed showed statistically significant differences at different levels of age,BMI,and H-Y stage(P<0.05).4.ASMI was positively correlated with vitamin B12 and BMI,and negatively correlated with age,H-Y stage,Hcy,white blood cell count,and neutrophil count.Grip strength was positively correlated with folic acid,vitamin B12,BMI,high-density lipoprotein cholesterol,and triglyceride,and negatively correlated with age,H-Y stage,Hcy,white blood cell count,and neutrophil count.Gait speed was positively correlated with folic acid,vitamin B12,BMI,and triglyceride,and negatively correlated with age,H-Y stage,Hcy,white blood cell count,and neutrophil count(P<0.05).5.The results of multivariate Logistic regression analysis showed that an increased Hcy level(OR=1.30)and the progression of H-Y stage(OR=2.41)were independent risk factors for PD patients with concurrent sarcopenia(P<0.05),while an increased vitamin B12 level(OR=0.99)and an increased BMI(OR=0.78)were protective factors for PD patients with concurrent sarcopenia(P<0.05).6.A nomogram model was constructed based on the independent influencing factors.The analysis of the ROC curve showed that the AUC value was 0.86(95%CI:0.79-0.93),indicating a high level of accuracy.The calibration curve suggested a good degree of fitting(P>0.05 in the HL test).The DCA showed a significant net benefit at most thresholds.Conclusions1.An elevated level of Hcy and the progression of the H-Y stage are independent risk factors for Parkinson’s disease(PD)patients with concurrent sarcopenia,while an increased level of vitamin B12 and a higher BMI are protective factors for PD patients with concurrent sarcopenia.2.The prediction model constructed based on Hcy,vitamin B12,H-Y stage,and BMI has the characteristics of simple operation and strong practicality.It can provide a quantitative tool for clinicians to identify the risk of concurrent sarcopenia in PD patients at an early stage,which is helpful for clinicians to implement risk management as early as possible.更多还原