DJ-1基因启动子区g.168_185del的多态性与帕金森病的关系

目的 了解DJ-1基因启动子区g.168_185del的多态性与帕金森病(PD)的关系.方法 采用病例-对照研究,应用聚合酶链反应、DNA测序等技术,对湖南汉族213例PD患者和195名正常对照者的DJ-1基因g.168_185del多态性进行检测.结果 g.168_185del多态在各组的基因型频率和等位基因频率比较差异无统计学意义(均P>0.05).结论 g.168_185del多态位点不是本组PD患者的患病危险因素.     

DJ-1基因多态性与帕金森病易感性的Meta分析

目的评价DJ-1基因多态性与帕金森病(PD)易感性的关系。方法检索知网、万方、Web of Science、Pub Med、EMBASE和Cochrane数据库,检索时间为2001年01月01日至2017年01月01日。确定文献纳入排除标准,并采用Newcastle-Ottawa Scale(NOS)进行质量评估,提取高质量文献的有用部分,使用stata12.0软件进行统计分析。结果共纳入12篇文献,收集到2895组病例和2817组对照,Meta分析结果显示,在帕金森病患者中,DJ-1基因g.168_185del缺失突变(OR=1.26,95%CI:1.06~1.50,P0.05)和c.G293A点突变(OR=2.74,95%CI:1.22~6.16,P0.05)均为PD的危险因素。在g.168_185del与PD相关性研究的亚组分析中,发现非中国人群g.168_185del多态性也是PD的危险因素(OR=1.41,95%CI:1.14~1.73,P0.05),但在中国人群中未发现其相关性(OR=0.98,95%CI:0.72~1.34,P0.05)。c.G293A与PD相关性病例对照研究中均为非中国人群,故未进行亚组分析。结论DJ-1基因g.168_185 del缺失突变和c.G293A点突变是PD的易感因素,但本Meta分析未发现DJ-1基因g.168_185 del缺失突变和c.G293A点突变与中国人群PD具有相关性。     

DJ-1基因g.168185del多态性与新疆维吾尔族、汉族帕金森病的关系

目的探讨DJ-1基因启动子区多态性位点g.168₁85del与新疆维吾尔（维）族、汉族帕金森病（PD）的关系。方法提取364例原发性PD患者（PD组,维族175例,汉族189例）及346名正常对照者（正常对照组）基因组DNA,采用PCR方法扩增DJ-1启动子区基因片段,测序验证g.168₁85del的基因型和等位基因频率。结果 PD组与正常对照组间、PD组中维族亚组与汉族亚组间〗DJ-1基因g.168₁85del基因型及等位基因频率差异无统计学意义。结论 DJ-1基因g.168₁85del多态性可能与维族及汉族PD的遗传易感性无关。     

载脂蛋白D基因多态与散发性阿尔茨海默病的相关性

目的 通过检测载脂蛋白D基因(apolipoprotein D gene,ApoD)单核苷酸多态位点,探讨其与北方汉族人群散发性阿尔茨海默病(sporadic Alzheimer's disease,SAD)的相关性.方法 应用聚合酶链反应(PCR)及直接测序筛查ApoD基因所有外显子及其两端内含子多态位点.选取等位基因频率大于10%的位点,利用PCR-限制性片段长度多态性(PCR-RFLP)技术,采用病例-对照相关性研究方法 ,研究256例SAD患者以及294名健康人的ApoD多态位点与SAD发病的关系.同时对位点间的连锁不平衡及构建的单体型进行相关性分析.结果 ApoD第2号外显子存在T/C多态性(rs5952),第3号内含子(rs1568566)存在C/T多态性.ApoD rs5952 T/C和rs1568566 C/T等位基因频率和基因型频率在SAD组和对照组间的分布差异有统计学意义.Logistic回归分析表明携带rs5952C或rs1568566T等位基因分别增加SAD发病风险:校正后rs5952 χ2=9.282(P=0.002);rs1568566 χ2=5.072(P=0.024).进一步分析证实性别和ApoD多态性存在交互作用.rs5952-rs1568566位点间存在连锁不平衡.结论 北方汉族人ApoD基因存在第2号外显子rs5952和第3号内含子rs1568566 2个多态位点;ApoD多态可增加SAD发病风险;携带rs5952T或rs1568566C单体型可能对SAD的发病有一定的保护作用.     

浙江沿海温岭地区帕金森病PINK1基因突变与多态性研究

目的 探讨浙江温岭地区帕金森病( Parkinson's disease,PD)患者PINK1基因突变和多态性分布特点,及其与PD的关系.方法 采用聚合酶链反应扩增200例PD组(早发性PD 112例、晚发性PD 88例)和220名相匹配的对照组(青年对照组68名、老年对照组152名)的PINK1基因1～8号外显子,并对扩增产物进行测序,斑点杂交法检测明确其基因型,计算其基因型频率和等位基因频率,并进行统计学分析.结果 未发现PD组和对照组出现PINK1基因外显子的缺失突变;在早发性PD组中有2例出现5号外显子杂合型突变(G12169A),发现该地区存在PINK1基因5号外显子G12164A,多态有G/G和G/A两种基因型,无A/A基因型,而G12101A多态有G/A和A/A两种基因型,无G/G基因型.PD组的PINK1基因5号外显子G12164A多态在A/A基因型频率84/200(42.0％)与对照组52/220(23.6％)相比有升高趋势(x2=4.034,P=0.045),在晚发性PD组中A/A基因型频率(40/88,45.5％)与老年对照组(32/152,21.1％)相比有升高趋势(x2=3.951,P=0.047),其余各组之间的等位基因频率比较差异均无统计学意义.结论 PINK1基因可能不是浙江温岭地区PD患者致病基因的突变热点;G12164A、G12101A连锁多态才是该地区晚发性PD患者的易患因素.     

载脂蛋白M基因多态与脑梗死的相关性

目的 探讨中国北方汉族人群载脂蛋白M(ApoM)基因多态与脑梗死的关系.方法 采用聚合酶链反应(PCR)扩增基因组DNA直接测序法结合PCR-限制性片段长度多肽(RFLP)方法检测560例脑梗死和550名健康对照的ApoM基因多态,发现1号内含子rs805264、5号内含子rs707922及rs707921 3个单核苷酸多态位点.结果 脑梗死组ApoM基因rs805264位点GA+AA型及A等位基因频率、rs707922位点GT+TT型及T等位基因频率、rs707921位点CA+AA型及A等位基因频率均明显高于对照组.ApoM基因rs805264、rs707922和rs707921 3个多态位点存在显著连锁不平衡,三座位等位基因G-G-C紧密连锁,A-T-A紧密连锁(χ2=2595.03,P<0.01).3个位点的每对之间均存在强连锁不平衡(D′=0.972～0.992).Logistic回归分析显示,A-T-A单体型与脑梗死明显相关(OR= 1.780, 95% CI 1.333～ 2.376,P<0.01).结论 ApoM基因rs805264位点GA基因型及A等位基因、rs707922位点GT基因型及T等位基因、rs707921位点CA基因型及A等位基因与脑梗死密切相关.ApoM基因A-T-A单体型可能与脑梗死遗传致病有关.     

单胺氧化酶B基因多态与早发帕金森病的相关性

目的 探讨单胺氧化酶B(MAO-B)基因型和等位基因与早发帕金森病(early-onset Parkinson's disease,EOPD)的关系.方法 采取聚合酶链反应-限制性片段长度多态性(PCR-RFLP)的方法,研究65例EOPD患者(<50岁)、60例晚发PD(late-onset Parkinson's disease,LOPD)患者(≥60岁)和66名健康对照者(<50岁)的基因型频率和等位基因频率的分布差异.结果 EOPD组的AA基因型频率(49/65,75.4%)高于健康对照组(34/66,51.5%),差异有统计学意义(x2=8.075,P=0.018);LOPD组分别与EOPD组、健康对照组的从基因型频率比较,差异无统计学意义;男性EOPD组分别与男性健康对照组、男性LOPD组,女性EOPD组分别与女性健康对照组、女性LOPD组的AA基因型频率比较,差异无统计学意义;男性LOPD组与男性健康对照组、女性LOPD组与女性健康对照组的AA基因型频率比较,差异无统计学意义.EOPD组的A等位基因频率(107/130,82.3%)高于健康对照组(87/132,65.9%),差异有统计学意义(X2=9.165,P=0.002);LOPD组分别与EOPD组、健康对照组的A等位基因频率比较,差异无统计学意义;男性EOPD组的A等位基因频率(60/70,85.7%)高于男性健康对照组(51/72,70.8%),差异有统计学意义(x2=4.606,P=0.032);女性EOPD组的A等位基因频率(47/60,78.3%)高于女性健康对照组(36/60,60.0%),差异有统计学意义(x2=4.728,P=0.030);男性LOPD组分别与男性EOPD组、男性健康对照组,女性LOPD组分别与女性EOPD组、女性健康对照组的A等位基因频率比较,差异均无统计学意义.结论 MAO-B的从基因型频率增高是EOPD组发病的危险因素;MAO-B的A等位基因频率增高是EOPD组、男性EOPD组及女性EOPD组发病的危险因素.     

中国东北地区CD40及CD40L基因多态性与散发帕金森病的相关性分析

目的 探究CD40基因rs1883832位点及CD40L基因rs1126535位点单核苷酸多态性与帕金森病(Parkinson disease,PD)的相关性。方法 本研究纳入285名中国东北地区汉族健康人和396例PD患者。根据其发病年龄将PD组患者再分为早发PD组(发病年龄≤50岁)和晚发PD组(发病年龄 50岁),收集一般临床资料,提取外周血基因组DNA,利用MALDI-TOF-PEX技术检测rs1883832位点及rs1126535位点多态性分布情况,分析其与帕金森病的相关性。结果 EOPD组与对照组rs1883832位点基因型分布有统计学差异(P 0. 05),等位基因频率在两组间没有统计学差异。PD组和LOPD组与对照组在rs1883832位点及rs1126535位点上,基因型及等位基因型频率无统计学差异。结论 CD40基因rs1883832位点单核苷酸多态性与中国东北地区汉族早发帕金森病相关,T等位基因可能是EOPD的危险因素。     

中国汉族人群早发性帕金森综合征DJ-1基因突变分析

目的 探讨中国汉族人群早发性帕金森综合征(early-onset parkinsonism,EOP)DJ-1基因突变情况.方法 应用实时荧光定量聚合酶链反应(PCR)结合DNA直接测序技术对160例EOP患者进行了DJ-1基因突变分析.结果 对DJ-1基因外显子重排突变分析发现,4例新的DJ-1基因外显子2的杂合缺失突变,突变频率2.5%(4/160);DNA直接测序方法未发现DJ-1基因的致病突变,发现了4种已报道的单核苷酸多态(SNP)和1种新的SNP,分别为:IVS4+30 T→G、IVS4+45 G→A、IVS4+46 G→A、IVS5+31 G→A和IVS6+52 C→T.结论 DJ-1基因外显子2的杂合缺失突变扩展了DJ-1基因的突变谱,可能是中国汉族人群EOP DJ-1基因突变的重要形式.     

帕金森病患者PINK1 LRRK2基因单核苷酸多态性分析

目的探讨PINK1基因rs45530340位点及LRRK2基因rs1491942位点单核苷酸多态性(single nucleotide polymorphism,SNP)与淮海地区汉族人群晚发散发性帕金森病(Parkinson’s disease,PD)的相关性。方法收集152例晚发散发性PD患者和160例年龄和性别相匹配的健康对照者,入组者均来自淮海地区汉族人群。提取外周血全基因组DNA,应用聚合酶链式反应(polymerase chain reaction,PCR)技术扩增包含多态位点的目的基因片段,通过琼脂糖凝胶电泳(AGE)检测PCR产物。对PCR产物分别用DNA限制性内切酶NlalV和SmlI进行酶切,用聚丙烯酰胺凝胶电泳(PAGE)、硝酸银染色检测酶切产物,采用聚合酶链式反应-限制性片段长度多态性(restriction fragment length polymorphism,RFLP)技术分析基因型,计算所有研究对象两个SNP位点的基因型频率和等位基因频率。结果 (1)PINK1基因rs45530340位点基因型和等位基因在晚发散发性PD组和正常对照组中的分布无统计学差异(基因型:χ2=1.572,P=0.456;等位基因:χ2=1.318,P=0.251)。(2)LRRK2基因rs1491942位点基因型和等位基因在晚发散发性PD组与正常对照组中的分布差异有统计学意义(基因型:χ2=6.802,P=0.033;等位基因C:χ2=7.448,P=0.006,OR=1.571,95%CI=1.135~2.176)。结论 (1)PINK1基因rs45530340多态位点可能不是淮海地区汉族人群晚发散发性PD患者的危险因素。(2)LRRK2基因rs1491942多态位点C等位基因可能是淮海地区汉族人群晚发散发性PD患者的危险因素。     

Cell death mechanisms in Parkinson's disease

Summary. Objective. While the causes of neuronal death in Parkinson's disease (PD) and other neurodegenerative disorders are still unknown, several mechanisms are under discussion: programmed vs. passive cell death (apoptosis vs. necrosis), mainly based on conflicting results on the rare presence or absence of DNA fragmentation in substantia nigra neurons using the in situ DNA-labeling (TUNEL) method. Design/Methods. In 4 cases of Parkinson's disease (PD), 2 cases of Dementia with Lewy bodies (DLB) and 3 age-matched controls, the TUNEL/ISEL method was used to detect DNA fragmentation in substantia nigra locus coeruleus and cerebral cortex [method by Gold et al. (1994)]. In addition, immunohistochemistry was performed for an array of apoptosis-related proteins, i.e. the recently described apoptosis specific protein cJun/AP1 (ASP), the proto-oncogenes c-Jun, c-Jun AP1, Bcl2, Bax, Bcl-x, p53, CD 95 (Fas/Apo-1), activated caspase 3, several heat shock proteins (α-B crystallin, ubiquitin), and α-synuclein. Results. None of the cases of PD, DLB, and controls showed convincing TUNEL-positivity nor morphologic signs of apoptosis in nigral, locus coeruleus or cortical neurons with or without Lewy bodies but variable numbers of TUNEL-positive astrocytes and microglial cells in substantia nigra of PD and DLB. There were no significant differences in the expression of c-Jun, ASP, Bcl-2, Bax, and Bcl-x in substantia nigra neurons between PD, DLB, and controls nor between cortical and subcortical neurons with and without Lewy bodies. No expression of p53, and activated caspase 3, or any of the examined stress proteins was seen in neurons, while reactive astroglia and microglia were decorated by antibodies to Bcl-2, Bax, α-B-crystallin and less, to Bcl-x and caspase 3. Lewy bodies, dystrophic neurites and axonal spheroids, all being negative for the applied apoptosis regulating proteins, showed strong expression of the examined stress proteins and of α-synuclein. Conclusions. These findings which are in line with previous results in Alzheimer's disease (Stadelmann et al., 1998) and Parkinson's disease (Banati et al., 1999) suggest that mechanisms distinct from classical apoptosis play a central role in the pathogenesis of PD and related neurodegenerative diseases. Further studies are warranted to elucidate the intracellular cascade of events leading to cell death in these disorders showing slow progression over many years. Received January 18, 1999; accepted April 20, 1999     

Visual symptoms in Parkinson's disease and Parkinson's disease dementia

Visual symptoms are common in PD and PD dementia and include difficulty reading, double vision, illusions, feelings of presence and passage, and complex visual hallucinations. Despite the established prognostic implications of complex visual hallucinations, the interaction between cognitive decline, visual impairment, and other visual symptoms remains poorly understood. Our aim was to characterize the spectrum of visual symptomatology in PD and examine clinical predictors for their occurrence. Sixty-four subjects with PD, 26 with PD dementia, and 32 age-matched controls were assessed for visual symptoms, cognitive impairment, and ocular pathology. Complex visual hallucinations were common in PD (17%) and PD dementia (89%). Dementia subjects reported illusions (65%) and presence (62%) more frequently than PD or control subjects, but the frequency of passage hallucinations in PD and PD dementia groups was equivalent (48% versus 69%, respectively; P = 0.102). Visual acuity and contrast sensitivity was impaired in parkinsonian subjects, with disease severity and age emerging as the key predictors. Regression analysis identified a variety of factors independently predictive of complex visual hallucinations (e.g., dementia, visual acuity, and depression), illusions (e.g., excessive daytime somnolence and disease severity), and presence (e.g., rapid eye movement sleep behavior disorder and excessive daytime somnolence). Our results demonstrate that different "hallucinatory" experiences in PD do not necessarily share common disease predictors and may, therefore, be driven by different pathophysiological mechanisms. If confirmed, such a finding will have important implications for future studies of visual symptoms and cognitive decline in PD and PD dementia.     

帕金森病与阿尔茨海默病

普遍认为帕金森病和阿尔茨海默病是两个独立的、有着显著判别的疾病。但是,相当数量为证据表明,二者具有相互重叠的临床和神经病理特征、相似的病因和病变发生机制。因此,现在有人认为这两种疾病的部分病例可能是同一种神经元退行性变疾病的不同表现形式。本文拟对此作一介绍。     

帕金森病与阿尔茨海默病

普遍认为帕金森病和阿尔茨海默病是两个独立的、有着显著差别的疾病.但是,相当数量的证据表明,二者具有相互重叠的临床和神经病理特征、相似的病因和病变发生机制.因此,现在有人认为这两种疾病的部分病例可能是同一种神经元退行性变疾病的不同表现形式.本文拟对此作一介绍.     

帕金森病伴发不宁腿综合征的临床特征及神经病理生化机制

目的初步探讨帕金森病(PD)伴发不宁腿综合征(RLS)的临床特征以及神经病理蛋白和神经递质水平的变化。方法收集连续就诊于北京天坛医院老年病科和神经内科的PD患者186例,将患者分为PD伴发RLS组(简称RLS组)和PD非伴发RLS(简称NRLS)组,采用不宁腿综合征评定量表(RLS-RS)评价RLS的临床表现及严重程度;采用酶联免疫吸附法检测脑脊液神经病理蛋白(包括α-突触核蛋白寡聚体、总Tau及不同部位磷酸化tau蛋白)水平,采用高效液相色谱检测脑脊液神经递质(包括多巴胺、乙酰胆碱、肾上腺素和5-羟色胺)的水平。分析各神经病理蛋白及神经递质与RLS-RS评分的关系。结果 (1)186例PD患者RLS的发生率为42.47%;RLS组的病程明显长于NRLS组(P0.05)。(2)RLS组Hoehn-Yahr分期及UPDRSⅢ评分均明显高于NRLS组(均P0.05)。(3)RLS组患者汉密尔顿焦虑量表(HAMA)、汉密尔顿抑郁量表(HAMD)、匹茨堡睡眠质量指数量表(PSQI)和疲劳严重程度量表(FSS)评分均高于NRLS组(均P0.01),而两组间蒙特利尔认知评估量表(MoCA)、改良淡漠评定量表(MAES)和爱泼沃斯思睡量表(ESS)评分比较差异无统计学意义(P0.05)。(4)RLS组脑脊液α-突触核蛋白寡聚体水平明显高于NRLS组〔(0.31±0.09)ng/mL比(0.21±0.08)ng/mL,P0.05〕。RLS组RLS-RS评分与脑脊液α-突触核蛋白寡聚体水平呈正相关(r=0.355,P0.01)。(5)RLS组脑脊液多巴胺和5-羟色胺水平明显低于NRLS组〔(5.53±3.67)pg/mL比(7.97±4.85)pg/mL,P0.01;(13.23±8.14)pg/mL比(19.21±7.50)pg/mL,P0.01〕。RLS组RLS-RS严重度评分与脑脊液多巴胺和5-羟色胺水平呈负相关(r=-0.274,P0.01;r=-0.360,P0.01)。(6)脑脊液α-突触核蛋白寡聚体水平与多巴胺以及5-羟色胺水平无相关性(r=-0.119,P=0.362;r=-0.127,P=0.327)。结论 RLS是PD常见的非运动症状之一,PD伴发RLS患者的运动症状更重,非运动症状中焦虑、抑郁、疲劳更重,睡眠质量更差。PD-RLS脑内α-突触核蛋白寡聚体沉积可能是PD-RLS的发生机制,多巴胺缺乏可能是PD-RLS的神经生化基础。     

Parkinson's disease

A number of changes have occurred in the management of Parkinson's disease in recent years, with the development of new therapeutic strategies based upon advances in pharmacotherapy and interventional procedures. The treatment of patients with Parkinson's disease is considered here with these advances in mind. Potential neuroprotective agents that might slow disease-progression are also considered, but at the present time these agents are more of academic interest than clinical relevance and their role remains to be established. Ablative surgery and stimulation procedures are also helpful in the management of Parkinson's disease, and the utility and limitations of these approaches are briefly summarized.