Kev Tshawb Fawb Kev Tshawb Fawb Txog Cov tsos mob tsis yog lub cev muaj zog nyob rau theem Prodromal ntawm Parkinson's Disease
Mar 27, 2022
Hu rau:joanna.jia@wecistanche.com/ WhatsApp: 008618081934791
Parkinson tus kab mobkab mobyog ib hom kab mob neurodegenerative, thiab kev kuaj mob ntxov thiab kev cuam tshuam tuaj yeem txhim kho cov kev mob tshwm sim ntawm cov neeg mob Pa.rcov kinsonkab mob. International Society of Movement Disorders hauv 2015 tau hais txog qhov tseem ceeb ntawm theem prodromal ntawmParkinson tus kab mobkab mob, nyob rau hauv uas cov neeg mob tau tsim kev hloov pauv hauv nruab nrab lossis peripheral neuropathological, thiab cov neeg mob tuaj yeem tshwm sim nrog qhov sib txawv ntawm cov tsos mob tsis yog lub cev muaj zog thiab cov cim qhia, tab sis qhov txwv tsis pub txav mus. Cov tsos mob tseem tsis txaus los kuaj xyuasParkinson tus kab mobkab mob. Nkag siab txog cov yam ntxwv tam sim no ntawm cov tsos mob tsis yog lub cev muaj zog thiab muaj peev xwm biomarkers nyob rau theem prodromal ntawmParkinson tus kab mobkab mobyuav pab cov kws kho mob los txheeb xyuas qhov xav tauParkinson tus kab mobkab mobcov neeg mob ua ntej. Cov yam ntxwv thiab cov txheej txheem ua tau ntawm cov tsos mob ntawm lub cev muaj zog (hyposmia, pw tsaug zog tsis zoo, kev paub tsis meej, cov tsos mob neuropsychiatric, thiab kev ua haujlwm tsis raug cai) thiab cov khoom muaj feem cuam tshuam tau muab cais thiab piav qhia, txhawm rau txhim kho cov kws kho mob kev nkag siab txog cov tsos mob tsis yog lub cev muaj zog hauv prodromal.Tus kab mob Parkinson. Ua tib zoo saib thiab ntxiv dag zog rau cov kev kho mob rov qab los yog cov kev tshawb fawb yav tom ntej.
Keeb kwm
Tus kab mob Parkinson(PD) yog ib qho ntawm cov kab mob uas tshwm sim qeeb qeeb hauv cov neeg laus. Qhov txawv txav hauv lub cev yog qhov hloov pauv loj ntawm pathological [1]. Cov tsos mob ntawm lub cev muaj zog ntawm PD(Tus kab mob Parkinson)yog tremor, rigidity, bradykinesia, thiab postural gait abnormalities. Cov kev tshawb fawb tsis ntev los no tau pom tias cov yam ntxwv ntawm cov kab mob pathological hloov pauv tshwm sim xyoo lossis ntau dua kaum xyoo ua ntej qhov pib ntawm cov tsos mob ntawm lub cev muaj zog hauv PD(Tus kab mob Parkinson)cov neeg mob. Ntxiv nrog rau ib puag ncig thiab caj ces, ntau cov tsos mob tsis yog lub cev muaj zog kuj pom muaj nyob rau theem prodromal ntawm PD.(Tus kab mob Parkinson)cov neeg mob, xws li hyposmia, pw tsaug zog tsis zoo, kev paub tsis meej, kev cuam tshuam cuam tshuam, thiab kev ua haujlwm tsis raug cai [2]. Kev kuaj mob ntxov ntawm PD yog qhov tseem ceeb rau kev cuam tshuam raws sijhawm thiab muaj txiaj ntsig hauv kev kis kab mob [1]. Xyoo 2015, International Parkinson's and Movement Disorders Association tau kho cov txheej txheem kuaj mob rau prodromal PD.(Tus kab mob Parkinson), uas tshwj xeeb tau hais txog qhov tseem ceeb ntawm cov tsos mob tsis yog lub cev muaj zog raws li cov cim ntxov ntawm PD(Tus kab mob Parkinson)[3]. Cov hauv qab no feem ntau yuav piav qhia txog kev sib raug zoo ntawm PD hom(Tus kab mob Parkinson)prodromal non-motor cov tsos mob thiab PD (Tus kab mob Parkinson).
cistanche tshuaj ntsuab salsa txiaj ntsigrauPD thiab AD
Parkinson tus kab mob prodromal cov tsos mob uas tsis yog lub cev muaj zog
2.1 hyposmia
Olfactory dysfunction yog ib qho ntawm qhov tsis ua haujlwm ntawm PD(Tus kab mob Parkinson). Daim ntawv tshaj tawm kev tshawb fawb hauv tsev tau pom tias 88. 43% ntawm PD(Tus kab mob Parkinson)cov neeg mob yuav muaj hyposmia [4]. Cov ntaub ntawv olfactory feem ntau nkag mus rau hauv thawj olfactory cortex ncaj qha los ntawm lub qhov muag olfactory los ntawm olfactory ib ntsuj av, nrog rau lub anterior olfactory nucleus, piriform cortex, olfactory tubercle, entorhinal cheeb tsam, periamyg dala cortex, thiab medial amygdala lub thib ob tej yaam num. , xws li Hippocampus, amygdala complex [5]. Nyob rau tib lub sijhawm, kev sib kis ntawm tsis hnov tsw cuam tshuam nrog kev tswj hwm ntawm ntau yam khoom siv xws li dopamine, acetylcholine, norepinephrine, thiab serotonin. Raws li qhov classic Braak staging, qee qhov kev tshawb fawb kwv yees tias qhov kev ua haujlwm tsis zoo ntawm PD.(Tus kab mob Parkinson)Cov neeg mob feem ntau yog vim qhov tshwm sim ntawm cov synapse nyob rau hauv lub hauv paus thiab theem nrab olfactory chaw zov me nyuam thiab lwm yam olfactory-related thaj chaw ua ntej lub peripheral qab haus huv, midbrain, cerebral cortex thiab lwm yam. Pathological deposition ntawm nuclear proteins [6] Nyob rau tib lub sijhawm, cov kev tshawb fawb tau pom tias olfactory dysfunction yuav tsis cuam tshuam tag nrho rau lub pathology ntawm olfactory qauv. Neurodegeneration ntawm amygdala thiab kev ua haujlwm hloov pauv ntawm cov kab mob ntsig txog cov kab mob neurotransmitters kuj tseem tuaj yeem ua rau muaj qhov tshwm sim ntawm olfactory dysfunction hauv PD.(Tus kab mob Parkinson) [6,7].
Olfactory dysfunction tuaj yeem muab faib ua qhov tsis hnov tsw paub tsis meej, olfactory discrimination disorder, thiab olfactory nco tsis meej, thiab lwm yam tshwm sim tuaj yeem tshwm sim ntau xyoo ua ntej PD(Tus kab mob Parkinson)kuaj mob. Ib txoj kev tshawb fawb yav tom ntej tau tshaj tawm tias olfactory dysfunction yog qhov ntxov tshaj plaws prodromal tsis yog lub cev muaj zog tshwm sim hauv cov pej xeem uas muaj qhov muag tsis pom kev pw tsaug zog tsis zoo (iRBD), yos rov qab mus rau 22 xyoo ua ntej qhov pib ntawm cov tsos mob tshwm sim hauv PD.(Tus kab mob Parkinson) thiab qhov tseeb ntawm kev kuaj mob tau siab ({{0}}}.889, 95 feem pua CI 0.825-0.954) [8]. Olfactory dysfunction yog qhov tshwj xeeb hauv PD(Tus kab mob Parkinson)piv rau lwm yam uas tsis yog lub cev muaj zog tshwm sim ntawm PD(Tus kab mob Parkinson)prodromal theem. Kev kawm yav tom ntej ntawm 1847 50-cov neeg muaj hnub nyoog tsis muaj PD(Tus kab mob Parkinson)qhia tau tias 60 feem pua ntawm cov neeg mob kuaj mob PD(Tus kab mob Parkinson)Tom qab 5 xyoos ntawm kev soj ntsuam muaj hyposmia ntawm lub hauv paus, piv nrog tsuas yog 29 feem pua ntawm cov neeg uas tsis muaj kev kuaj mob ntawm PD.(Tus kab mob Parkinson). There is hyposmia at the baseline level [9]. Another retrospective study showed that anosmia was 75% sensitive and 86% specific for differentiating patients >50 xyoo nrog kev kuaj mob ntawm PD(Tus kab mob Parkinson)5 xyoos, thiab anosmia hauv PD(Tus kab mob Parkinson)thiab dementia nrog Lewy lub cev (Dementia nrog Lewy Bodies, DLB) zoo li yog ib qho kev tshwm sim tshwj xeeb hauv theem prodromal, thiab tam sim no tsis muaj pov thawj tias muaj anosmia nyob rau hauv prodromal theem ntawm Huntington tus kab mob, spinocerebellar ataxia los yog mob supranuclear palsy [10 ]. Nyob rau tib lub sijhawm, qee qhov kev tshawb fawb tau pom tias muaj ib feem sib tshooj ntawm cov kev hloov pauv pathophysiological ntawm olfactory dysfunction nyob rau hauv prodromal theem ntawm PD.(Tus kab mob Parkinson)thiab lwm yam tsos mob uas tsis yog lub cev muaj zog, xws li kev paub tsis meej thiab kev pw tsaug zog [11].
Anti-Parkinson tus kab mob: Cistanche tshuaj ntsuab
2.2 Kev pw tsaug zog tsis zoo
80% ntawm PD(Tus kab mob Parkinson)cov neeg mob pw tsaug zog [12] Ntxiv rau cov tsos mob ntawm lub cev muaj zog thiab cov tsos mob tsis yog lub cev muaj zog ntawm PD(Tus kab mob Parkinson), uas tuaj yeem ua rau pw tsaug zog tsis zoo hauv cov neeg mob, qee qhov PD(Tus kab mob Parkinson)Cov neeg mob kuj tuaj yeem muaj kev pw tsaug zog tsis zoo raws li kev kho mob tseem ceeb hauv theem prodromal. Cov tsos mob tshwm sim muaj feem xyuam nrog PD(Tus kab mob Parkinson). Kev pw tsaug zog feem ntau muaj xws li: pw tsaug zog, pw tsis tsaug zog ceg, RBD, pw tsaug zog ntau hnub, obstructive pw tsaug zog apnea thiab pw tsaug zog atherosclerosis [13]. Ntawm lawv, ceev RBD muaj qhov siab tshaj plaws hauv kev kwv yees qhov tshwm sim ntawm PD(Tus kab mob Parkinson), thiab pw tsaug zog atherosclerosis, pw tsaug zog apnea, thiab insomnia kuj tseem muaj feem cuam tshuam rau PD(Tus kab mob Parkinson).
RBD yog manifested li parasomnia ntsig txog kev npau suav phem nyob rau hauv lub qhov muag ceev ceev (rem) theem thaum pw tsaug zog [14]. Lub pathogenesis ntawm RBD feem ntau tsom rau ntawm / tawm ntawm rem pw tsaug zog theem nyob rau hauv lub hlwb thiab medulla oblongata. Locus coeruleus, dorsolateral tegmental nucleus, pontine peduncle nucleus, raphe nucleus, medulla oblongata giant cell reticulum, thiab ventrolateral reticulospinal tract, uas koom nrog kev tswj hwm ntawm kev pw tsaug zog, tuaj yeem ua rau RBD. Qhov tshwm sim ntawm tus kab mob no feem ntau yog kuaj mob los ntawm polysomnography [15, 16]. Cov kev tshawb fawb tam sim no qhia tias iRBD yog theem pib ntawm -synucleinopathy, thiab feem ntau cov neeg mob iRBD muaj qhov txawv txav ntawm -synuclein feem ntau nyob hauv lub hlwb (sublocus coeruleus thiab loj cell nucleus), diencephalon, amygdala thiab lub paj hlwb uas nws kim heev. Neocortex [17]. Tsis tas li ntawd xwb, cov neeg mob iRBD kuj muaj qhov txawv txav ntawm pathological hloov ntawm -synuclein hauv cov hlab ntsha peripheral, uas tuaj yeem cuam tshuam cov kab mob paravertebral sympathetic, ganglia hauv cov ntaub so ntswg epicardial adipose, thiab myenteric plexus [17]. Nrog rau kev ncua ntev ntawm cov tsos mob RBD, qhov tshwm sim ntawm cov neeg mob uas muaj kev paub tsis meej, tsis meej pem, thiab hyposmia kuj maj mam nce, uas tej zaum yuav cuam tshuam rau qhov chaw tso nyiaj ntawm -synuclein [18]. Schenck et al. tau ua cov kev tshawb fawb yav tom ntej hauv xyoo 1996 thiab 2013, raws li, thiab pom tias feem pua ntawm cov neeg mob iRBD uas tsim PD(Tus kab mob Parkinson)yog 38 feem pua tom qab 4 xyoo ntawm kev soj ntsuam, thiab qhov feem ntawm PD(Tus kab mob Parkinson)tsim tom qab 16 xyoo ntawm kev soj ntsuam tau nce mus rau 44.5 feem pua. 8 feem pua [19]. Kev tshawb nrhiav yav dhau los ntawm 174 iRBD cov neeg mob nrog qhov nruab nrab ntawm 4 xyoo tau pom tias 65 tus neeg mob tsim -synuclein-txog cov kab mob neurodegenerative, ntawm 24 yog PD.(Tus kab mob Parkinson)[18]. Txawm hais tias RBD, raws li qhov tseem ceeb ntawm kev kho mob tshwm sim ntawm PD(Tus kab mob Parkinson)prodromal theem, yuav pib li cas los yog ceev PD(Tus kab mob Parkinson)Kev nce qib tseem tsis tau paub meej, kev kho mob, nws tuaj yeem txhim kho qhov kev kwv yees ntawm PD yav tom ntej(Tus kab mob Parkinson)los ntawm cov xwm txheej ntawm cov neeg mob iRBD, xws li hnub nyoog siab, txiv neej pw, pw tsaug zog nruab hnub, thiab kev kho mob comorbidities. Cov neeg mob raug kev txom nyem los ntawm hyposmia, kev tsis sib haum xeeb ntawm cov xim, kev nyuaj siab, autonomic dysfunction thiab kev paub tsis meej, los yog cov duab ntawm txawv txav deposition ntawm -synuclein nyob rau hauv lub hauv paus paj hlwb [15, 20].
Ntxiv rau RBD, nocturnal pw tsaug zog apnea yog ib qho kev pheej hmoo txaus ntshai rau PD(Tus kab mob Parkinson). Ib txoj kev tshawb fawb txog 1944 cov neeg mob pw tsaug zog apnea qhia tias 0 0 feem pua ntawm cov neeg mob tsim PD(Tus kab mob Parkinson)tom qab 3 xyoos piv nrog cov kev tswj ib txwm muaj. Ntawm lawv, cov txiv neej thiab cov neeg pw tsaug zog apnea hnub nyoog tshaj 60 xyoo muaj feem ntau raug kev txom nyem los ntawm PD(Tus kab mob Parkinson)[21]. Qhov no tej zaum yuav muaj feem xyuam rau qhov tseeb tias mob hypoxia-induced oxidative kev nyuaj siab thiab inflammatory teb los ntawm nocturnal pw tsaug zog apnea accelerate qhov kev puas tsuaj ntawm substantia nigra dopamine neurons [15]. Qee cov kws tshawb fawb ntseeg tias qhov poob ntawm kev pw tsaug zog zoo thiab pw tsaug zog tsis sib haum nrog kev laus kuj yog qhov tshwm sim ntawm PD.(Tus kab mob Parkinson). Cov kev tshawb fawb tau pom tias qhov txo qis ntawm kev pw tsaug zog qeeb qeeb hauv cov neeg laus feem ntau cuam tshuam nrog atrophy ntawm medial prefrontal grey teeb meem, thaum qeeb-yoj pw tsaug zog cuam tshuam txog synaptic ntom lossis lub zog ntawm cortical synapses [15]. Lwm txoj kev tshawb fawb pom tau hais tias kev pw tsaug zog tsis sib haum xeeb los ntawm kev laus ncaj qha cuam tshuam rau glutamatergic system ntawm lub hauv paus paj hlwb kom tshem tawm cov protein ntau txawv txav hauv cov kua cerebrospinal, suav nrog -synuclein, amyloid (amyloid-beta protein, A ), TDP-43 thiab phosphorylated tau protein, thiab lwm yam, thiab ntau dhau ntawm cov proteins uas muaj feem xyuam rau qhov tshwm sim thiab kev loj hlob ntawm PD.(Tus kab mob Parkinson)kab mob [22]. Tsis tas li ntawd xwb, kev pw tsaug zog atherosclerosis los yog insomnia ntev los ntawm kev ua haujlwm lossis kev ua neej kuj tseem muaj feem cuam tshuam rau prodromal PD.(Tus kab mob Parkinson). Txoj kev tshawb fawb yav tom ntej tau pom tias cov kws saib xyuas neeg mob uas feem ntau ua haujlwm hmo ntuj muaj kev pheej hmoo ntawm PD(Tus kab mob Parkinson)piv nrog cov kws saib xyuas neeg mob uas tsis ua haujlwm hmo ntuj. [23], cov neeg mob insomnia ntev tshaj 3 m muaj kev pheej hmoo siab ntawm kev tsim PD(Tus kab mob Parkinson)tshaj li cov neeg ib txwm muaj, uas tej zaum yuav cuam tshuam rau qhov txawv txav melatonin concentration tshwm sim los ntawm kev hloov pauv hauv circadian atherosclerosis, thaum cov ntshav melatonin thiab cortisol concentrations hauv PD.(Tus kab mob Parkinson)cov neeg mob siab dua cov neeg nyob hauv ib txwm muaj. Qhov tshwm sim ntawm kev pw tsaug zog nruab hnub nyob rau hauv prodromal theem ntawm PD(Tus kab mob Parkinson)kuj tseem tuaj yeem cuam tshuam nrog kev hloov pauv hauv circadian atherosclerosis [15], tab sis cov txheej txheem tshwj xeeb tseem yuav tsum tau tshawb nrhiav hauv cov qauv kev tshawb fawb loj.
CistancheGensengnce kev txawj ntse thiab txhim kho kev nco
2.3 Kev paub tsis meej
Kev tshawb fawb qhia tau tias 32. 9 feem pua ntawm PD kuaj mob tshiab(Tus kab mob Parkinson)Cov neeg mob muaj kev puas hlwb me me (Mild paub tsis meej, MCI) [24], thiab 83 feem pua ntawm cov neeg mob PD-MCI yuav nce mus rau PD(Tus kab mob Parkinson)dementia nyob rau hauv kev tshawb nrhiav txog li 20 xyoo (Parkinson's disease dementia, PDD) [25]. Kev paub tsis meej txog PD(Tus kab mob Parkinson)Feem ntau tshwm sim hauv kev paub txog yam xws li kev saib xyuas, kev tswj hwm lub hwj chim, lus, thiab kev taw qhia visuospatial [26]. Cov kev tshawb fawb tau pom tias PD-MCI cov neeg mob uas muaj mob hnyav dua tom qab cortex ntsig txog kev ua haujlwm raug puas tsuaj yog piv nrog rau kev puas tsuaj ntawm lub ntsej muag. Cov neeg mob PDMCI hnyav tuaj yeem nce mus rau PDD [27]. Piv nrog rau lwm cov kab mob degenerative, qhov tshwm sim ntawm kev nco tsis zoo hauv PD(Tus kab mob Parkinson)Cov neeg mob nyob rau theem pib tsis yog qhov tseem ceeb, thiab nyob rau hauv PDD theem, raws li cov lus hais saum toj no kev paub txog kev puas tsuaj, nws ntxiv mus rau kev pom thiab lo lus nco, kev ua haujlwm thiab kev kawm thiab kev nco. Kev puas tsuaj [28]. Kev paub tsis meej uas cuam tshuam nrog PD(Tus kab mob Parkinson)Feem ntau yog cuam tshuam nrog kev degeneration ntawm subcortical neurons thiab atrophy ntawm cov nuclei sib thooj los yog cortex tshwm sim los ntawm qhov txawv txav ntawm synuclein, uas feem ntau tsis koom nrog hippocampus [28, 29]. Lub degeneration ntawm subcortical neurons tuaj yeem ua rau muaj qhov txawv txav ntawm ntau yam neurotransmitters, ntawm cov uas tsis muaj peev xwm ntawm cholinergic neurons kom xa acetylcholine tau pom zoo nyob rau hauv nucleus basalis ntawm Meynert (nbM), thaum lub me me Lewis Abnormal deposition ntawm lub cev kuj yog. ntau heev hauv nbM, thiab cov neuronal degeneration ntawm nbM yog tam sim no suav tias yog ib qho ntawm cov cim tseem ceeb kom paub qhov txawv PD(Tus kab mob Parkinson)los ntawm Alzheimer's disease (AD) [30].
Cov yam ntxwv ntawm kev paub txog kev puas siab puas ntsws yog ib qho tseem ceeb hauv kev kho mob tshwm sim ntawm theem prodromal ntawm PD(Tus kab mob Parkinson). Kev tshawb nrhiav yav dhau los tsis ntev los no tau lees paub tias qhov nruab nrab ntawm kev kuaj mob ua ntej ntawm PD(Tus kab mob Parkinson)Cov neeg mob yog 5. Tsis pub dhau 6 xyoo, cov qhab nia ntawm Mini-Mental State Examination (MMSE) tau pom tias muaj kev poob qis; 7. Tsis pub dhau 1 xyoos, cov neeg mob tau txais kev tsis txaus siab ntawm tsab ntawv-Digit-Substitution Test (LDST); thiab Stroop xeem cov haujlwm kuj tau kuaj pom hauv PD(Tus kab mob Parkinson)cov neeg mob piv rau kev tswj ib txwm muaj. Qhov qub nruab nrab 3. 8 txog 6. Qhov sib txawv tshwm sim hauv 2 xyoo; thiab nco poob tau tshwm sim ua ntej PD(Tus kab mob Parkinson)kev kuaj mob 1. 5 y yog maj mam tshwm sim [31]. Yog tias lub sijhawm prodromal nrog kev cuam tshuam ntawm kev tshuav nyiaj li cas, nruab hnub tsis tsaug zog, tsis muaj kev cuam tshuam los yog RBD hauv cov neeg mob MCI, qhov kev pheej hmoo ntawm kev nce mus rau PDD tau nce ntau [28, 32]. Ntxiv nrog rau cov yam ntxwv ntawm kev paub txog kev puas tsuaj, cov neeg nqa khoom ntawm apolipoprotein E (ApoE) ε4 allele, tau (microtubule-associated protein tau, MAPT) noob hloov, H1 / H2 haplotype thiab cov piam thaj hauv lub hlwb hloov pauv hauv glucocerebrosidase (GBA) noob yog tag nrho. Kev pheej hmoo rau kev puas siab puas ntsws cuam tshuam nrog prodromal PD(Tus kab mob Parkinson)[28]. Tsis tas li ntawd, nrog kev txhim kho ntawm kev kho mob imaging technology nyob rau hauv cov neeg mob nrog prodromal PD(Tus kab mob Parkinson)thiab cov neeg mob PD-MCI thiab PDD nrog kev kuaj pom tseeb, nws kuj tseem muab qee qhov kev pom zoo rau cov neeg mob MCI nyob rau theem prodromal. Cov kev tshawb fawb tau pom tias kev ua haujlwm ntawm magnetic resonance imaging (fMRI) ) thiab metabolic-related positron emission tomography (positron emission tomography, PET) hauv PD cov neeg mob uas muaj kev puas siab puas ntsws ntau dua rau ob sab pem hauv ntej lobe, occipital lobe, parietal lobe thiab caudate nucleus atrophy thiab. hypometabolism [33,34], Diffusion tensor imaging (DTI) tau qhia tias cov neeg mob uas tsim PDD muaj feem ntau yuav muaj kev nce qib siab diffusivity (MD) hauv nruab nrab cov teeb meem dawb [35], thiab cholinergic PET qhia tias cov neeg mob uas tsim PDD ntau dua. zoo li yuav tsim PDD. Cov kev ua cholinergic ntawm lub frontal thiab lub cev nqaij daim tawv cortices yog nws txo qis [36]. Ib yam li ntawd, qee qhov biomarkers hauv cov kua cerebrospinal kuj tuaj yeem ua lub luag haujlwm hauv kev kwv yees cov kev coj ntawm kev paub tsis meej hauv PD.(Tus kab mob Parkinson), thiab cov kev tshawb fawb tau pom tias qib qis ntawm A 42, qib siab ntawm cov hlab plawv fatty acid-binding protein, thiab qib siab ntawm -synucleus. Txhua cov proteins tuaj yeem ua lub luag haujlwm hauv kev kwv yees qhov kev poob qis ntawm kev paub txog kev ua haujlwm cuam tshuam nrog lub sijhawm prodromal ntawm PD(Tus kab mob Parkinson) [28].
Tiv thaiv neurons thiab txhim kho kev nco:cistanche ntxiv
2.4 Cov tsos mob neuropsychiatric
30% ntawm PD(Tus kab mob Parkinson)Cov neeg mob muaj ntau theem ntawm kev ntxhov siab thiab kev nyuaj siab cov tsos mob, uas cov tsos mob ntawm kev nyuaj siab yog lub ntsiab tshwm sim [37]. Ntxiv rau qhov thib ob, PD-txog cov tsos mob ntawm kev puas siab puas ntsws feem ntau cuam tshuam nrog qhov tsis txaus ntawm cov neurotransmitters hauv nruab nrab paj hlwb. Cov kws kho mob cov txheeb cais tau pom tias lub sijhawm lub qhov rais los ntawm thawj qhov pib ntawm kev nyuaj siab rau kev kuaj mob ntawm PD(Tus kab mob Parkinson)tuaj yeem nyob ntawm 1 m txog 36 xyoo, nrog rau lub sijhawm nruab nrab ntawm 10 xyoo [38]. Vim tias tsis muaj qhov tshwj xeeb ntawm qhov tshwm sim ntawm kev nyuaj siab hauv cov pej xeem [39], cov tsos mob ntawm kev nyuaj siab tsuas yog qhov tseem ceeb me me rau kev kuaj mob ntawm prodromal PD.(Tus kab mob Parkinson)[40]. Cov kev tshawb fawb yav tom ntej tau pom tias cov neeg mob uas muaj kev ntxhov siab thiab kev nyuaj siab nyob rau theem prodromal ntawm PD(Tus kab mob Parkinson), piv nrog rau pawg tswj hwm ib txwm muaj, tsis muaj qhov tshwj xeeb tshwj xeeb hauv theem prodromal tshwj tsis yog rau cov qhab nia qis me ntsis, tsuas yog nyob rau theem prodromal 2. Kev cuam tshuam cuam tshuam hauv PD(Tus kab mob Parkinson)Cov neeg mob tsuas yog qhov tseem ceeb tom qab li 3 xyoos [31]. Txawm li cas los xij, kev tshawb fawb hla cov tsos mob kuj qhia tau tias yog cov neeg mob nyuaj siab muaj tsev neeg keeb kwm ntawm PD(Tus kab mob Parkinson), hyposmia, cem quav, me dyskinesia, los yog hyperechoic substantia nigra, lawv kuj yog cov cim kev kho mob rau kev nce mus rau PD [40-43]. Cov kev tshawb fawb tsis ntev los no tau pom tias cov neeg mob uas muaj kev nyuaj siab loj (MDD) thiab cov tsos mob saum toj no muaj kev nyiam ntau dua los tsim PD.(Tus kab mob Parkinson) [44].
2.5 Autonomic tsis ua haujlwm
Autonomic dysfunction yog suav tias yog ib qho ntawm cov tsis muaj lub cev muaj zog ntawm PD(Tus kab mob Parkinson), txawm 10-20 xyoo ua ntej PD(Tus kab mob Parkinson)Kev kuaj mob [45]. Nyob rau tib lub sijhawm, autonomic dysfunction ua ke nrog rau lwm cov tsos mob tsis yog lub cev muaj zog, tshwj xeeb tshaj yog RBD thiab hyposmia, yog qhov tseem ceeb rau kev kuaj mob sib txawv ntawm -synucleinopathies [8]. Ib txoj kev tshawb fawb hla ntu tau pom tias kwv yees li 84 feem pua ntawm PD(Tus kab mob Parkinson)Cov neeg mob muaj kev ua haujlwm tsis zoo ntawm lub cev [46], thiab kev ua haujlwm tsis zoo ntawm cov hlab plawv, plab zom mov, cov kab mob genitourinary, thiab cov menyuam yaus txav tau ntau dua. Cov kev tshwm sim no tuaj yeem tshwm sim los ntawm cov kab mob neurodegenerative ntxov uas cuam tshuam nrog lub dorsal motor nucleus ntawm lub paj hlwb vagus thiab degeneration ntawm alpha-synuclein hauv Lewy neurites thiab Lewy lub cev ntawm sympathetic ganglia nrog rau lub plawv, periadrenal cov ntaub so ntswg, zais zis, tawv nqaij, txoj hnyuv, thiab sympathetic ganglia. ua los ntawm deposition [10] Cov tsos mob ntawm cov hlab plawv yog qhov feem ntau pom thiab kawm txog qhov tshwm sim ntawm kev ua haujlwm tsis muaj zog, uas yuav luag txhua yam hauv PD.(Tus kab mob Parkinson)Cov neeg mob thiab tej zaum yuav ua ntej cov tsos mob ntawm lub cev muaj zog, suav nrog orthostatic hypotension, hypotension, thiab supine hypertension. , tab sis nws muaj kev cuam tshuam zoo heev los ntawm yam xws li tshuaj, hnub nyoog, ib puag ncig, lub sijhawm ntsuas ntshav siab, thiab cov qauv coj ua. Nws tau raug tshaj tawm tias so lub plawv dhia < 70="" bpm="" nyob="" rau="" hauv="" lub="" supine="" txoj="" hauj="" lwm="" thiab="" lub="" plawv="" dhia="" teb="">< 10="" bpm="" tom="" qab="" kev="" hloov="" postural="" yog="" ze="" ze="" rau="" pd="" dlb="" phenotype="" transformation="" tom="" qab="" tsis="" suav="" cov="" ntshav="" siab="" [47,="" 48].="" gastrointestinal="" tsos="" mob="" feem="" ntau="" yog="" cem="" quav,="" salivation,="" thiab="" nqos="" nyuaj.="" ntawm="" lawv,="" cem="" quav="" yog="" ib="" qho="" kev="" tsis="" txaus="" siab="" hauv="" txhua="" theem="" ntawm="" idiopathic="">(Tus kab mob Parkinson), thiab qhov tshwm sim tuaj yeem ncav cuag 70 feem pua rau 80 feem pua ua ntej PD(Tus kab mob Parkinson)Kev kuaj mob, thiab nws tuaj yeem tshwm sim 10 txog 16 xyoo ua ntej cov tsos mob ntawm PD(Tus kab mob Parkinson)pom [8, 9]. Qee qhov kev tshawb fawb tau pom tias kev ua haujlwm tsis zoo tuaj yeem tshwm sim hauv thawj 10 txog 16 xyoo ntawm lub sijhawm prodromal ntawm PD.(Tus kab mob Parkinson), thiab nws zoo li txuas ntxiv nrog orthostatic hypotension. Cov tsos mob ntawm cov zis feem ntau tshwm sim 7 txog 9 xyoo ua ntej PD(Tus kab mob Parkinson)phenotype transformation, kuj lig thiab cov tsos mob me [8].
Summary thiab Outlook
Yuav kom suav tau, cov tsos mob tsis yog lub cev muaj zog nyob rau theem prodromal ntawm PD cov neeg mob ua lub luag haujlwm tseem ceeb hauv kev txhim kho pathophysiological ntawm PD.(Tus kab mob Parkinson). Lub hauv paus pathological ntawm ntau yam tsis yog lub cev muaj zog cov tsos mob thiab cov kev sib raug zoo neuronal degeneration, -synaptic nucleus Abnormal protein deposition muaj feem xyuam, tab sis kev kho mob, qhov kev txiav txim ntawm prodromal non-motor tsos mob nyob rau hauv PD.(Tus kab mob Parkinson)cov neeg mob tseem tsis xwm yeem. Tsis tas li ntawd, ntau cov kev tshawb fawb tau lees paub tias qhov tshwm sim thiab kev loj hlob ntawm cov tsos mob tsis yog lub cev muaj zog nyob rau theem prodromal ntawm PD.(Tus kab mob Parkinson)sib tshooj thiab sib cuam tshuam. Qhov tshwj xeeb pathogenesis ntawm kev puas tsuaj ntawm txhua qhov system nyob rau hauv prodromal theem ntawm PD(Tus kab mob Parkinson)tseem tsis tau meej meej, thiab qhov kev tshawb fawb loj loj tseem xav tau hauv kev kho mob. Saib xyuas cov yam ntxwv ntawm qhov tshwm sim thiab kev loj hlob ntawm ntau yam tsis yog lub cev muaj zog cov tsos mob, siv cov ntshav, cerebrospinal kua, imaging thiab lwm yam biomarkers rau kev tsom xam, thiab nrhiav tau ib tug ua ke ntawm biomarkers nrog tsis tshua muaj siab rhiab heev thiab tshwj xeeb los pab txhawb kev soj ntsuam ntawm tej PD.(Tus kab mob Parkinson)precursors. Txhawm rau kwv yees qhov kev loj hlob zoo ntawm PD mus ntev(Tus kab mob Parkinson), nws yog qhov tsim nyog rau kev kuaj mob ntxov thiab kev cuam tshuam ntxov ntawm cov kws kho mob, thiab thaum kawg ua tiav lub hom phiaj ntawm kev pab cov neeg mob.
Cov ntaub ntawv
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