便秘、结肠黏膜炎症及肠源性内毒素与帕金森病相关性研究

目的: 探讨帕金森病( Parkinson's disease,PD)患者肠道症状（便秘）、结肠病理改变及肠源性内毒素（lipopolysaccharide,LPS）与PD的相关性，为寻找PD的早期标志物及发病机制提供理论及实验根据。方法: 通过便秘问卷及判别式分析对102例PD患者的便秘进行分型，多因素Logistic回归分析患者的便秘类型与PD患者年龄、运动症状病程、便秘病程的关系；6例早期伴严重便秘的PD患者给予结肠镜检测及结肠黏膜组织免疫组化检测；78例PD患者（无便秘23例和有便秘55例），空腹抽取外周血，鲎试剂动态浊度法检测外周静脉血LPS含量。结果:（1）102例PD患者中无便秘23例，有便秘79例。其中慢传输障碍型便秘（slow-transit constipation,STC)，混合型便秘（mixture of the two，Mixed），进出口障碍型便秘（rectal evacuatory disorder,RED)分别为31例（39.24%）、33例（41.77%）和15例（18.99%）。（2）6例伴便秘的PD患者结肠黏膜均呈慢性炎症改变，伴有大量的CD+4细胞浸润。（3）78例PD患者中，LPS≥0.1 EU/mL 15例，0.01～0.1 EU/mL 29例，<0.01 EU/mL 34例；LPS增高与便秘相关（P<0.05）。结论: 便秘、结肠黏膜炎症及肠源性LPS诱发的慢性低度炎症与PD发生发展相关。

Study on the relationship between constipation,colonic mucosal inflammation,intestinal LPS and Parkinson's disease

AIM: To investigate the correlationship between intestinal symptoms (constipation), colon pathological changes, lipopolysaccharide（LPS）and Parkinson's disease（PD） so as to provide theoretical and experimental basis for the early detection of PD and its pathogenesis. METHODS: 102 PD patients were randomly divided into three groups through constipation questionnaire and discriminant analysis. Multivariate logistic regression analysis was used to analyze the relationship between the types of constipation and age, course of disease as well as course of constipation. 6 PD patients with constipation in were performed colonoscopy, and the infiltration of lymphocytes in colonic mucosa was detected by immunohistochemistry. LPS of 78 PD patients (23 cases without constipation and 55 cases with constipation) were detected by dynamic turbidimetric limulus test. RESULTS: (1) Within the total 102 PD patients, 23 cases presented without constipation while 79 cases with constipation, among which the STC, Mixed, RED were 31 cases (39.24%), 33 cases (41.77%) and 15 cases (18.99%) , respectively. (2) The colon mucosa of 6 PD patients with constipation showed chronic inflammation and a large number of CD+4 cell infiltration.(3) There were 15 cases of PD patients with the amount of LPS more than 0.1 EU/mL, 29 cases 0.1 to 0.01 EU/mL, and 34 cases <0.01 EU/mL among the 78 cases of PD patients, and the increased LPS was related to the constipation of PD patients. CONCLUSION: Constipation, colonic mucosal inflammation, chronic low-grade inflammation-induced intestinal LPS are associated with the occurrence and development of PD.