Study And Analysis Of Pulmonary Function In Patients With Early Idiopathic Parkinson's Disease

Objective The goal of this study is to identify potential abnormal changes that may serve as possible diagnostic markers to promote the early clinical screening and diagnosis of idiopathic Parkinson's disease(IPD).For this purpose,we performed clinical investigations of pulmonary function,respiratory muscle strength and respiratory center drive in patients with early IPD.Methods In this study,100 patients with early IPD(Hoehn-Yahr stage 1-2)and 60 healthy controls(HC)with matched age,gender,height,weight and body mass index(BMI)were included.All subjects were undertaken the clinical examination of pulmonary function,respiratory muscle strength,and respiratory central drive,including the lung ventilation function parameters,such as forced vital capacity(FVC),forced expiratory volume in 1s(FEV1),forced expiratory volume in 1s/forced vital capacity(FEV1/FVC),peak expiratory flow(PEF),residual volume(RV),total lung volume(TLC),and pulmonary diffusion function,such as carbon monoxide diffusion capacity(DLCOcSB),and respiratory muscle strength,such as maximal inspiratory pressure(PIMAX)and maximum expiratory pressure(PEMAX),and the respiratory center drive parameter,such as the airway occlusion pressure after 0.1second(P0.1).At the same time,all the IPD patients were also subjected to a series of Parkinson's disease related neuropsychological tests,including the new version of the Movement Disorder Society-Unified Parkinson Disease Rating Scale(MDS-UPDRS),Non-Motor Symptoms Questionnaire(NMSQ),REM Sleep Behavior Disorder Screening Questionnaire(RBDSQ),Cleveland Constipation Scoring system(CCS),Parkinson's Disease Sleep Scale-2(PDSS-2),Hamilton Depression Scale(HAMD),Hamilton Anxiety Scale(HAMA),and Mini Mental State Examination(MMSE).Statistical methods such as t-test and ANOVA were used to compare the differences in pulmonary function,respiratory muscle strength,respiratory center drive between IPD patients and control subjects.Pearson correlation analysis was used to find out the correlation between the results.Results Compared with the control subjects,patients with early IPD had a slight decrease in routine ventilation and diffusion functions,such as FVC,FEV1,FEV1/FVC,PEF,RV,TLC,DLCOcSB.However,these indicators were all within the normal reference range without statistical differences between the two groups(P>0.05).As compared to controls,patients with early IPD had significantly lower respiratory muscle strength,such as PIMAX(P<0.001)and PEMAX(P<0.001).Patients with early IPD had a significant increase in respiratory center drivers,such as P0.1(P<0.001)relative to controls.Patients with early IPD were divided into stage 1and stage 2 according to Hoehn-Yahr scale.There was no significant difference in pulmonary routine ventilation and diffusion function.We found significantly lower PIMAX(P<0.001)and PEMAX(P=0.016),and significantly higher P0.1(P<0.001)as compared to controls.For patients with early IPD that were categorized by gender and compared with matched controls,the results show: PEF(P=0.011),PIMAX(P=0.046)and PEMAX(P=0.044)in male patients with early IPD was significantly lower and P0.1(P<0.001)was significantly higher than controls.TLC(P=0.020),DLCOcSB(P=0.046),PIMAX(P<0.001),and PEMAX(P=0.002)were significantly lower in female patients with early idiopathic Parkinson's disease than in male healthy control,and P0.1(P<0.001)was significantly higher in female healthy control.For patients with early IPD that were categorzied by age(50-59 years old group,60-69 years old group and 70-79 years old group),the results show: in the50-59 years old group,FEV1/FVC(P=0.029),DLCOcSB(P=0.006),PIMAX(P=0.041),PEMAX(P=0.016)in patients with early IPD was significantly lower,and P0.1(P =0.004)was significantly higher than age matched controls.In the 60-69 age group,PEF(P=0.007),PIMAX(P<0.001)and PEMAX(P=0.042)in patients with IPD was significantly lower,and P0.1(P<0.001)was significantly higher than age matched controls.In the 70-79 age group,FVC(P=0.003),FEV1(P<0.001),PEF(P=0.028),TLC(P=0.006),PIMAX(P<0.001)and PEMAX(P<0.001)in patients with early IPD was significantly lower than,and P0.1(P<0.001)was significantly higher than age matched controls.Pearson correlation analysis was conducted on the evaluation results of pulmonary function,respiratory muscle strength,respiratory center drive and neuropsychological scale in patients with early IPD.(PIMAX)was negatively correlated with the disease course(r=-0.160,P=0.022),Hoehn-Yahr scale(r=-0.159,P=0.022),MDS-UPDRS(r=-0.172,P=0.014),and positively correlatedwith PEF(r=0.249,P<0.001),RV(r=0.138,P<0.048),DLCOcSB(r=0.149,P<0.032),PEMAX(r=0.281,P<0.001).PEMAX was negatively correlated with MDS-UPDRS(r=-0.170,P=0.014),and positively correlated with FVC(r=0.207,P=0.003),FEV1(r=0.238,P=0.001)?FEV1/FVC(r=0.197,P=0.005)?PEF(r=0.380,P<0.001)?RV(r=0.238,P=0.0010),TLC(r=0.252,P<0.001)?NMSQ(r=0.189,P=0.006)?PDSS-2(r=0.229,P=0.001)?MMSE(r=0.195,P=0.005)?HAMD(r=0.355,P<0.001)?HAMA(r=0.320,P<0.001),P0.1 was negatively correlated with FEV1/FVC(r=-0.213,P=0.002),CCS(r=-0.183,P=0.009),and PEMAX(r=-0.183,P=0.008).Conclusion There was a significant decrease in respiratory muscle force(PIMAX,PEMAX)and an increase in respiratory central drive(P0.1)without obvious changes in routine ventilator and diffusion function in patients with early IPD.These abnormal changes may serve as biomarkers to support early diagnosis and screening of IPD.