| BackgroundParkinson’s disease(PD)is a common age-related progressive neurodegenerative disease that affects up to 1%of people over the age of 60.Its clinical manifestations are mainly extrapyramidal symptoms accompanied by a variety of non-motor symptoms.At present,the clinical diagnosis of PD mainly depends on the medical history,physical examination and the response to dopaminergic drugs.Misdiagnosis is common,especially in early PD patients.Therefore,it is very important to find a biomarker to assist clinical diagnosis.The occurrence of PD involves a variety of etiology and pathogenesis,among which oxidative stress is the common pathway.Uric acid(UA)is the end product of purine metabolism and has antioxidant properties.Previous studies have shown that UA has neuroprotective effect,and the level of UA is significantly reduced in PD patients.Elevated levels of Homocysteine(HCY),a sulfur-containing amino acid that is converted from methionine,have been found to be a high risk factor for neurodegenerative disease,and nearly 30 percent of PD patients have elevated plasma levels of HCY.In addition,many basic studies have shown that UA and HCY play an important role in the pathogenesis of PD and are closely related to the occurrence and development of PD.Therefore the both have the potential to be effective biomarkers for PD.However,in PD,the relationship between UA,Hey and disease stage,motor symptoms,daily living ability,equivalent daily dose of dopamine,cognitive function and other non-motor symptoms has not been determined.To explore the relationship is helpful to guide the research on the pathogenesis of PD and the development of clinical drug therapeutic targets.PurposeThe purpose of this study was to investigate the differences in serum UA and HCY levels between PD patients and normal control group,as well as the correlation between serum UA and HCY levels in PD patients and disease stage,motor symptoms,daily living ability,equivalent daily dose of dopamine,cognitive function and other non-motor symptoms.Patient Selection and Methods1.Subjects A total of 150 patients with idiopathic PD who were hospitalized in the First Affiliated Hospital of Zhengzhou University from September 2018 to December 2020 were prospectively included,and 123 normal controls matched with gender and age were selected during the same period.All subjects met the inclusion and exclusion criteria.Baseline data and biochemical indicators of concern were recorded for each subject,including gender,age,smoking history,alcohol consumption history,history of hypertension,history of diabetes,and serum UA and HCY levels.The age of onset,course of disease,education,medication history and daily equivalent dose of dopamine(LED)were recorded in PD patients.2.Scale assessment and cognitive grouping of PD Two professional neurologists conducted scale evaluation for PD patients,including the modified H-Y staging scale,the new MDS-UPDRS scale and the MMSE scale,which were used to evaluate disease staging,disease severity and cognitive function,respectively.For PD patients receiving anti-Parkinson’s medication and with obvious switching phenomenon,H-Y staging and part 3 of MDS-UPDRS scale were assessed at their close phase.According to MMSE scoring criteria(illiterate>17,primary school>20,junior high school and above>24 are cognitively normal),PD patients were divided into cognitively impaired group and cognitively normal group.3.Test for serum UA and HCY All inpatients and healthy volunteers for outpatient physical examination were collected 2ml median elbow venous blood under fasting state,and the serum was centrifuged within 1 hour.The serum UA and HCY levels were determined by automatic biochemical analyzer.4.Statistical methods Statistical analysis software SPSS 21.0 was used for statistical analysis.Counting data was expressed by frequency(rate or composition ratio),and the difference between two samples was compared by chi-square test.Shapiro-Wilk test was used for normality test.Data consistent with normal distribution was expressed as mean±standard deviation,t-test of two independent samples was used for comparison between two samples.Means and percentiles[M(P25,P75)]were used for data of non-normal distribution,and Wilcoxon rank test was used for comparison between two samples.Spearman correlation method was used for correlation analysis.P<0.05 was considered to be statistically significant.Results1.Compared with the control group,there were no significant differences in age,gender,smoking history,drinking history,history of hypertension and history of diabetes mellitus.Serum UA level in PD group was significantly lower than that in the control group[(245.47±59.84)umol/L vs(271.24±55.72)umol/L,P<0.05],and serum HCY level in PD group was significantly higher than that in the control group[(15.72±5.56)umol/L vs(12.42±2.94)umol/L,P<0.05].2.In PD group with cognitive impairment,the proportion of women,MDS-UPDRS-Ⅱ score and MDS-UPDRS-Ⅲ score are significantly higher than that in the normal cognition group;The serum UA level in PD group with cognitive impairment was significantly lower than that in the group without cognitive impairment[(221.53±62.15)umol/L vs(256.51±54.79)umol/L,P<0.05].3.In PD group,the serum HCY levels were positively correlated with MDS-UPDRS-Ⅱ scores and LEDs(P<0.05).ConclusionLow serum Uric acid level and high serum Homocysteine level may be associated with the prevalence of Parkinson’s disease.The lower the serum Uric acid level,the higher the risk of cognitive impairment.The serum Homocysteine level is positively correlated with daily equivalent dose of dopamine in Parkinson’s disease. |
