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帕金森病患者营养状况及其与认知功能的相关性
Nutritional status and its correlation with cognitive function in patients with Parkinson’s disease
目的 探讨帕金森病（PD）患者营养不良风险的发生情况，以及高营养不良风险与认知障碍的发生是否存在相关性。方法 纳入2023年3月至2025年1月泰州市第四人民医院收入的150例PD患者，采用老年营养风险指数（GNRI）评估PD患者的营养状况，GNRI评分≥98分表示不存在营养不良风险，评分< 98分表示高营养不良风险。将150例患者分为高GNRI组（评分≥98分）和低GNRI组（评分< 98分），采用简易精神状态量表（MMSE）对2组PD患者进行认知功能评估，分析认知障碍的患病率。采用Logistic回归分析营养不良风险与认知障碍的相关性。结果 150例PD患者中存在高营养不良风险的患者共70例，高营养不良风险发生率为46.7%。低GNRI组70例，高GNRI组80例，合并认知障碍患者共71例，患病率为47.3%，其中低GNRI组43例发生认知障碍，发病率为61.4%，MMSE评分为21.5（14.0，26.0）分，高GNRI组发生认知障碍者有28例，发病率为35.0%，MMSE评分为23.5（18.8，27.0）分，2组患者的认知障碍发生率、MMSE评分对比差异有统计学意义（均P < 0.05）。同时，2组患者的年龄、发病时间、H-Y分级、甘油三酯、甲状腺功能、血红蛋白、血糖、尿酸比较差异均有统计学意义（均P < 0.05），在血管危险因素、文化程度等方面比较差异无统计学意义（均P > 0.05）。多因素二元Logistic回归分析显示，在校正了疾病病程、H-Y分级等因素后，存在认知障碍（OR=2.66，P = 0.009）、年龄（OR=0.93，P = 0.004）、促甲状腺激素（OR=1.36，P = 0.006）是PD患者发生营养不良风险的影响因素。结论 PD患者发生营养不良风险高，有营养不良风险的PD患者认知障碍的发病率更高，存在认知障碍是PD患者发生高营养不良风险的危险因素。
Objective To investigate the prevalence of malnutrition risk in patients with Parkinson’s disease （PD）， and explore the correlation between high malnutrition risk and cognitive impairment. Methods A total of 150 PD patients admitted to the Forth People’s Hospital of Taizhou from March 2023 to January 2025 were included. The GeriatricNutritional Risk Index （GNRI） was used to assess the nutritional status of PD patients. A GNRI score ≥98 indicated no malnutrition risk， while a score < 98 indicated malnutrition risk. The patients were divided into a high GNRI group （score ≥98） and a low GNRI group （score < 98）. Cognitive function was evaluated using the Mini-Mental State Examination （MMSE）， and the prevalence of cognitive impairment was analyzed. Logistic regression was used to analyze the correlation between malnutrition risk and cognitive impairment. Results Among the 150 patients， 70 were at risk of malnutrition， with a high malnutrition risk prevalence of 46.7%. The low GNRI group comprised 70 patients， while the high GNRI group comprised 80 patients. A total of 71 patients had cognitive impairment， with an incidence rate of 47.3%.In the low GNRI group， 43 patients had cognitive impairment， with an incidence rate of 61.4% and an MMSE score of 21.5 （14.0， 26.0）. In the high GNRI group， 28 patients had cognitive impairment， with an incidence of 35.0% and an MMSE score of 23.5 （18.8， 27.0）. The differences in the incidence of cognitive impairment and MMSE scores between the two groups were statistically significant （both P < 0.05）. At the same time， significant differences were observed between the two groups in terms of age， disease duration， H-Y stage， triglyceride levels， thyroid function， hemoglobin ， blood glucose， and uric acid levels （all P < 0.05）， while there were no statistically significant differences in vascular risk factors or educational level （all P > 0.05）. Multivariate binary logistic regression analysis suggested that cognitive impairment （OR=2.66，P = 0.009），age（OR=0.93， P = 0.004）， TSH（OR=1.36，P =0.006） were influencing factors for malnutrition risk in PD patients after correcting factors such as disease duration and H-Y stage. Conclusions PD patients have a high risk of malnutrition， and those at risk of malnutrition exhibit a higher incidence of cognitive impairment. Cognitive impairment is a risk factor for high malnutrition risk in PD patients.
帕金森病 / 营养不良 / 老年营养风险指数 / 认知障碍 {{custom_keyword}} /
Parkinson’s disease / Malnutrition / Geriatric nutritional risk index / Cognitive impairment {{custom_keyword}} /
表1 低GNRI组与高GRNI组帕金森病患者的一般资料比较Table 1 Comparison of general information between Parkinson, s disease patients with low GNRI and high GRNI |
| 项 目 | 低GNRI组（n=70） | 高GNRI组（n=80） | χ 2/Z/t值 | P值 |
|---|---|---|---|---|
| 性别/n（%） | 0.048 | 0.827 | ||
| 男 | 38（54.3） | 42（52.5） | ||
| 女 | 32（45.7） | 38（47.5） | ||
| 年龄/岁 | 76.0（72.0，79.0） | 72.0（67.0，76.0） | 3.714 | <0.001 |
| 身高/cm | 160.0（157.3，170.0） | 163.5（158.0，169.0） | -0.590 | 0.555 |
| 体质量/kg | 59.19±10.31 | 64.39±8.43 | -3.358 | 0.001 |
| 文化程度/n（%） | 1.655 | 0.437 | ||
| 文盲 | 22（31.4） | 33（41.3） | ||
| 小学 | 22（31.4） | 20（25.0） | ||
| 初中及以上 | 26（37.1） | 27（33.8） | ||
| 病程/年 | 3.0（2.0，6.0） | 2.0（1.0，5.0） | 2.528 | 0.011 |
| H-Y分级 | 3.0（2.5，4.0） | 3.0（1.9，3.6） | 2.292 | 0.022 |
| PD治疗方案/n（%） | 1.219 | 0.544 | ||
| 多巴制剂/多巴脱羧酶+激动剂 | 50（71.4） | 61（76.3） | ||
| 多巴制剂/多巴脱羧酶+激动剂+金刚烷胺 | 17（24.3） | 14（17.5） | ||
| 其他（单药、联合苯海索） | 3（4.3） | 5（6.3） | ||
| 是否存在认知障碍/n（%） | 10.460 | 0.001 | ||
| 是 | 43（61.4） | 28（35.0） | ||
| 否 | 27（38.6） | 52（65.0） | ||
| MMSE/分 | 21.5（14.0，26.0） | 23.5（18.8，27.0） | -2.155 | 0.031 |
| GNRI/分 | 93.1（89.8，95.6） | 102.2（100.7，104.8） | -10.496 | <0.001 |
| 高血压/n（%） | 0.964 | 0.326 | ||
| 否 | 38（54.3） | 37（46.3） | ||
| 是 | 32（45.7） | 43（53.8） | ||
| 糖尿病/n（%） | 0.049 | 0.825 | ||
| 否 | 57（81.4） | 64（80.0） | ||
| 是 | 13（18.6） | 16（20.0） | ||
| 冠心病/n（%） | 3.621 | 0.057 | ||
| 否 | 54（77.1） | 71（88.8） | ||
| 是 | 16（22.9） | 9（11.2） | ||
| 血红蛋白/（g/L） | 118.9±15.5 | 129.8±14.0 | -4.532 | <0.001 |
| FT3/（pmol/L） | 4.2（3.7，4.6） | 4.6（4.1，5.2） | -3.524 | <0.001 |
| FT4/（pmol/L） | 12.0（11.0，12.8） | 11.3（10.0，12.5） | 2.505 | 0.012 |
| T3/（nmol/L） | 1.25（1.01，1.39） | 1.4（1.23，1.58） | -3.553 | <0.001 |
| T4/（nmol/L） | 119.0±21.2 | 123.6±22.2 | -1.297 | 0.197 |
| TSH/（mU/L） | 1.57（1.11，2.86） | 2.60（1.55，3.77） | -2.867 | 0.004 |
| 低密度脂蛋白胆固醇/（mmol/L） | 2.46±0.71 | 2.52±0.76 | -0.551 | 0.583 |
| 高密度脂蛋白胆固醇/（mmol/L） | 1.11（0.97，1.27） | 1.20（1.05，1.38） | -1.586 | 0.113 |
| 总胆固醇/（mmol/L） | 4.0±0.9 | 4.2±1.1 | -0.837 | 0.404 |
| 甘油三酯/（mmol/L） | 0.97（0.82，1.35） | 1.21（0.91，1.83） | -2.579 | 0.010 |
| 血糖/（mmol/L） | 5.0（4.6，5.5） | 5.3（4.9，5.8） | -2.185 | 0.029 |
| 血尿酸/（mmol/L） | 299.5（236.3，363.5） | 332.5（278.8，398.8） | -1.999 | 0.046 |
表2 帕金森病患者营养风险的多因素二元Logistic回归分析Table 2 Multivariate binary logistic regression analysis of nutritional risk in Parkinson, s disease patients |
| 自变量 | β值 | β值标准误 | Z值 | P值 | OR（95%CI） |
|---|---|---|---|---|---|
| 常量 | 3.671 | 1.896 | 1.936 | 0.053 | |
| 年龄 | -0.068 | 0.023 | -2.918 | 0.004 | 0.93（0.89，0.98） |
| 是否存在认知障碍 | 0.980 | 0.374 | 2.623 | 0.009 | 2.66（1.28，5.54） |
| 病程 | -0.042 | 0.059 | -0.715 | 0.475 | 0.96（0.86，1.08） |
| H-Y分级 | -0.163 | 0.211 | -0.771 | 0.441 | 0.85（0.56，1.29） |
| T3 | -0.170 | 0.197 | -0.862 | 0.389 | 0.84（0.57，1.24） |
| TSH | 0.307 | 0.111 | 2.772 | 0.006 | 1.36（1.09，1.69） |
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