Urate as a Predictor of the Rate of Clinical Decline in Parkinson Disease

被引：288

作者：

Ascherio, Alberto ^{[1
,2
,3
]}

LeWitt, Peter A. ^{[6
,7
]}

Xu, Kui ^{[4
]}

Eberly, Shirley ^{[8
]}

Watts, Arthur ^{[8
]}

Matson, Wayne R. ^{[5
]}

Marras, Connie ^{[12
]}

Kieburtz, Karl ^{[9
]}

Rudolph, Alice ^{[9
]}

Bogdanov, Mikhail B. ^{[5
]}

Schwid, Steven R. ^{[9
]}

Tennis, Marsha ^{[4
]}

Tanner, Caroline M. ^{[13
]}

Beal, M. Flint ^{[10
]}

Lang, Anthony E. ^{[12
]}

Oakes, David ^{[8
]}

Fahn, Stanley ^{[11
]}

Shoulson, Ira ^{[9
]}

Schwarzschild, Michael A. ^{[4
]}

机构：

[1] Harvard Univ, Sch Publ Hlth, Dept Nutr, Boston, MA 02115 USA

[2] Harvard Univ, Sch Publ Hlth, Dept Epidemiol, Boston, MA 02115 USA

[3] Harvard Univ, Brigham & Womens Hosp, Sch Med, Dept Med,Channing Lab, Boston, MA 02115 USA

[4] Massachusetts Gen Hosp, MassGen Inst Neurodegenerat Dis, Dept Neurol, Boston, MA 02129 USA

[5] Bedford Vet Adm Med Ctr, Bedford, England

[6] Henry Ford Hosp, Dept Neurol, Detroit, MI 48202 USA

[7] Wayne State Univ, Sch Med, Detroit, MI 48202 USA

[8] Univ Rochester, Dept Biostat, Rochester, NY 14627 USA

[9] Univ Rochester, Dept Neurol, Rochester, NY USA

[10] Cornell Univ, Dept Neurol & Neurosci, New York, NY 10021 USA

[11] Columbia Univ, Dept Neurol, New York, NY USA

[12] Univ Toronto, Toronto Western Hosp, Morton & Gloria Shulman Movement Disorders Ctr, Toronto, ON M5T 2S8, Canada

[13] Parkinsons Inst, Dept Clin Res, Sunnyvale, CA USA

来源：

ARCHIVES OF NEUROLOGY | 2009年 / 66卷 / 12期

基金：

美国国家卫生研究院;

关键词：

SERUM URIC-ACID; 3RD NATIONAL-HEALTH; PLASMA URATE; VITAMIN-E; CONCENTRATION GRADIENTS; ANTIOXIDANT CAPACITY; MULTIPLE-SCLEROSIS; RISK; PEROXYNITRITE; METABOLISM;

D O I：

10.1001/archneurol.2009.247

中图分类号：

R74 [神经病学与精神病学];

学科分类号：

100204 [神经病学];

摘要：

Background: The risk of Parkinson disease (PD) and its rate of progression may decline with increasing concentration of blood urate, a major antioxidant. Objective: To determine whether serum and cerebrospinal fluid concentrations of urate predict clinical progression in patients with PD. Design, Setting, and Participants: Eight hundred subjects with early PD enrolled in the Deprenyl and Tocopherol Antioxidative Therapy of Parkinsonism (DATATOP) trial. The pretreatment urate concentration was measured in serum for 774 subjects and in cerebrospinal fluid for 713 subjects. Main Outcome Measures: Treatment-, age-, and sex-adjusted hazard ratios (HRs) for clinical disability requiring levodopa therapy, the prespecified primary end point of the original DATATOP trial. Results: The HR of progressing to the primary end point decreased with increasing serum urate concentrations (HR for highest vs lowest quintile=0.64; 95% confidence interval [CI], 0.44-0.94; HR for a 1-SD increase=0.82; 95% CI, 0.73-0.93). In analyses stratified by alpha-tocopherol treatment (2000 IU/d), a decrease in the HR for the primary end point was seen only among subjects not treated with alpha-tocopherol (HR for a 1-SD increase=0.75; 95% CI, 0.62-0.89; vs HR for those treated=0.90; 95% CI, 0.75-1.08). Results were similar for the rate of change in the Unified Parkinson's Disease Rating Scale score. Cerebrospinal fluid urate concentration was also inversely related to both the primary end point (HR for highest vs lowest quintile=0.65; 95% CI, 0.44-0.96; HR for a 1-SD increase=0.89; 95% CI, 0.79-1.02) and the rate of change in the Unified Parkinson's Disease Rating Scale score. As with serum urate concentration, these associations were present only among subjects not treated with alpha-tocopherol. Conclusions: Higher serum and cerebrospinal fluid urate concentrations at baseline were associated with slower rates of clinical decline. The findings strengthen the link between urate concentration and PD and the rationale for considering central nervous system urate concentration elevation as a potential strategy to slow PD progression.

引用

页码：1460 / 1468

页数：9

共 55 条

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