Correlation Between Serum 25-hydroxyvitamin D3 And Clinical Symptoms Of Parkinson’s Disease

Objective:To study the correlation between serum vitamin D and clinical symptoms of Parkinson’s disease,and to explore the value of vitamin D level in PD monitoring,management and precision treatment.Methods:A total of 215 PD patients in outpatient and inpatient clinics from September2019 to September 2020 were collected as the experimental group from Shengjing Hospital Affiliated to China Medical University.A total of 215 healthy patients with PD matched in age and gender and without other known neuropsychiatric diseases were selected from the physical examination center database of our hospital as the control group.Data collection date,age,gender,length of education,smoking history,dairy intake history,alcohol consumption history,pesticide exposure history,PD course,and average sunshine duration in the last 3 months were recorded.The drug use of PD patients in recent 3 months was asked in detail,and the daily equivalent agent（LED）of levodopa was calculated.PD patients are recorded with a head-up tilt HUT testing bed resting state,tilted 60°upright min 1 and 3 min,the change of the blood pressure.The net body height and net weight of PD patients were measured,and body mass index（BMI）was calculated.The motor symptoms of PD patients were assessed by Hoehn-Yahr and Part 3 of the unified Parkinson’s Disease Comprehensive Rating Scale（UPDRS-III）,the risk of falling was assessed using the Berg Balance Scale（BBT）,and all PD patients were recorded for the subtypes of PD,which were tremor subtype,postural and gait abnormality subtype,and a combination of both.Non-motor symptoms of PD were recorded by NMSQ（Non-motor symptoms questionnaire）.The Mini-mental state examination（MMSE）and Montreal cognitive assessment（Mo CA）were used to preliminarily screen cognitive dysfunction.Autonomic nervous dysfunction was assessed by the scale for outcomes in PD for autonomic symptoms SCOPA-AUT.Hamilton Depression Scale（HAMD）and Hamilton Anxiety Scale（HAMA）were used to evaluate the emotional disorder of PD patients.Impulse control disorders were assessed using the Questionnaire for Impulsive-Compulsive Disorders in Parkinson’s Disease（QUIP-Current-Short）.Sleep conditions was assessed by Pittsburgh sleep quality index（PSQI）and Epworth Sleepiness Scale（ESS）.Fatigue severity scale（FSS）was used to evaluate fatigue symptoms.Hypoosmia was determined by HRS score less than 23.The scores of item 17 in UPDRS Part 2 were recorded to determine whether PD patients had pain.Fasting serum levels of calcium,phosphorus and 25（OH）D₃in the morning were collected and determined.According to whether 25（OH）D₃was less than 20ng/m L,they were divided into two groups:vitamin D deficiency group（25（OH）D₃≤20ng/m L）and vitamin D non-deficiency group（25（OH）D₃>20ng/m L）.Univariate analysis was used to compare the differences between the two groups in general data and scores of various scales,and then correlation analysis and regression analysis were conducted to explore whether vitamin D level was an independent risk factor for various clinical symptoms of PD.Results:1.There was no significant difference between 25（OH）D₃level and serum calcium ion level,phosphorus level,statistical month and average sunshine duration.2.In general data of PD group and healthy control group,there were no statistically significant differences in age,gender,BMI,statistical month and average sunshine duration between the two groups.The serum level of 25（OH）D₃in PD group was21.86±9.56ng/m L,compared with 25.84±6.79ng/m L in healthy control group（P<0.001）,and the difference was statistically significant.25（OH）D₃≤20ng/m L was associated with PD（P<0.001）,while 25（OH）D₃<30ng/m L was not associated with PD risk.3.There were no statistically significant differences between the 25（OH）D₃deficiency group and the 25（OH）D₃non-deficiency group in age,gender,BMI,Calcium phosphate levels,years of education,PD course,history of tobacco and alcohol use,history of dairy intake,pesticide exposure history,disease subtype,month of participation in statistics,total score of UPDRS,H-Y stage,ESS,HRS,frozen GAIT,constipation,urinary symptoms,RBD,PLS,hallucination,etc.The scores of LED,UPDRS Part III,MMSE,MOCA,FSS,PSQI,HAMD,HAMA,NMSQ,SCOPA-AUT,Berg and other scales in the vitamin D deficiency group were higher（P<0.001）,and the incidence rate of postural-hypotension was higher,with statistically significant differences.4.25（OH）D₃level,HAMD score and BBT score were independently correlated with MMSE（P<0.05）.25（OH）D₃level,NMSQ scale score,BBT score,SCOPA-AUT score and PSQI score were independently correlated（P<0.05）.25（OH）D₃level,MOCA scale score,SCOPA-AUT score,smoking history and NMSQ score were independently correlated（P<0.05）.25（OH）D₃level,postupositional hypotension,MOCA scale score,MMSE scale score,NMSQ score and SCOPA-AUT score were independently correlated（P<0.05）.Conclusion:1.The level of 25（OH）D₃in PD patients is lower than that in healthy people.The severity of motor symptoms in PD patients with vitamin D deficiency is greater,and the balance,autonomic nervous function symptoms,cognitive level,and sleep condition are worse than that in patients without vitamin D deficiency.2.25（OH）D₃level was an independent influencing factor for cognitive impairment,sleep disturbance and autonomic nervous dysfunction in PD patients.