HCMV感染对老年帕金森病合并糖尿病视网膜病变患者视网膜功能和运动症状的影响  

Effect of HCMV infection on retinal function and motor symptoms of elderly Parkinson's disease patients complicated with diabetes retinopathy

作　　者：宋彦锡 张江山 程启慧[1] 林海丽[1] 吴海燕 SONG Yan-xi;ZHANG Jiang-shan;CHENG Qi-hui;LIN Hai-li;WU Hai-yan(Haikou People's Hospital,Haikou,Hainan 570203,China)

机构地区：[1]海口市人民医院神经内科,海南海口570203

出　　处：《中华医院感染学杂志》2023年第11期1695-1699,共5页Chinese Journal of Nosocomiology

基　　金：海南省卫生健康行业科研基金资助项目(20A200363)。

摘　　要：目的探究人巨细胞病毒(HCMV)感染对老年帕金森病(PD)合并糖尿病视网膜病变(DR)患者视网膜功能、运动症状的影响。方法选取2018年3月-2021年3月海口市人民医院收治的老年PD合并DR患者87例为研究对象,根据HCMV感染情况,将患者分为感染组(n=38)和未感染组(n=49),比较两组患者的视网膜功能和运动症状,蛋白免疫印迹法检测单个核细胞磷脂酰肌醇-3-激酶(PI3K)、蛋白激酶B(AKT)、雷帕霉素靶体蛋白(mTOR)的表达水平,多因素Logistic回归分析法分析HCMV感染的危险因素。结果感染组患者的黄斑厚度、视野平均缺损值(MD)和视网膜神经纤维层厚度(RNFL)均小于未感染组,日常生活活动和运动能力评分均高于未感染组(P<0.05);感染组患者单个核细胞PI3K、AKT和mTOR蛋白表达水平均高于未感染组(P<0.05);Logistic回归分析结果显示,空腹血糖(FPG)、胰岛素敏感指数(ISI)和CD_(4)^(+)/CD_(8)^(+)是PD合并糖尿病DR患者HCMV感染的危险因素,空腹胰岛素(FINS)是HCMV感染的保护因素(P<0.05)。结论糖代谢、胰岛素功能及免疫功能与HCMV感染的病理过程密切相关,而HCMV感染会加重老年PD合并DR患者视网膜病变与运动症状,其机制可能与HCMV感染激活PI3K/AKT/mTOR信号通路有关。OBJECTIVE To explore the influence of human cytomegalovirus(HCMV)infection on retinal function and motor symptoms in elderly patients with Parkinson's disease(PD)complicated with diabetic retinopathy(DR).METHODS A total of 87 patients with PD and DR who were admitted to the Haikou People's Hospital from Mar.2018 to Mar.2021 were selected as the study subjects,and were divided into the infected group(n=38)and the uninfected group(n=49)according to presence or absence of HCMV infection.The retinal function and motor symptoms were compared between the two groups.The expression levels of phosphoinositide 3-kinase(PI3K),protein kinase B(AKT)and mammalian target of rapamycin(mTOR)in mononuclear cells were detected by Western blot.Logistic regression analysis was used to analyze the risk factors of HCMV infection.RESULTS The macular thickness,mean deviation(MD)and retinal nerve fiber layer thickness(RNFL)of the infected group were smaller than those of the uninfected group,while the activities of daily living and motor ability scores were higher than those of the uninfected group(P<0.05).The protein expression levels of PI3K,AKT and mTOR in mononuclear cells of the infected group were significantly higher than those in the uninfected group(P<0.05).Logistic regression analysis showed that fasting plasma glucose(FPG),insulin sensitivity index(ISI)and CD_(4)^(+)/CD_(8)^(+)were independent risk factors for HCMV infection,while fasting insulin(FINS)was a protective factor(P<0.05).CONCLUSION Glucose metabolism,insulin function and immune function were closely related to the pathological process of HCMV infection,while HCMV infection aggravated retinopathy and motor symptoms in elderly patients with PD and DR.The mechanism might be related to the activation of PI3K/AKT/mTOR signaling pathway by HCMV infection.

关 键 词：人巨细胞病毒 感染 帕金森病 糖尿病视网膜病变 磷脂酰肌醇-3-激酶 蛋白激酶B 雷帕霉素靶体蛋白 危险因素 运动症状评估 

分 类 号：R781.64[医药卫生—口腔医学]