帕金森病便秘的整骨疗法对肠道微生物群的影响：一项初步研究。
Gut Microbiome Changes with Osteopathic Treatment of Constipation in Parkinson's Disease: A Pilot Study.
作者信息
Mancini Jayme D, Yao Sheldon, Martinez Luis R, Shakil Haque, Li To Shan
机构信息
New York Institute of Technology College of Osteopathic Medicine, Northern Boulevard, Old Westbury, NY, USA.
Department of Oral Biology, University of Florida College of Dentistry, Gainesville, FL, USA.
出版信息
Neurology (ECronicon). 2021 Feb;13(2):19-33. Epub 2021 Jan 30.
INTRODUCTION
The gut microbiome appears to be predictive of Parkinson's disease (PD) with constipation. Chronic constipation frequently manifests prior to motor symptoms and impairs quality of life. An osteopathic manipulative medicine (OMM) sequence used physical exam assessment and manual treatment of neuromusculoskeletal dysfunctions pertinent to constipation in PD for this prospective ABA-design study, IRB-NYITBHS1065. The effects of 4 weekly treatments on the gut microbiome among men and women over 40 years old with chronic constipation and PD were investigated. Severity of PD was rated with the Movement Disorders Society-Unified PD rating scale (UPDRS) in six subjects with constipation. Also, the Bristol stool scale and questionnaires validated for constipation were administered for diagnosis, symptom severity, and quality of life during a 4-week control-period (A), 4-weekly OMM-treatments (B), and 2-weeks no-intervention (A). Biweekly stool samples were assessed for normalized microbiota abundance.
RESULTS
The mean Bristol rating improved from type 2 (± 1) Pre-OMM to 3 (± 1; p = .167; d = 0.677) Post-OMM. Mean constipation severity significantly decreased (p = .010; d = 1.508) Post-OMM. Mean quality of life significantly improved (p = .041; d = 1.072) Post-OMM. The Pre-OMM mean number of families within the phylum Firmicutes decreased by 3 (p = .043; d = 1.177) Post-OMM. There were significant changes in the normalized abundance of phyla Actinobacteria (p = .040; d = 0.845) and Verrucomicrobia (p = .024; d = 0.675) as well as in genus Roseburia (p = .033; d = 1.109), Intestinimonas (p = .035; d = 0.627) and Anaerotruncus (p = .004) Post-OMM.
CONCLUSION
The gut microbiome shifted among individuals with constipation and PD after four weekly treatments with the OMM-sequence. Changes in the gut microbiome Post-OMM were associated with UPDRS results and constipation measures. Clinical trials and studies to develop the gut microbiome into a validated biomarker for PD are necessary to understand the impact of OMM in patients with PD and constipation.
引言
肠道微生物群似乎可预测帕金森病（PD）伴便秘的情况。慢性便秘常在运动症状出现之前就已出现，并会损害生活质量。在这项前瞻性ABA设计研究（IRB-NYITBHS1065）中，一种整骨手法医学（OMM）序列采用体格检查评估和针对PD便秘相关神经肌肉骨骼功能障碍的手法治疗。研究了4周治疗对40岁以上患有慢性便秘和PD的男性和女性肠道微生物群的影响。使用运动障碍协会统一PD评定量表（UPDRS）对6名便秘患者的PD严重程度进行评分。此外，在为期4周的对照期（A）、4周的OMM治疗期（B）和2周的无干预期（A），使用布里斯托大便分类法和经过验证的便秘问卷来进行诊断、评估症状严重程度和生活质量。每两周采集一次粪便样本，评估标准化微生物群丰度。
结果
OMM治疗后，布里斯托评分平均值从治疗前的2型（±1）提高到3型（±1；p = 0.167；d = 0.677）。OMM治疗后，便秘严重程度平均值显著降低（p = 0.010；d = 1.508）。OMM治疗后，生活质量平均值显著改善（p = 0.041；d = 1.072）。OMM治疗后，厚壁菌门内的平均菌属数量减少了3个（p = 0.043；d = 1.177）。放线菌门（p = 0.040；d = 0.845）和疣微菌门（p = 0.024；d = 0.675）以及罗氏菌属（p = 0.033；d = 1.109）、肠道单胞菌属（p = 0.035；d = 0.627）和厌氧短杆菌属（p = 0.004）的标准化丰度在OMM治疗后有显著变化。
结论
在对便秘和PD患者进行4周的OMM序列治疗后，其肠道微生物群发生了变化。OMM治疗后肠道微生物群的变化与UPDRS结果和便秘指标相关。有必要开展临床试验和研究，将肠道微生物群发展成为PD的有效生物标志物，以了解OMM对PD和便秘患者的影响。
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