帕金森病中的体重变化与体力活动：能量平衡、疾病进展与生活方式照护的汇聚标志物

文献信息

中文摘要

背景： 体重变化在帕金森病（PD）中常见但常被忽视，可发生于前驱期、早期和晚期疾病阶段。体重减轻可能反映能量消耗增加、自主神经功能障碍、吞咽困难、胃肠功能障碍、食欲改变以及调节饥饿、饱腹感和奖赏的中枢通路受累。相反，体重增加可能与多巴胺能治疗、冲动控制或暴食行为、活动能力下降以及术后变化有关。新兴的纵向数据提示，体重变异性不仅仅是营养问题，还可能识别出不同的临床轨迹，包括体重减轻患者更快的认知和功能衰退，以及体重增加患者不同的运动/非运动模式。与此同时，体力活动和结构化锻炼日益被认为是PD照护的核心组成部分，有证据支持其症状获益、可能的疾病修饰作用，甚至与偶发PD的保护性关联。本综述探讨PD中体重变化与体力活动之间的交叉点，提出两者均反映了能量平衡、运动储备、代谢调节和生活方式相关韧性的更广泛破坏。我们讨论临床机制、生物标志物、预后意义，以及将体重监测、营养评估和个体化体力活动处方整合到常规PD照护中的实用方法。

英文摘要

Weight changes are common but often overlooked in Parkinson's disease (PD), occurring across prodromal, early, and advanced disease stages. Weight loss may reflect increased energy expenditure, dysautonomia, dysphagia, gastrointestinal dysfunction, altered appetite, and involvement of central pathways regulating hunger, satiety, and reward. Conversely, weight gain may occur in relation to dopaminergic treatment, impulse-control or binge-eating behaviours, reduced mobility, and post-surgical changes. Emerging longitudinal data suggest that weight variability is not merely a nutritional issue, but may identify distinct clinical trajectories, including faster cognitive and functional decline in patients with weight loss and different motor/non-motor patterns in those with weight gain. In parallel, physical activity and structured exercise are increasingly recognized as central components of PD care, with evidence supporting symptomatic benefits, possible disease-modifying effects, and even a protective association against incident PD. This review examines the intersection between weight changes and physical activity in PD, proposing that both reflect a broader disruption of energy balance, motor reserve, metabolic regulation, and lifestyle-related resilience. We discuss clinical mechanisms, biomarkers, prognostic implications, and practical approaches to integrate weight monitoring, nutritional assessment, and individualized physical activity prescriptions into routine PD care.