The only characteristic of alpha-synuclein (AS) accumulation in the gastrointestinal (GI) tract of Parkinson’s disease (PD) found in pathological studies is the “rostrocaudal gradient,” which describes the more frequent presence of AS accumulation in the upper GI tract than in the lower GI tract. This study aimed to determine the diagnostic accuracy and identify predictors of AS accumulation in the GI tract of PD patients. The frequency of AS accumulation in the GI tract was compared between PD patients (N = 97) who underwent radical GI surgery for cancer and individually matched controls (N = 94). We evaluated AS accumulation in the neural structures using phosphorylated AS immunohistochemistry. A multivariable logistic regression analysis was conducted to determine the predictors of AS accumulation in the GI tract of PD patients. The frequency of AS accumulation was significantly higher in PD patients (75.3%) than in controls (8.5%, p-value < 0.001). The sensitivity and specificity of the full-layer evaluation were 75.3% and 91.5%, respectively. When the evaluation was confined to the mucosal/submucosal layer, the sensitivity and specificity were 46.9% and 94.7%, respectively. The rostrocaudal gradient of AS accumulation was found in PD patients. The duration from symptom onset to surgery was significantly longer in PD patients with AS accumulation (4.9 ± 4.9 years) than in PD patients without AS accumulation (1.8 ± 4.1 years, p-value = 0.005). Both disease duration and rostrocaudal gradient independently predicted the presence of AS accumulation in the GI tract of PD patients. Our study suggests PD-related AS accumulation in the GI tract follows a temporally increasing but spatially static progression pattern.

病理研究中发现的帕金森病 (PD) 胃肠道 (GI) 中 α-突触核蛋白 (AS) 积聚的唯一特征是“头尾梯度”，它描述了上胃肠道中 AS 积聚的出现频率高于其他部位。在下胃肠道。本研究旨在确定帕金森病患者胃肠道中 AS 积累的诊断准确性并确定预测因子。对接受癌症根治性胃肠道手术的 PD 患者 ( N = 97) 和单独匹配的对照 ( N = 94) 之间胃肠道中 AS 积累的频率进行了比较。我们使用磷酸化 AS 免疫组织化学评估了神经结构中 AS 的积累。进行多变量逻辑回归分析以确定 PD 患者胃肠道中 AS 积累的预测因素。 PD 患者中 AS 积累的频率 (75.3%) 显着高于对照组 (8.5%， p值 < 0.001)。全层评估的敏感性和特异性分别为75.3%和91.5%。当评估仅限于粘膜/粘膜下层时，敏感性和特异性分别为46.9%和94.7%。在 PD 患者中发现了 AS 积累的头尾梯度。具有 AS 累积的 PD 患者从症状出现到手术的持续时间（4.9 ± 4.9 年）明显长于无 AS 累积的 PD 患者（1.8 ± 4.1 年， p值 = 0.005）。疾病持续时间和颈尾梯度均可独立预测 PD 患者胃肠道中 AS 蓄积的存在。我们的研究表明，胃肠道中与 PD 相关的 AS 积累遵循时间上增加但空间上静态的进展模式。