急性阶梯式左旋多巴试验受试者工作特征曲线在帕金森病诊断中的应用  

Receiver Operating Characteristics Curve of Acute Levodopa Challenge Test in Parkinson Disease

作　　者：冯涛[1] 王拥军[1] 李伟[1] 芦林龙[1] 马锐华[1] 史伟雄[1] 李娜[1] 王琰[1] 

机构地区：[1]首都医科大学附属北京天坛医院神经内科,北京市100050

出　　处：《中国康复理论与实践》2007年第7期658-660,共3页Chinese Journal of Rehabilitation Theory and Practice

摘　　要：目的建立急性阶梯式左旋多巴试验,观察原发性帕金森病和非帕金森病帕金森综合征患者急性多巴反应性受试者工作特征(ROC)曲线,以期选择适当的运功改善程度指标临界值诊断原发性帕金森病。方法对帕金森病患者102例和非帕金森病帕金森综合征患者49例进行不同剂量水平的急性左旋多巴试验,以统一帕金森病评分量表(UPDRS)运动部分评分为指标,比较两组患者在不同左旋多巴/苄丝肼剂量水平服药后UPDRS运动部分评分平均最大改善率的差异,建立急性左旋多巴试验的ROC曲线,计算不同临界值下的诊断敏感度和特异度。结果在左旋多巴/苄丝肼150/37.5mg、200/50mg、300/75mg剂量均有临界值可到达80%以上的敏感度和特异度。临界值设定在300/75mg剂量水平的28.5%时可达到97.1%的敏感度;临界值设定在150/37.5mg剂量水平的22.5%可达到93.2%的特异度。结论通过阶梯式急性左旋多巴试验方法可以有效量化帕金森病患者的多巴反应性。选择一定的UPDRS运动评分最大改善率为临界值可使该试验在帕金森病诊断中达到较高的敏感度和特异度。Objective To establish a new protocol and receiver operator characteristic curves of acute levodopa challenge test with consecutive dosage of levodopa in Parkinson disease （PD）. Methods The levodopa responsiveness was analyzed in 151 parkinsonian patients, including 102 with a clinical diagnosis of PD and 49 with non-PD parkinsonian syndrome. All patients received consec- utive dosage of oral levodopa/benserazide （50/12.5 mg, 100/25 mg, 150/37.5 mg, 200/50 mg, 300/75 mg） every morning in 5 days. The UPDRS part Ⅲ scores were evaluated every 30 min until 6 h after administration. The maximum improvement of UPDRS part Ⅲ scores was compared between patients with PD and those with non-PD. The receiver operating characteristics curves were plotted comparing PD vs non-PD. The cutoff of improvement was defined as the value with maximal diagnostic sensitivity and maximal specificity. Results The sensitivity and specificity of the test were over 80% with selective cut-off point were 150/37.5 mg, 200/ 50 mg and 300/75 mg of levodopa/benserazide. The sensitivity was 97. 1% when the cut-off point was set at 28.5% with 300/75 mg of levodopa/benserazide. The specificity was 93.2% when the cut-off point was set at 22.5% with 150/37.5 mg of levodopa/ benserazide. Conclusion The acute levodopa challenge test with consecutive dosage of levodopa/benserazide should be used to assess the levodopa responsiveness. The cutoff of improvements may be useful in diagnosis of PD.

关 键 词：帕金森病 左旋多巴反应性 急性左旋多巴治疗试验 受试者工作特征曲线 

分 类 号：R742.5[医药卫生—神经病学与精神病学]