多巴胺能药物治疗对帕金森病运动并发症影响的系统评价  

Systematic evaluation on influence of doparminergic therapy： on motor complications in Parkinson＇s disease

作　　者：周明珠[1] 刘振国[1] 陈伟[1] 陆丽霞[1] 吴佳英[1] 戚辰[1] 

机构地区：[1]上海交通大学医学院附属新华医院神经科,200092

出　　处：《中华医学杂志》2009年第7期438-444,共7页National Medical Journal of China

基　　金：教育部留学回国人员科研启动基金（2006-331）;上海市教育委员会基金（06BZ048）;上海市浦江人才计划;上海市科委上海-飞利浦研究与发展基金合作基金（07SP07005）

摘　　要：目的系统评价多巴胺能药物对帕金森病（PD）运动并发症的影响。方法提出2个临床问题，（1）左旋多巴（LD）的剂量、疗程、起始治疗时间是否为运动并发症的影响因素？（2）多巴胺受体激动剂（DA）起始治疗是否可以延缓运动并发症的发生？通过Medline、Embase、Cochrane Database，检索国内外至2008年5月已发表的关于LD对PD异动症（DK）或症状波动（MF）影响的前瞻性及回顾性研究以及早期单用DA与LD比较治疗PD的随机对照临床研究（RCT），对所纳入文献进行评价。结果对于问题（1）共纳入12项文献，包括包括1项RCT，5项队列研究，6项病例对照研究。对于问题（2）共纳入6项RCTs。因研究存在临床异质性，仅对结果进行描述性分析。结果显示LD起始剂量、每公斤体重LD剂量、研究终点LD累积剂量、研究终点LD累积等效剂量对运动并发症的发生可能是独立的影响因素。LD起始治疗时间与运动并发症无相关性。运用DA起始治疗可以减少DK的发生（CALM—PD：HR=0．37，95％CI：0．25～0．56，P〈0．001；PELMOPET：HR=0．48，95％CI=0．29～0．80，P〈0．001；Ropinirole 056：HR=0．4，95％CI：0．2—0．8，P=0．007；REAL—PET：HR=8．28，95％CI：2．46～27．93，P〈0．001）。LD疗程与运动并发症的相关性还需进一步研究证实。结论从目前的研究可以初步分析出影响PD运动并发症的因素，但仍需要更多高质量的研究进一步作出评估。Objective To investigate the impact of doparminergic therapy on the onset of motor complications in Parkinson＇s disease （PD）. Methods Two clinical questions were identified. （1） Whether levodopa （LD）dose, LD treatment duration, the time from disease onset to initiation of LD can predict the onset of motor complications in PD？ and （2） whether dopamine agonists （DA） used in de novo patients can delay the onset of motor complications？ Literatures on observation studies of factors associated with motor complications and randomized controlled trials （ RCTs ） of DA compared to LD in treatment of de novo patients published before May 2008 were retrieved from Pubmed, EMbase, and Cochrane Database. Methodology quality was critically assessed. Results 12 articles on the first question were selected,including one RCT,five cohort studies, six case-control studies. Six RCTs on the second question were selected. Because of clinical heterogeneity among the researches thus retrieved, recta-analysis was not conducted, and qualitative analysis showed that initial LD dose, LD dose per kilogram body weight, accumulated LD dose, and accumulated LD equivalent dose might be independent factors associated with motor complications. The time from disease onset to initiation of LD was not correlated with motor complications. DA as initial treatment was associated with later occurrence of dyskinesias （CALM-PD ：HR = 0.37,95%CI：0.25 -0.56,P〈0.001; PELMOPET：HR =0.48,95%CI=0.29 -0.80,P〈0.001; Ropinirole 056 ： HR = 0.4,95 % CI： 0. 2 - 0. 8, P = 0. 007 ; RE AL-PET ： HR = 8.28,95 % C!： 2. 46 - 27.93, P 〈 0. 001 ） . The relationship between LD treatment duration and motor complications could not be concluded from present evidence. Conclusion Initial LD dose, LD dose per kilogram body weight, accumulated LD dose, and accumulated LD equivalent dose may be independent factors associated with motor complications. The time from disease onset to initiation of LD was not correlated with motor complicat

关 键 词：帕金森病 左旋多巴 多巴胺受体激动剂 异动症 

分 类 号：R686[医药卫生—骨科学]