新发帕金森病的急性多巴反应性评价  

Acute Tests with L-dopa-carbidopa in De novo Patients with Primary Parkinson's Disease

作　　者：冯涛[1] 芦林龙[1] 张璇[1] 李伟[1] 于学英[1] 杨雅琴[1] 王拥军[1] 

机构地区：[1]首都医科大学附属北京天坛医院神经内科,100050

出　　处：《中国临床神经科学》2009年第4期377-380,共4页Chinese Journal of Clinical Neurosciences

摘　　要：目的:建立急性左旋多巴负荷试验用于鉴别新发帕金森病(PD)与新发帕金森综合征(PDS)患者,并筛选评价指标的临界值。方法:选择89例有PD样表现但未服用过左旋多巴的患者,根据临床诊断分为PD组(n=48)和PDS组(n=41),进行了急性左旋多巴/卡比多巴(100/25mg)试验。根据两组患者统一PD评分运动分量表(UPDRS-III)评分的平均最大改善率进行比较,并建立受试者工作特征(ROC)曲线,以该曲线上最大Youden指数对应的运动评分最大改善率作为临界值。结果:PD组在服用左旋多巴-卡比多巴后的平均UPDRS-III评分平均最大改善率高于PDS组,差异有统计学意义(P<0.01)。建立的ROC曲线在鉴别PD和PDS差异具有统计学意义,ROC曲线下面积为0.827(P<0.01),对应上网UPDRS运动评分改善率的最佳临界值为12.45%(Youden指数0.565,敏感度80.9%,特异度75.6%)。结论:急性左旋多巴-卡比多巴试验可作为PD疗效和诊断的一种辅助参考方法。Aim： To establish a new type of acute test with L-dopa-carbidopa and evaluate its diagnostic value in de novo patients with primary Parkinson＇s disease（PD） and parkinsonism（PDS）. Methods： 89 de novo patients were enrolled in this study, which include 48 patients with primary PD and 41 patients with PDS. The patients underwent the acute test with 100/25 mg of L-dopa-carbidopa. The peak UPDRS-III improvement after administration of L-dopa-carbidopa compared with the baseline was defined as motor response to L-dopa. The receiver operating characteristic（ROC） curves comparing the motor response of primary PD with that of non-PD were plotted. The points on ROC curves with maximal Youden index were defined as the optimal cutoff points. Results： The maximum UPDRS-Ⅲ improvement of de novo patients with PD was significantly higher than that of patients with PDS （19.15% ± 10.26% vs 8.63% ± 6.07%, P〈0.01）. The area under the curve of ROC for the test was 0.827（P〈0.01）. The optimal cutoff points for UPDRS-Ⅲ improvement was 12.45% （Youden index 0.565, sensitivity 80.9%, specificity 75.6%）. Conclusion： This test of L-dopa-carbidopa can be used to evaluate L-dopa-responsiveness in patients with primary PD as an additional tool for clinical diagnoses of PD.

关 键 词：帕金森病 左旋多巴 帕金森综合征 

分 类 号：R742.5[医药卫生—神经病学与精神病学]