普拉克索治疗帕金森病运动并发症的临床研究  

Clinical study of pramipexole on treatment of Parkinson＇ s disease with motor complications

作　　者：刘红[1] 张本恕[1] 王钰[1] 

机构地区：[1]天津医科大学总医院神经内科,300052

出　　处：《中华神经科杂志》2009年第12期845-848,共4页Chinese Journal of Neurology

摘　　要：目的探讨普拉克索对经复方左旋多巴治疗并且已经出现运动并发症的中晚期帕金森病（PD）患者的疗效和安全性。方法42例PD患者在原有复方左旋多巴治疗的基础上加用普拉克索1．5～3．0mg／d，为期12周。疗效指标为治疗前后统一PD评定量表（Unified Parkinson’s DiseaseRating Scale，UPDRS）及汉密尔顿抑郁量表（Hamilton Depression Scale，HAMD）评分，其中UPDRSI及HAMD用于评价精神、行为、情绪等非运动症状；UPDRSⅡ评价日常生活活动能力；UPDRSⅢ、Ⅳ及“开”期和“关”期时间的变化用于评价运动功能，并对患者的临床疗效进行整体评价。安全性指标为不良反应、血压、脉搏、实验室检查、心电图及对认知功能的影响。结果治疗12周后，UPDRS各项评分均减少，差异具有统计学意义（UPDRS总分：52．05±7．69与39．26±7．64，t=25．378，P〈0．05）。UPDRS运动评分改善22．61％，“开”期持续时间增加约1．64h；复方左旋多巴用量平均减少129．46mg／d；治疗并发症评分变化均值下降1．45分；HAMD评分均值下降6．14分。不良反应主要有头晕、嗜睡、恶心、便秘、厌食等。结论普拉克索对运动症状和非运动症状均有较好的疗效，不良反应发生率低，中晚期PD患者加用普拉克索是安全而有效的。Objective To investigate the efficacy and safety of pramipexole in the treatment of Parkinson＇ s disease （ PD ） in middle-to-advanced stage. Methods Forty-two PD patients having been treated with levodopa were enrolled in the study. In addition to levodopa, pramipexole was added at 1.5--3.0 mg/d. The efficacy of pramipexole was assessed by using the Unified Parkinson＇ s Disease Rating Scale （UPDRS） and Hamilton Depression Scale （HAMD） score. The UPDRS I and HAMD were used to evaluate non-motor symptoms such as behavior, mood, depression. The UPDRS Ⅱ was used to evaluate ability in daily life. The score of UPDRS Ⅲ, Ⅳ and the duration of on time and off time were used to evaluate motor symptoms. The overall evolution of clinical efficacy in using pramipexole was summarized. The safety was evaluated on the basis of adverse events, blood pressure, pulse, laboratory tests, ECG and cognition function recordings. Results There was a significant improvement in parkinsonian symptoms after administering pramlpexole. Each of UPDRS scores from start point to endpoint was declined （ UPDRS total ： 52. 05±7.69 vs 39. 26 ±7.64,t =25. 378, P 〈0. 05）. At the end of 12-weeks trial, the averaged UPDRS Ⅲ score had decreased by 22. 61% , the duration of on times increased by 1.64 hours. The daily levodopa dosage was reduced by 129.46 mg/d. The treatment complications score had decreased by 1.45. The averaged HAMD score had decreased by 6. 14. The main adverse events were dizziness, somnolence, nausea, constipation, and anorexia. Condusion Pramipexole is well effective in improving motor symptoms as well as non-motor symptoms such as depression, and the adverse events is mild. Pramipexole is a safe and effective treatment in Chinese patients with PD.

关 键 词：帕金森病 运动障碍 左旋多巴 多巴胺激动剂 苯并噻唑类 

分 类 号：R742.5[医药卫生—神经病学与精神病学] R749.3[医药卫生—临床医学]