托卡朋治疗帕金森病运动功能波动的临床观察  

Clinical trial of catechol O methyltransferase inhibitor tolcapone in the treatment of motor function fluctuation of Parkinson's disease

作　　者：王新德[1,2,3] 张文记[1,2,3] 陈生弟[1,2,3] 翁中芳[1,2,3] 刘道宽[1,2,3] 王坚[1,2,3] 

机构地区：[1]卫生部北京医院帕金森病和锥体外系疾病诊疗中心 [2]上海第二医科大学附属瑞金医院神经科 [3]上海医科大学附属华山医院神经科

出　　处：《中华老年医学杂志》1999年第2期84-87,共4页Chinese Journal of Geriatrics

摘　　要：目的研究儿茶酚－氧位－甲基转移酶抑制剂（ＣＯＭＴＩ）托卡朋对帕金森病（ＰＤ）患者在复方左旋多巴治疗过程中出现的运动功能波动，如开－关现象、剂末现象、疗效减退、左旋多巴用量减少情况，并观察不良反应。方法对６９例ＰＤ患者采用多中心自身对照开放方法进行临床观察。应用复方左旋多巴剂量稳定６周后，对符合入选条件者给予托卡朋５０～１００ｍｇ每天３次，１疗程为６周，总的临床观察时间为１２周。结果托卡朋治疗前改良Ｗｅｂｓｔｅｒ评分为（１４．６４±４．４３）分，治疗后为（９．７１±４．０３）分，平均分数减少了３３．２％（Ｐ＜０．０１）。６９例中，显效１０例（１４．５％），进步４３例（６２．３％），稍有进步１５例（２１．７％），无效１例（１．５％）；总有效率为９８．５％。有开－关现象的２２例中，从患者日记统计，托卡朋治疗后“开”期从（６．２３±２．８０）小时延长至（９．００±３．３５）小时（Ｐ＜０．０１）。６９例中，有８例左旋多巴剂量在治疗后较治疗前减少３４．６％。６９例患者中３４例出现不同类型的轻度不良反应，随治疗进行可自行缓解。结论托卡朋是治疗使用复方左旋多巴时出现的运动功能波动，如开－关现象、剂末现象和疗效减退者的有效药?Objective To study the efficacy of catechol O methyltransferase inhibitor (COMTI) tolcapone in the treatment of motor function fluctuation such as on off phenomenon, end of dose phenomenon, reduction of levodopa requirement and its side effects. Methods Sixty nine cases of Parkinson's disease were studied clinically with multicenter, open label method. In the first 6 weeks a stable dose of levodopa was given to patients fitting in with the entering criteria, then tolcapone 50 100 mg three times per day was added to levodopa therapy for the next 6 weeks. The total time of clinical observation was 12 weeks. Results The scores of modified Webster's scale prior and post tolcapone therapy were 14.64±4.43 and 9.71±4.03 respectively. On the average there was a 33.2% reduction of the Webster's scores ( P <0.01). Among the 69 cases, there were 10 cases with significant therapeutic effects (14.5%), 43 cases with therapeutic effects (62.3%), 15 cases with slight therapeutic effects (21.7%) and one case without therapeutic effects (1.5%). In 22 cases with on off phenomenon treated with tolcapone, daily “on” time, according to patients' diaries, was increased from (6.23±2.80) hours to (9.00±3.35) hours ( P <0.01). Among the 69 cases, 34.6% of daily levodopa intake was reduced after treatment with tolcapone from baseline in 8 cases. In 34 cases, different mild adverse effects were observed and they subsided spontaneously in the course of tolcapone treatment. Conclusions Tolcapone is an effective drug for treatment of motor function fluctuation occurring during levodopa therapy such as on off phenomenon, end of dose phenomenon and decrease of levodopa therapeutic effects.

关 键 词：帕金森病 左旋多巴 COMTI 治疗 

分 类 号：R742.505[医药卫生—神经病学与精神病学]