左旋多巴诱导的帕金森病患者剂末现象发生的预测因素  

Factors predictive of the development of levodopa-induced wearing-off in Parkinson's disease

作　　者：徐绍君[1] 朱红灿[1] 李春[1] 张齐[1] 段晓佳[1] 赵芳芳[1] 

机构地区：[1]郑州大学第一附属医院神经内科,河南郑州450052

出　　处：《中风与神经疾病杂志》2014年第2期143-146,共4页Journal of Apoplexy and Nervous Diseases

摘　　要：目的研究左旋多巴(LD)诱导的帕金森病(PD)患者剂末现象(WO)发生的预测因素。方法收集使用LD治疗的原发性PD患者113例,记录性别、年龄、起病年龄、病程、LD日剂量、LD疗程、使用的其他抗PD药物、WO的发生时间等资料,H-Y分级和UPDRS运动部分(UPDRS PartⅢ)评分用于评估疾病的严重程度。结果 113例PD患者中出现WO患者43例(38.3%),与未发生WO的患者相比,发生WO的患者起病年龄早(P<0.042),病程长(P<0.001),LD起始剂量较高(P<0.001),起病至首次使用DA治疗的间隔时间较长(P<0.001),UPDRS运动部分评分及H-Y分级较高(P<0.001),以DA启动治疗的患者较LD启动治疗后再添加DA的患者WO发生率低(P=0.002)。起病年龄、病程、LD起始剂量、UPDRS运动部分(UPDRS PartⅢ)评分是WO发展的独立影响因素。结论较早的起病年龄、较长的病程、较高的LD起始剂量、较长的LD使用时间、较晚的DA起始治疗时间、较高的UPDRS PartⅢ评分及H-Y分级是WO发展的预测因素。Objective To evaluate factors associated with the wearing-off(WO) of levodopa(LD) therapy in Parkinson's patients. Methods 113 patients with idiopathic Parkinson's disease(PD) on LD therapy were enrolled in this study; age,gender,age at onset of PD,disease duration,presence of wearing-off,and treatment with anti-Parkinsonian drugs were all recorded. The Unified Parkinson's Disease Rating Scale(UPDRS) and Hoehn and Yahr stage were used to assess PD severity. Results 43 subjects(38. 3%) developed WO. The following characteristics in patients with WO were significant: higher mean age at onset of PD(P = 0. 042); longer duration of PD(P < 0. 001); higher initial LD dose(P < 0. 001); longer time to dopamine agonist(DA) initiation(P < 0. 001); and higher UPDRS Part III scores and Hoehn and Yahr stage(P < 0. 001). Patients that selected DA as a first treatment were at a significantly lower risk of WO than patients who were given LD first followed by DA(P = 0. 002). Age at PD onset,disease duration,initial LD dose,UPDRS Part III scores were the independent variables most associated with WO. Conclusion Factors significantly associated with earlier WO occurrence were younger age at PD onset,longer disease duration,higher initial LD dose,longer LD use,late DA initiation,higher Hoehn and Yahr stage,and more severe UPDRS Part III scores.

关 键 词：帕金森病 剂末现象 左旋多巴 预测因素 

分 类 号：R742.5[医药卫生—神经病学与精神病学]