帕金森病异动症危险因素及左旋多巴安全剂量的数据驱动分析  

Risk factors for dyskinesia and levodopa safe dosage for Parkinson's disease based on data-mining analysis

作　　者：陈慧敏[1] 李芳菲[1] 郜丽妍[1] 房进平 曹振汤 刘亘梁[1] 冯涛[1] 马惠姿[1] CHEN Hui-min LI Fang-fei GAO Li-yan et al(Department of Neurology ,Affiliated Tiantan Hospital of Capital Medical University ,Beijing 100050, China)

机构地区：[1]首都医科大学附属北京天坛医院神经病学中心神经变性病科国家神经系统疾病临床医学研究中心北京脑重大疾病研究院帕金森病研究所,100050

出　　处：《中华老年心脑血管病杂志》2017年第8期789-792,共4页Chinese Journal of Geriatric Heart,Brain and Vessel Diseases

基　　金：国家自然科学基金(81571226);十三五国家重点研发计划(2016YFC1306501);北京市科技计划(Z151100003915150;Z151100003915117;Z171100001017041)

摘　　要：目的探讨帕金森病(Parkinson's disease,PD)异动症的临床危险因素,并基于数据驱动方法分析PD患者异动症的左旋多巴安全剂量。方法选择2012年3月~2013年7月在首都医科大学附属北京天坛医院神经变性病科住院的PD患者163例,其中伴发异动症患者20例(异动组),不伴异动症患者143例(非异动组)。logistic回归分析PD异动症潜在危险因素;利用分类决策树模型计算左旋多巴安全剂量。结果异动组病程、Hoehn-Yahr(H-Y)分期、统一PD评定量表(UPDRS)Ⅰ、UPDRSⅡ、UPDRSⅢ、UPDRSⅣ、左旋多巴等效剂量、左旋多巴、多巴受体激动剂、抗胆碱能药、恩他卡朋、金刚烷胺比例明显高于非异动组(P<0.05,P<0.01),起病年龄[(51.8±14.3)岁vs(59.2±10.8)岁,P=0.007]明显低于非异动组。logistic回归分析显示,H-Y分期(HR=3.544,P=0.047)、病程(HR=1.233,P=0.033)为PD异动症的危险因素,其中左旋多巴等效剂量(P=0.055)为可能的危险因素。分类决策树模型预测提示,左旋多巴等效剂量387.5mg/d为区别异动组与非异动组的左旋多巴安全剂量。结论 PD异动症可能与左旋多巴等效剂量、运动症状严重程度、病程有关。Objective To study the risk factors for dyskinesia and the levodop safe dosage for Parkinson＇s disease（PD）based on data mining analysis.Methods One hundred and sixty-three PD patients admitted to our hospital from March 2012 to July 2013 were divided into dyskinesia group（n=20）and dyskinesia-free group（n=143）.Risk factors for dyskinesia were analyzed by logistic regression analysis and levodop safe dosage for PD was calculated according to the decision tree classification（DTC）model.Results The disease duration was significantly longer and the H-Y stage,UPDRSⅠ-Ⅳ scores,levodopa equivalent dosage,rates of used levodop,dopamine receptor agonists,anticholinergic drugs,catechol-O-methyl transferase inhibitor,amatadine were significantly higher while the onset age of disease was significantly younger in dyskinesia group than in dyskinesia-free group（P〈0.05,P〈0.01）.Logistic regression analysis showed that H-Y stage（HR=3.544,P=0.047）and disease duration（HR=1.233,P=0.033）were the risk factors for dyskinesia while levodopa equivalent dosage was a possible risk factor for dyskinesia（P=0.055）.DTC model indicated that levodopa equivalent dosage（387.5mg/d）was a safe dosage for dyskinesia of PD.Conclusion Dyskinesia of PD is associated with levodopa equivalent dosage,severity and duration of disease.Levodopa equivalent dosage is a safe dosage for dyskinesia of PD.

关 键 词：帕金森病 左旋多巴 药物剂量计算 运动障碍 危险因素 

分 类 号：R742.5[医药卫生—神经病学与精神病学]