醋甲唑胺治疗正常压力脑积水患者5例分析  

Study of Methazolamide in five patients with normal pressure hydrocephalus

作　　者：杨琼[1] 滑蓉蓉 刘春艳[1] 刘星 李熙宇 邢岩[1] YANG Qiong;HUA Rongrong;LIU Chunyan;LIU Xing;LI Xiyu;XING Yan(Department of Neurology,Aviation General Hospital,China Medical University,Beijing100012,China)

机构地区：[1]中国医科大学航空总医院神经内科,北京100012

出　　处：《中国医药导报》2020年第26期53-56,74,共5页China Medical Herald

基　　金：北京市自然科学基金资助项目(7202237);航空总医院重点疾病研究室科研项目(JB2019-015);北京神经变性病学会基金资助项目(BNDS201901)。

摘　　要：目的研究醋甲唑胺(MTZ)对正常压力脑积水(NPH)患者治疗的有效性及安全性,探讨其作用机制,丰富NPH的治疗手段,拓宽MTZ应用新途径。方法收集中国医科大学航空总医院2019—2020年4例特发性正常压力脑积水(iNPH)和1例继发性正常压力脑积水(sNPH)患者。iNPH患者均符合2005年国际iNPH指南诊断标准,5例患者均完善单次腰穿放液试验阳性,且因各种原因不适宜或拒绝手术治疗,在征得患者及家属同意后,给予口服MTZ 25~50 mg,2次/d进行治疗。评价患者口服MTZ前后步态评分、认知评定、膀胱功能测定、头MRI检查、iNPH分级评分。口服MTZ后iNPH评分改善≥1分定义为有效,并密切观察药物不良反应,评估MTZ对NPH的有效性及安全性。结果5例患者中4例有效,轻度改善1例,明显改善3例(2例iNPH和1例sNPH患者),表现为步态、认知或膀胱功能三方面改善。5例患者均未发现明确的MTZ相关的不良反应。结论MTZ可能成为潜在的治疗NPH的药物之一,但仍需大样本随机对照试验进一步证实。Objective To study the effectiveness and safety of Methazolamide(MTZ)in the treatment of patients with normal pressure hydrocephalus(NPH),to explore its mechanism of action,to enrich NPH treatment methods,and to broaden new ways of MTZ application.Methods A total of four cases of idiopathic normal pressure hydrocephalus(iNPH)and one case of secondary normal pressure hydrocephalus(sNPH)were collected from 2019 to 2020 in Aviation General Hospital,China Medical University.All iNPH patients met the diagnostic criteria of the 2005 International iNPH Guidelines.The five patients were all tested positive for a single lumbar puncture and were not suitable for or refused surgical treatment for various reasons.After obtaining the consent of the patient and their family members,they were given oral MTZ 25-50 mg,two times per day for treatment.The gait score,cognitive assessment,bladder function measurement,head MRI examination,iNPH grading score before and after oral MTZ were evaluated.After oral administration of MTZ,an improvement in iNPH score is greater than or equal to one point was defined as effective,and adverse drug reactions could be closely observed to evaluate the effectiveness and safety of MTZ on NPH.Results Among the five patients,four case were effective,including one case was slightly improved,and three cases were improved significantly(two patients with iNPH and one patient with sNPH),showed improvements in gait,cognition or bladder function.None of the five patients found clear MTZ-related adverse reactions.Conclusion MTZ may become one of the potential drugs for the treatment of NPH,but it still needs to be further confirmed by large randomized controlled trials.

关 键 词：醋甲唑胺 乙酰唑胺 正常压力脑积水 腰穿放液试验 

分 类 号：R742.7[医药卫生—神经病学与精神病学]