帕金森病初始药物治疗对患者症状和生活质量的影响  

Impact of initial treatment on future symptoms and quality of life in Parkinson's disease

作　　者：李玉旺[1] 董萌 陈学姣 王敏 李欣 陈蕾[1] LI Yu-wang;DONG Meng;CHEN Xue-jiao;WANG Min;LI Xin;CHEN Lei(Department of Neurology,Tianjin Huanhu Hospital,Tianjin Key Laboratory of Cerebral Vascular and Neurodegenerative Diseases,Tianjin 300350,China)

机构地区：[1]天津市环湖医院神经内科天津市脑血管与神经变性重点实验室,300350

出　　处：《中国现代神经疾病杂志》2022年第4期278-282,共5页Chinese Journal of Contemporary Neurology and Neurosurgery

基　　金：天津市医学重点学科(专科)建设项目

摘　　要：目的探讨不同初始药物治疗方案对帕金森病患者运动症状、认知功能及生活质量的影响。方法收集2016年1月至2022年1月天津市环湖医院收治的134例原发性帕金森病患者,按照初始治疗药物分为左旋多巴组(87例)和非左旋多巴组(47例)。根据患者用药情况及药物种类计算左旋多巴等效剂量(LED);采用统一帕金森病评价量表第三部分(UPDRSⅢ)、简易智能状态检查量表(MMSE)、蒙特利尔认知评价量表(MoCA)和39项帕金森病调查表(PDQ⁃39)评价运动症状、认知功能、生活质量;依据左旋多巴负荷试验前后UPDRSⅢ评分计算最大改善率;多因素线性逐步回归分析运动症状、认知功能、生活质量、左旋多巴负荷试验最大改善率与初始药物治疗之间的线性数量关系。结果与非左旋多巴组相比,左旋多巴组患者MMSE评分(Z=⁃3.200,P=0.001)、MoCA评分(Z=⁃2.736,P=0.006)、左旋多巴负荷试验最大改善率(t=⁃2.411,P=0.018)更高,而PDQ⁃39评分更低(t=2.631,P=0.010)。其中左旋多巴负荷试验最大改善率(标准化偏回归系数=0.222,P=0.008)、MMSE评分(标准化偏回归系数=0.278,P=0.001)、MoCA评分(标准化偏回归系数=0.241,P=0.005)与左旋多巴初始治疗存在正向线性回归关系,PDQ⁃39评分与左旋多巴初始治疗存在负向线性回归关系(标准化偏回归系数=⁃0.235,P=0.006),而UPDRSⅢ评分与初始治疗无关(P=0.697)。结论帕金森病初始治疗药物的选择对运动症状进展无影响,但认知功能和生活质量可从左旋多巴初始治疗中获益。Objective To explore the effects of different initial drug treatment on motor symptoms,cognitive function and quality of life in patients with Parkinson's disease(PD).Methods Data of 134 PD patients who hospitalized in Tianjin Huanhu Hospital from January 2016 to January 2022 were collected.The patients were divided into levodopa and non⁃levodopa initial treatment groups basing on their initial therapy.The levodopa equivalent dose(LED)was calculated according to the anti⁃parkinsonism medications they were taking.The motor symptoms,cognitive function and quality of life were evaluated with Unified Parkinson's Disease Rating ScaleⅢ(UPDRSⅢ),Mini⁃Mental State Examination(MMSE),Montreal Cognitive Assessment(MoCA)and 39⁃Item Parkinson's Disease Questionnaire(PDQ⁃39).Additionally,the maximum improvement rate of the levodopa challenge test was calculated.The association between motor symptoms,cognitive function,quality of life,maximum improvement rate of the levodopa challenge test and initial drug treatment was analyzed by multiple linear stepwise regression.Results Compared with non⁃levodopa group,patients in levodopa group had higher MMSE score(Z=⁃3.200,P=0.001),MoCA score(Z=⁃2.736,P=0.006)and the maximum improvement rate of levodopa challenge test(t=⁃2.411,P=0.018),and lower PDQ⁃39 score(t=2.631,P=0.010).Multiple linear stepwise regression analysis showed that there was a positive linear regression relationship between the maximum improvement rate of the levodopa challenge test(standardized partial regression coefficient=0.222,P=0.008),MMSE score(standardized partial regression coefficient=0.278,P=0.001),MoCA score(standardized partial regression coefficient=0.241,P=0.005)and the initial treatment of levodopa,and there was a negative linear regression relationship between PDQ⁃39 score and the initial treatment of levodopa(standardized partial regression coefficient=⁃0.235,P=0.006).There was no significant association between initial treatment and UPDRSⅢscore(P=0.697).Conclusions The init

关 键 词：帕金森病 左旋多巴 多巴胺激动剂 初始治疗(非MeSH词) 

分 类 号：R742.5[医药卫生—神经病学与精神病学]