CAJ | 학술논문

背景:司来吉兰可有效缓解早期帕金森病的运动障碍症状,但对于早期帕金森病预后的影响争议甚多.神经影像学的研究进展使得帕金森病多巴胺能神经元的变性程度客观标记成为可能.目的:利用影像学观察研究司来吉兰对早期帕金森病多巴胺能神经元的影响.设计:以患者为研究对象的随机对照实验.单位:一所军队医院的神经内科和一所军医大学医院的核医学科、神经内科.对象:2001-04/10第二军医大学长海医院神经内科帕金森病专病门诊筛选的25例未经任何药物治疗的早期帕金森病患者.干预:25例患者随机分为安慰剂组和司来吉兰治疗组,安慰剂组13例,司来吉兰治疗组12例.联合帕金森病量表(Unified Parkinson's disease rating scale,PDRS)评分后,按照逐渐增量的原则,分别给予安慰剂和司来吉兰治疗(起始剂量均为0.05 mg).每周增加0.05 mg,经过4周的加量期,剂量均达到0.2 mg,此后维持剂量恒定.于入组时、治疗13个月后分别行多巴胺转运蛋白(99Tcm-TRODAT-1)单光子发射型计算机体层扫描(single photon emission-computeredtomography,PECT)检查,半定量法分析起病肢体对侧、同侧纹状体放射计数.于入组时、治疗6个月、治疗13个月后分别进行UPDRS评分.主要观察指标:①主要结局:两组治疗13个月后起病肢体对侧、同侧纹状体99Tcm-TRODAT-1特异性摄取降低百分率的比较.②次要结局:两组UPDRS评分的变化.结果:治疗13个月后起病肢体对侧、同侧纹状体99Tcm-TRODAT-1特异性摄取降低百分率分别为:安慰剂组(28.9±13.0)%、(31.8±15.6)%;司来吉兰治疗组(30.39±14.7)%、(32.6±16.6)%,两组之间比较差异无显著性意义(P＞0.05).UPDRS评分:治疗6个月后,安慰剂组(23.7±4.3)分,司来吉兰治疗组(13.1±5.5)分;治疗13个月后,安慰剂组(27.0±4.3)分,司来吉兰治疗组(9.8±4.8)分,司来吉兰治疗组明显优于安慰剂组(P＜0.05).结论:司来吉兰对早期帕金森病的临床效果较好,而且不加重纹状体多巴胺能神经元的凋亡. 揹景:司來吉蘭可有效緩解早期帕金森病的運動障礙癥狀,但對于早期帕金森病預後的影響爭議甚多.神經影像學的研究進展使得帕金森病多巴胺能神經元的變性程度客觀標記成為可能.目的:利用影像學觀察研究司來吉蘭對早期帕金森病多巴胺能神經元的影響.設計:以患者為研究對象的隨機對照實驗.單位:一所軍隊醫院的神經內科和一所軍醫大學醫院的覈醫學科、神經內科.對象:2001-04/10第二軍醫大學長海醫院神經內科帕金森病專病門診篩選的25例未經任何藥物治療的早期帕金森病患者.榦預:25例患者隨機分為安慰劑組和司來吉蘭治療組,安慰劑組13例,司來吉蘭治療組12例.聯閤帕金森病量錶(Unified Parkinson's disease rating scale,PDRS)評分後,按照逐漸增量的原則,分彆給予安慰劑和司來吉蘭治療(起始劑量均為0.05 mg).每週增加0.05 mg,經過4週的加量期,劑量均達到0.2 mg,此後維持劑量恆定.于入組時、治療13箇月後分彆行多巴胺轉運蛋白(99Tcm-TRODAT-1)單光子髮射型計算機體層掃描(single photon emission-computeredtomography,PECT)檢查,半定量法分析起病肢體對側、同側紋狀體放射計數.于入組時、治療6箇月、治療13箇月後分彆進行UPDRS評分.主要觀察指標:①主要結跼:兩組治療13箇月後起病肢體對側、同側紋狀體99Tcm-TRODAT-1特異性攝取降低百分率的比較.②次要結跼:兩組UPDRS評分的變化.結果:治療13箇月後起病肢體對側、同側紋狀體99Tcm-TRODAT-1特異性攝取降低百分率分彆為:安慰劑組(28.9±13.0)%、(31.8±15.6)%;司來吉蘭治療組(30.39±14.7)%、(32.6±16.6)%,兩組之間比較差異無顯著性意義(P＞0.05).UPDRS評分:治療6箇月後,安慰劑組(23.7±4.3)分,司來吉蘭治療組(13.1±5.5)分;治療13箇月後,安慰劑組(27.0±4.3)分,司來吉蘭治療組(9.8±4.8)分,司來吉蘭治療組明顯優于安慰劑組(P＜0.05).結論:司來吉蘭對早期帕金森病的臨床效果較好,而且不加重紋狀體多巴胺能神經元的凋亡.
배경:사래길란가유효완해조기파금삼병적운동장애증상,단대우조기파금삼병예후적영향쟁의심다.신경영상학적연구진전사득파금삼병다파알능신경원적변성정도객관표기성위가능.목적:이용영상학관찰연구사래길란대조기파금삼병다파알능신경원적영향.설계:이환자위연구대상적수궤대조실험.단위:일소군대의원적신경내과화일소군의대학의원적핵의학과、신경내과.대상:2001-04/10제이군의대학장해의원신경내과파금삼병전병문진사선적25례미경임하약물치료적조기파금삼병환자.간예:25례환자수궤분위안위제조화사래길란치료조,안위제조13례,사래길란치료조12례.연합파금삼병량표(Unified Parkinson's disease rating scale,PDRS)평분후,안조축점증량적원칙,분별급여안위제화사래길란치료(기시제량균위0.05 mg).매주증가0.05 mg,경과4주적가량기,제량균체도0.2 mg,차후유지제량항정.우입조시、치료13개월후분별행다파알전운단백(99Tcm-TRODAT-1)단광자발사형계산궤체층소묘(single photon emission-computeredtomography,PECT)검사,반정량법분석기병지체대측、동측문상체방사계수.우입조시、치료6개월、치료13개월후분별진행UPDRS평분.주요관찰지표:①주요결국:량조치료13개월후기병지체대측、동측문상체99Tcm-TRODAT-1특이성섭취강저백분솔적비교.②차요결국:량조UPDRS평분적변화.결과:치료13개월후기병지체대측、동측문상체99Tcm-TRODAT-1특이성섭취강저백분솔분별위:안위제조(28.9±13.0)%、(31.8±15.6)%;사래길란치료조(30.39±14.7)%、(32.6±16.6)%,량조지간비교차이무현저성의의(P＞0.05).UPDRS평분:치료6개월후,안위제조(23.7±4.3)분,사래길란치료조(13.1±5.5)분;치료13개월후,안위제조(27.0±4.3)분,사래길란치료조(9.8±4.8)분,사래길란치료조명현우우안위제조(P＜0.05).결론:사래길란대조기파금삼병적림상효과교호,이차불가중문상체다파알능신경원적조망.
BACKGROUND: Selegiline can effectively alleviate motor disorder symptoms during the earlier stage of Parkinson disease(PD),but the influence on prognosis is still warmly discussed. With the development of neuroiconologicai study,the objective predictor for dopaminergic neuronal degeneration in PD would became possible.OBJECTIVE: To observe the influence of selegiline on dopaminergic neurons in earlier stage of PD with the aid of iconology.DESIGN: Randomized controlled study based on patients.SETTING: Neurological department in a military hospital of Chinese PLA,the nuclear medicine and neurological department in a military medical hospital of Chinese PLA.PARTICIPANTS: Between April and December 2001,25 patients were selected from PD specific clinic of Changhai Hospital,the Second Military Medical University of Chinese PLA. They were confirmed of earlier stage of PD without given any related drugs.INTERVENTIONS: Totally 25 patients were randomly divided into placebo group of 13 cases and selegiline group of 12 cases. After assessed with unified PD rating scale(UPDRS),they were given placebo and selegiline respectively with the dosage gradually increased from 0.05 mg at the beginning and added with 0.05 mg every week for four weeks until reaching the sustaining dosage of 0.2 mg. Dopamine transporting protein (99Tcm-TRODAT-1) examination and single photon emission-computerized tomography (SPECT) were performed at entering the experiment and after the treatment for 13 months,and semi-quantitative analysis was used for counting striatal emission of the ipsilateral and contralateral side. Scores for UPDRS were obtained at entering the experiment,after the treatment for 6months and 13 months.MAIN OUTCOME MEASURES:①Main outcomes:The differences ofstriatal 99Tcm-TRODAT-1 specific intake decreasing percentage on ipsilateral and contralateral side were compared between the two groups after the treatment for 13 months.②Subordinate outcome:Scores for UPDRS of the two groups was also compared.RESULTS: After the treatment for 13 months,striatal 99Tcm-TRODAT-1 specific intake decreasing percentages were (28.9 ± 13.0)% and(31.8 ± 15.6) % on ipsilateral and contralateral side of placebo group compared with the corresponding (30.39 ± 14. 7)% and(32.6 ± 16. 6)% of the selegiline group,the difference was of no statistical significance( P ＞ 0.05). Scores for UPDR was(23.7 ±4.3) in placebo group and(13.1 ± 5.5) in selegiline group after the treatment for 6 months,and(27.0 ±4.3) and(9. 8 ±4. 8) after the treatment for 13 months,indicating that slegiline group was obviously better than placebo group( P ＜ 0. 05).CONCLUSION: Selegiline showed better therapeutic effect in the treatment of earlier-stage PD without increasing the apoptosis of striatal dopaminergic neurons.