帕金森病%多巴胺%体层摄影术,发射型计算机,单光子
帕金森病%多巴胺%體層攝影術,髮射型計算機,單光子
파금삼병%다파알%체층섭영술,발사형계산궤,단광자
背景:培高利特与美多巴都是治疗帕金森病的有效药物,但对于帕金森病患者愈后的影响尚有争议,神经影像学的进展使得定量评价药物治疗对帕金森病的预后影响成为可能.目的:采用99Tcm-TRODAT-1多巴胺能转运体单光子发射型计算机体层扫描成像结合联合帕金森病量表评分,观察培高利特、美多巴作为起始治疗对早期帕金森病患者预后及对纹状体多巴胺能神经元的影响.设计:随机分组、平行对照、安慰剂对照实验.单位:解放军第八一医院神经内科,解放军第二军医大学长海医院神经内科与核医学科.对象:选择2002-02/07上海长海医院神经内科帕金森病专病门诊收治的未经任何药物治疗的早期帕金森病患者36例,随机分为安坦对照组、培高利特组、美多巴组,12例/组.所有入选患者均书面同意参加试验,诊断符合英国帕金森病协会制定的临床诊断标准,本实验经过长海医院伦理委员会批准实施.干预措施:安坦对照组、培高利特组、美多巴组患者接受联合帕金森病量表评分、多巴胺转运体行单光子发射型计算机体层扫描显像检查后,分别服用各自药物,每粒安坦、培高利特、美多巴胶囊含药物分别为0.05,0.05,125 mg.第1周时1粒/次,1次/d;以后每周的日剂量较上周日剂量增加1粒,治疗1个月使日剂量分别达到0.2,0.2,500 mg.此后维持剂量恒定,治疗6,10个月分别用联合帕金森病量表进行疗效评定.所有患者治疗10个月后,分别进行脑纹状体多巴胺转运体单光子发射型计算机体层扫描成像,半定量法分析受累肢体同侧或对侧纹状体99Tcm-TRODAT-1的特异性摄取值.主要观察指标:①比较3组治疗10个月后受累肢体同侧、对侧99Tcm-TRODAT-1特异性摄取值降低百分率的变化.②比较3组治疗前后联合帕金森病量表评分的变化.结果:实验纳入患者36例,治疗10个月后3组各脱落1例,最终33例患者进入结果分析.①各组治疗10个月后受累肢体同侧、对侧99Tcm-TRODAT-1特异性摄取值降低百分率的变化:治疗10个月后,美多巴组受累肢体同侧、对侧99Tcm-TRODAT-1特异性摄取值降低百分率均明显高于安坦对照组、培高利特组[(46.3±19.4)%,(28.9±13.0)%,(34.4±18.1)%;(47.5±20.8)%,(31.8±15.6)%,(33.8±17.2)%;P均＜0.05].②各组治疗前后联合帕金森病量表评分的变化:与治疗前比较,治疗10个月后安坦对照组无明显变化,但美多巴组、培高利特组均明显下降[(15.5±8.68),(6.4±9.05)分;(15.8±6.75),(10.36±8.30)分;P均＜0.05].结论:美多巴、培高利特虽都能对早期帕金森病起到有效治疗,但对于帕金森病患者的预后影响不同.美多巴可能会加速多巴胺能神经元的凋亡而使病情恶化,培高利特则不影响帕金森病的预后,更适合作为早期帕金森病治疗的选择药物.
揹景:培高利特與美多巴都是治療帕金森病的有效藥物,但對于帕金森病患者愈後的影響尚有爭議,神經影像學的進展使得定量評價藥物治療對帕金森病的預後影響成為可能.目的:採用99Tcm-TRODAT-1多巴胺能轉運體單光子髮射型計算機體層掃描成像結閤聯閤帕金森病量錶評分,觀察培高利特、美多巴作為起始治療對早期帕金森病患者預後及對紋狀體多巴胺能神經元的影響.設計:隨機分組、平行對照、安慰劑對照實驗.單位:解放軍第八一醫院神經內科,解放軍第二軍醫大學長海醫院神經內科與覈醫學科.對象:選擇2002-02/07上海長海醫院神經內科帕金森病專病門診收治的未經任何藥物治療的早期帕金森病患者36例,隨機分為安坦對照組、培高利特組、美多巴組,12例/組.所有入選患者均書麵同意參加試驗,診斷符閤英國帕金森病協會製定的臨床診斷標準,本實驗經過長海醫院倫理委員會批準實施.榦預措施:安坦對照組、培高利特組、美多巴組患者接受聯閤帕金森病量錶評分、多巴胺轉運體行單光子髮射型計算機體層掃描顯像檢查後,分彆服用各自藥物,每粒安坦、培高利特、美多巴膠囊含藥物分彆為0.05,0.05,125 mg.第1週時1粒/次,1次/d;以後每週的日劑量較上週日劑量增加1粒,治療1箇月使日劑量分彆達到0.2,0.2,500 mg.此後維持劑量恆定,治療6,10箇月分彆用聯閤帕金森病量錶進行療效評定.所有患者治療10箇月後,分彆進行腦紋狀體多巴胺轉運體單光子髮射型計算機體層掃描成像,半定量法分析受纍肢體同側或對側紋狀體99Tcm-TRODAT-1的特異性攝取值.主要觀察指標:①比較3組治療10箇月後受纍肢體同側、對側99Tcm-TRODAT-1特異性攝取值降低百分率的變化.②比較3組治療前後聯閤帕金森病量錶評分的變化.結果:實驗納入患者36例,治療10箇月後3組各脫落1例,最終33例患者進入結果分析.①各組治療10箇月後受纍肢體同側、對側99Tcm-TRODAT-1特異性攝取值降低百分率的變化:治療10箇月後,美多巴組受纍肢體同側、對側99Tcm-TRODAT-1特異性攝取值降低百分率均明顯高于安坦對照組、培高利特組[(46.3±19.4)%,(28.9±13.0)%,(34.4±18.1)%;(47.5±20.8)%,(31.8±15.6)%,(33.8±17.2)%;P均＜0.05].②各組治療前後聯閤帕金森病量錶評分的變化:與治療前比較,治療10箇月後安坦對照組無明顯變化,但美多巴組、培高利特組均明顯下降[(15.5±8.68),(6.4±9.05)分;(15.8±6.75),(10.36±8.30)分;P均＜0.05].結論:美多巴、培高利特雖都能對早期帕金森病起到有效治療,但對于帕金森病患者的預後影響不同.美多巴可能會加速多巴胺能神經元的凋亡而使病情噁化,培高利特則不影響帕金森病的預後,更適閤作為早期帕金森病治療的選擇藥物.
배경:배고리특여미다파도시치료파금삼병적유효약물,단대우파금삼병환자유후적영향상유쟁의,신경영상학적진전사득정량평개약물치료대파금삼병적예후영향성위가능.목적:채용99Tcm-TRODAT-1다파알능전운체단광자발사형계산궤체층소묘성상결합연합파금삼병량표평분,관찰배고리특、미다파작위기시치료대조기파금삼병환자예후급대문상체다파알능신경원적영향.설계:수궤분조、평행대조、안위제대조실험.단위:해방군제팔일의원신경내과,해방군제이군의대학장해의원신경내과여핵의학과.대상:선택2002-02/07상해장해의원신경내과파금삼병전병문진수치적미경임하약물치료적조기파금삼병환자36례,수궤분위안탄대조조、배고리특조、미다파조,12례/조.소유입선환자균서면동의삼가시험,진단부합영국파금삼병협회제정적림상진단표준,본실험경과장해의원윤리위원회비준실시.간예조시:안탄대조조、배고리특조、미다파조환자접수연합파금삼병량표평분、다파알전운체행단광자발사형계산궤체층소묘현상검사후,분별복용각자약물,매립안탄、배고리특、미다파효낭함약물분별위0.05,0.05,125 mg.제1주시1립/차,1차/d;이후매주적일제량교상주일제량증가1립,치료1개월사일제량분별체도0.2,0.2,500 mg.차후유지제량항정,치료6,10개월분별용연합파금삼병량표진행료효평정.소유환자치료10개월후,분별진행뇌문상체다파알전운체단광자발사형계산궤체층소묘성상,반정량법분석수루지체동측혹대측문상체99Tcm-TRODAT-1적특이성섭취치.주요관찰지표:①비교3조치료10개월후수루지체동측、대측99Tcm-TRODAT-1특이성섭취치강저백분솔적변화.②비교3조치료전후연합파금삼병량표평분적변화.결과:실험납입환자36례,치료10개월후3조각탈락1례,최종33례환자진입결과분석.①각조치료10개월후수루지체동측、대측99Tcm-TRODAT-1특이성섭취치강저백분솔적변화:치료10개월후,미다파조수루지체동측、대측99Tcm-TRODAT-1특이성섭취치강저백분솔균명현고우안탄대조조、배고리특조[(46.3±19.4)%,(28.9±13.0)%,(34.4±18.1)%;(47.5±20.8)%,(31.8±15.6)%,(33.8±17.2)%;P균＜0.05].②각조치료전후연합파금삼병량표평분적변화:여치료전비교,치료10개월후안탄대조조무명현변화,단미다파조、배고리특조균명현하강[(15.5±8.68),(6.4±9.05)분;(15.8±6.75),(10.36±8.30)분;P균＜0.05].결론:미다파、배고리특수도능대조기파금삼병기도유효치료,단대우파금삼병환자적예후영향불동.미다파가능회가속다파알능신경원적조망이사병정악화,배고리특칙불영향파금삼병적예후,경괄합작위조기파금삼병치료적선택약물.
BACKGROUND: Pergolide and madopar are the effective medicines to treat Parkinson disease, but the effects on the prognosis of patients with Parkinson disease are still under discussion. The progress of neuroimaging makes it possible to evaluate quantitatively the effect of the drug treatment on the prognosis of Parkinson disease.OBJBCTIVE: To observe the influence of pergolide or madopar as initial treatment on the prognosis and the striatal dopaminergic neuron in patients with early Parkinson disease by means of 99Tcm-TRODAT-1 dopamine transporter imaging single-photon emission computed tomtheography (SPECT) in combination with Parkinson disease scale.DESIGN: A randomized grouping, parallel control and placebo control trial.SETTING: Department of Neurology, the 81 Hospital of Chinese PLA;Department of Neurology and Department of Nuclear Medicine, Changhai Hospital of the Second Military Medical University of Chinese PLA.PARTICIPANTS: Thirty-six patients with early Parkinson disease who were recruited at the Specific Clinic of Parkinson Disease in the Shanghai Changhai Hospital affiliated to the Second Military Medical University of Chinese PLA and did not receive any drug treatment before, were enrolled between February and July 2002. They were randomly divided into artane control group (n=12), pergolide-treated group (n=12) and madopar-treated group. The diagnosis accorded with the clinical diagnostic standard set by United Kingdom Society of Parkinson Disease. This protocol was approved by the Medical Ethics Committee of Changhai Hospital, and all the subjects were enrolled in this study with informed consent.INTERVENTIONS: After test with unified Parkinson disease rating scale (UPDRS) and 99Tcm-TRODAT-1 SPECT, patients in the artane control group, pergolide-treated group and madopar-treated group were treated with corresponding drugs respectively, and each capsule of artane, pergolide and madopar contained drug of 0.05, 0.05 and 125 mg respectively. In the 1st week, the dosage was 1 capsule for each time, once a day, and then the daily dosage was increased by 1 capsule per week later, and the daily dosage reached 0.2, 0.2 and 500 mg respectively after 1 month, and then the dosages were kept constant. The curative effects were evaluated with UPDRS at 6 and 10 months after treatment. At 10 months after treatment,the 99Tcm-TRODAT-1 specific intakes of ipsilateral or contralateral striatum of the affected limb were tested with striatum dopamine transporter SPECT and semi-quantitative analysis.MAIN OUTCOME MEASURES: ① Changes of percentage of 99Tcm-TRODAT-1 decrease of ipsilateral or contralateral striatum of the affected limb at 10 months after treatment were compared among the three groups;② Changes of UPDRS scores before and after treatment were compared among the three groups.RESULTS: Totally 36 patients were involved in the study, and 1 case lost in each of the 3 groups respectively at 10 months after treatment, finally 33 cases entered the analysis of results. ① Changes of percentage of 99Tcm-TRODAT-1 decrease of ipsilateral or contralateral striatum of the affected limb at 10 months after treatment: At 10 months after treatment, the percentage of 99Tcm-TRODAT-1 decrease of ipsilateral or contralateral striatum of the affected limb were obviously higher in the madopar-treated group than in the artane control group and pergolide-treated group [(46.3±19.4)%, (28.9±13.0)%, (34.4±18,1)%; (47.5±20.8)%, (31.8±15.6)%, (33.8±17.2)%; P all ＜ 0.05]. ② Changes of UPDRS scores before and after treatment: As compared with the UPDRS scores before treatment, there was no obvious change in the artane control group at 10 months after treatment,but those in the madopar-treated group and pergolide-treated group were obviously decreased [(15.5±8.68), (6.4±9.05); (15.8±6.75), (10.36±8.30); Pall ＜ 0.05].CONCLUSION: Both madopar and pergolide can ameliorate the symptoms of early Parkinson disease, but they had different influences on the prognosis of patients with Parkinson disease. Madopar may accelerate the apoptosis of dopaminergic neuron and then aggravate the severity, but pergolide does not affect the prognosis of Parkinson disease, so it is a more suitable selective drug for the treatment of early Parkinson disease.
