郝美美,田甜,班玉霞,白如玉,康志霞

• 1:延安市人民医院

摘要(Abstract)：

目的 观察左旋多巴联合司来吉兰或普拉克索治疗帕金森病（PD）患者的疗效及对非运动症状评分、姿势步态和生存质量的影响。方法 按随机抽签法将2021-03—2024-03延安市人民医院治疗的PD患者分为观察组（n=52）和对照组（n=52）。对照组采取左旋多巴联合司来吉兰治疗，观察组采取左旋多巴联合普拉克索治疗，持续1个月。比较2组疗效和不良反应发生情况，观察治疗前和治疗1个月后2组患者运动能力、非运动症状评分（NMSS）、姿势步态（步幅、步速、步频、步幅变异度）和生存质量[帕金森病生存质量问卷（PDQ-39）评分]。结果 2组总有效率和不良反应发生率比较差异均无统计学意义（χ~2=1.507、1.682,P>0.05）。治疗1个月后，2组患者UPDRS-Ⅲ评分、NMSS评分（严重程度、发生频率）、步幅变异度均较治疗前显著降低，观察组低于对照组（P<0.05）。2组患者步幅、步速、步频、PDQ-39评分均较治疗前显著提高，观察组高于对照组（P<0.05）。结论 左旋多巴联合普拉克索对于改善PD患者的运动症状和非运动症状具有较好的效果，可改善患者姿势步态和生存质量。

关键词(KeyWords)： 帕金森病;左旋多巴;司来吉兰;普拉克索;非运动症状;姿势步态;生存质量

Abstract:

Keywords:

基金项目(Foundation): 延安市人民医院培育基金项目(编号:2022PY-15);; 陕西省重点研发计划项目(编号:S2021-YF-YBSF-1175)

作者(Author): 郝美美,田甜,班玉霞,白如玉,康志霞

参考文献(References)：

• [1] MORRIS H R,SPILLANTINI M G,SUE C M,et al. The pathogenesis of Parkinson’s disease[J]. Lancet,2024,403(10423):293-304.
• [2] BLOEM B R,OKUN M S,KLEIN C. Parkinson’s disease[J].Lancet,2021,397(10291):2284-2303.
• [3]张静，张永智，张新庆，等.左旋多巴联合醒脑开窍针刺法治疗帕金森病患者的疗效[J].中国实用神经疾病杂志，2024,27(3):361-366.
• [4] WANG K,LIU Z H,LI X Y,et al. Efficacy and safety of selegiline for the treatment of Parkinson’s disease:A systematic review and meta-analysis[J]. Front Aging Neurosci,2023,15:1134472.
• [5] JIANG D Q,LI M X,JIANG L L,et al. Comparison of selegiline and levodopa combination therapy versus levodopa monotherapy in the treatment of Parkinson’s disease:a meta-analysis[J]. Aging Clin Exp Res,2020,32(5):769-779.
• [6] WEI S Z,YAO X Y,WANG C T,et al. Pramipexole regulates depression-like behavior via dopamine D3 receptor in a mouse model of Parkinson’s disease[J]. Brain Res Bull,2021,177:363-372.
• [7] CLARKE C E,SPELLER J M,CLARKE J A. Pramipexole for levodopa-induced complications in Parkinson’s disease[J].Cochrane Database Syst Rev,2000,2000(3):CD002261.
• [8] POSTUMA R B,BERG D. The New Diagnostic Criteria for Parkinson’s Disease[J]. Int Rev Neurobiol,2017,132:55-78.
• [9] MARTíNEZ-MARTíN P,RODRíGUEZ-BLáZQUEZ C,ALVAREZ M,et al. Parkinson’s disease severity levels and MDS-Unified Parkinson’s Disease Rating Scale[J]. Parkinsonism Relat Disord,2015,21(1):50-54.
• [10] GUO Y,GOETZ C G,STEBBINS G T,et al. Using Movement Disorder Society Unified Parkinson’s Disease Rating Scale Parts2 and 3 Simultaneously:Combining the Patient Voice with Clinician Ratings[J]. Mov Disord,2023,38(3):453-463.
• [11] BUCK P O,TRAUTMAN H,CLARK J. Scales for assessing nonmotor symptom severity changes in Parkinson’s disease patients with symptom fluctuations[J]. Int J Neurosci,2010,120(8):523-530.
• [12] JESUS-RIBEIRO J,VIEIRA E,FERREIRA P,et al. Reliability and Validity of 39-Item Parkinson’s Disease Questionnaire and Parkinson’s Disease Quality of Life Questionnaire[J]. Acta Med Port,2017,30(5):395-401.
• [13]徐天阳，刘恒方，郭亚培，等. MRI联合交感皮肤反应及经颅超声诊断帕金森病与多系统萎缩P型的研究[J].中国实用神经疾病杂志，2024,27(4):403-408.
• [14] KOSCHEL J,RAY CHAUDHURI K,T?NGES L,et al.Implications of dopaminergic medication withdrawal in Parkinson’s disease[J]. J Neural Transm(Vienna),2022,129(9):1169-1178.
• [15] FERNANDEZ-ESPEJO E. Pathogenesis of Parkinson’s disease:prospects of neuroprotective and restorative therapies[J]. Mol Neurobiol,2004,29(1):15-30.
• [16] WANG Y,JIANG D Q,LU C S,et al. Efficacy and safety of combination therapy with pramipexole and levodopa vs levodopa monotherapy in patients with Parkinson disease:A systematic review and meta-analysis[J]. Medicine(Baltimore), 2021,100(44):e27511.
• [17] PEDROSA A J,WALDTHALER J,MüGGE F,et al. Non-lesional treatments for tremor in Parkinson’s disease:A systematic review and meta-analysis[J]. Eur J Neurol,2023,30(8):2544-2556.
• [18] ZHANG Q,CHEN X,CHEN F,et al. Dopamine agonists versus levodopa monotherapy in early Parkinson’s disease for the potential risks of motor complications:A network meta-analysis[J]. Eur J Pharmacol,2023,954:175884.
• [19] TáBI T,VéCSEI L,YOUDIM M B,et al. Selegiline:a molecule with innovative potential[J]. J Neural Transm(Vienna),2020,127(5):831-842.
• [20] JIN H,WANG R. Alzheimer-Associated Neuronal Thread Protein:Research Course and Prospects for the Future[J]. J Alzheimers Dis,2021,80(3):963-971.
• [21] LI Y,KANG M,WANG H,et al. Urinary Alzheimer-Associated Neuronal Thread Protein is not Elevated in Patients with Subjective Cognitive Decline and Patients with Depressive State[J]. J Alzheimers Dis,2019,71(4):1115-1123.
• [22] LI Y,GUAN S,JIN H,et al. The relationship between urinary Alzheimer-associated neuronal thread protein and blood biochemical indicators in the general population[J]. Aging(Albany NY),2020,12(15):15260-15280.
• [23] HEINRICH M,SIEG M,KRUPPA J,et al. Association between genetic variants of the cholinergic system and postoperative delirium and cognitive dysfunction in elderly patients[J]. BMC Med Genomics,2021,14(1):248.
• [24] KULISEVSKY J. Pharmacological management of Parkinson’s disease motor symptoms:update and recommendations from an expert[J]. Rev Neurol,2022,75(s04):S1-S10.
• [25] MANCEAU C,CONSTANT E,BRUGALLéE,et al. Couples facing the“honeymoon period” of Parkinson’s disease:A qualitative study of dyadic functioning[J]. Br J Health Psychol,2023,28(2):366-382.
• [26] MCFARTHING K,BUFF S,RAFALOFF G,et al. Parkinson’s Disease Drug Therapies in the Clinical Trial Pipeline:2024Update[J]. J Parkinsons Dis,2024,14(5):899-912.
• [27] KURIHARA K,MISHIMA T,FUJIOKA S,et al. Efficacy and safety evaluation of safinamide as an add-on treatment to levodopa for Parkinson’s disease[J]. Expert Opin Drug Saf,2022,21(2):137-147.
• [28] ZHONG T,TANG R,GONG S,et al. The remission phase in type1 diabetes:Changing epidemiology,definitions,and emerging immuno-metabolic mechanisms[J]. Diabetes Metab Res Rev,2020,36(2):e3207.