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(UPDRS Ⅲ)、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。

关键词: 帕金森病, 左旋多巴, 多巴胺激动剂, 初始治疗(非 MeSH 词)

Abstract: 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 Scale Ⅲ (UPDRS Ⅲ), 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 UPDRS Ⅲ score (P=0.697). Conclusions The initial treatment has no different influence on motor symptom progress in patients with PD, however, patients may have more benefits in cognitive function and quality of life from levodopa initial therapy.

Key words: Parkinson disease, Levodopa, Dopamine agonists, Initial treatment (not in MeSH)