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普拉克索治疗早期帕金森病的效果观察

作者：许翔 谢安木 于永鹏 李德全 李冉

【摘要】 目的 观察多巴胺受体激动剂普拉克索对早期帕金森 (PD) 病人的治疗效果。方法 选择早期PD病人60例，随机分成美多芭组和普拉克索组，两组病人从小剂量开始渐增加剂量至症状稳定后维持治疗，采用改良WEBSTER和帕金森统一量表(UPDRS)评分比较两组治疗1、3个月后的效果。结果 普拉克索组治疗1月时改良的WEBSTER评分和UPDRS评分较治疗前无显著改善(P>0.05)，改良WEBSTER评分3个月时较治疗前及1月时有显著改善(F=35.286,q=11.92、7.69,P<0.01);UPDRS评分3个月时较治疗前及1月时有显著改善(F=8.812,q=5.88、3.68,P<0.01)。美多芭组WEBSTER评分于治疗1、3个月后较治疗前均有显著改善(F=76.619，q=11.85、17.31,P<0.01);UPDRS评分于治疗1、3个月后较治疗前均有显著改善(F=39.032，q=9.34、11.85,P<0.01);WEBSTER评分和UPDRS评分治疗3个月时较治疗1月时无进一步改善(P>0.05)。美多芭组于治疗1、3个月时UPDRS评分改善均优于普拉克索组(t=3.767、3.347,P<0.01、0.05)。结论 普拉克索能改善早期帕金森病人的临床症状，但普拉克索短期内在控制临床症状方面效果不及美多芭。

【关键词】 帕金森病;普拉克索;美多芭;治疗结果

[ABSTRACT] Objective To investigate the therapeutic efficacy of Pramipexole for early Parkinson disease (PD). Me?thods Sixty patients with PD in their early stage were enrolled and divided into Madopar and Pramipexole group in random. The drugs were started from low dose, and gradually increased until the symptoms were stable and then maintenance therapy was kee?ping for 1-3 months. WEBSTER score and unified Parkinson disease rating scale (UPDRS) were used to assess the efficacy. Results As compared with pre?treatment, both WEBSTER score and UPDRS score after one month of treatment with Pramipexole was not significantly different (P>0.05); after three months of treatment, WEBSTER score showed markedly improved compared with pretherapy and after one month of therapy (F=35.286,q=11.92,P<0.01); the same result was obtained by UPDRS (q=7.69,P<0.01). In Madopar group, WEBSTER score showed that after one?and three?month Madopar therapy, the patients’ condition was much improved than pretherapy (F=76.619;q=11.85,17.31;P<0.01); UPDRS score showed a similar result (F=39.032;q=9.34,11.85;P<0.01). As for WEBSTER and UPDRS score, the result showed no further improvement was achieved after three months of therapy as compared with after one?month medication (P>0.05). After one and three months of therapy, the UPDRS score indicated that the improvement of Madopar group was better than Pramipexole (t=3.767,3.347;P<0.01,0.05). Conclusion Pramipexole is effective for improving the symptoms of patients with early Parkinson disease,but in controlling the clinical signs in short duration, Pramipexole is not as good as Madopar.

[KEY WORDS] parkinson disease; madopar; pramipexole; treatment outcome

帕金森病(PD)是目前最常见的神经变性病之一，以黑质多巴胺能神经元变性缺失和路易小体形成为病理特征。临床表现主要为运动减少、静止性震颤和肌强直等。目前，PD的药物治疗仍然以多巴制剂替代疗法为主,是PD治疗的金标准[1], 但长期应用左旋多巴有许多副作用，如运动波动、异动症等等。普拉克索是近年研究较多的多巴胺(DA) 受体激动剂，主要应用于左旋多巴的辅助治疗，但目前研究显示，一些DA受体激动剂不但能缓解其临床症状,还具有神经保护作用[2]，因此我们选择30 例早期PD的病人，观察DA 受体激动剂普拉克索单药对早期PD的治疗作用。现将结果报告如下。

1 资料与方法