帕金森病的研究进展-中山大学附属第一医院神经内科徐评议.ppt

* * * * * * * 与左旋多巴合用治疗晚期PD患者时，可以改善晚期帕金森病患者的ADL评分和运动症状评分。 * 与美多巴相比，息宁有效维持血药浓度平稳，在治疗窗内避免异动和剂末现象的发生。 这是一项随机、均衡、三交叉（多巴丝肼HBS胶囊100mg、息宁200mg和多巴丝肼标准片200mg)的研究，18名健康志愿者每天服用600mg左旋多巴（200mg，一日三次)连续7天，旨在评估服用多剂量（200mg左旋多巴 一日三次）情况下的药代动力学参数的变化，包括AUC,Cmax,Cmin,Fi,M/P比值,Tmax和T1/2。 结果显示：与传统的左旋多巴/脱羧酶抑制剂复方制剂比较，息宁? (卡左双多巴控释片)显著降低左旋多巴的Cmax达55%，P0.001;显著降低清晨左旋多巴的Cmin达256%，P0.001. SDc，短期应答均差，是指所有时间的血浆多巴浓度的平均差。 * * 而在B组无运动波动的患者中，与基线值相比，改用息宁控释片后，患者的UPDRS I、II、III量表评分也有显著改善，P=0.001，但UPDRS IV除外。 * * 一项开放式，前瞻性，多中心研究，旨在评估中-重度PD患者由标准息宁? 片转换为息宁? (卡左双多巴控释片)治疗的有效性和安全性。 450名轻中度PD患者的患者由息宁标准片（STD）换用息宁CR（控释剂).共分2组，A组包括299名出现一种或多种运动波动的患者，B组包括151名无运动波动的患者。主要研究终点为应用UPDRS，Hoehn Yahr 分期, Schawb England 量表，睡眠问卷和运动障碍问卷对患者进行评估。 结果显示：A组伴运动波动患者改用息宁控释片后，患者的UPDRS I、II、III、IV量表评分均显著改善，P0.001. R9, P77, C2, Par2, L1-7 * Bhidayasiri R, Truong DD. J Neurol Sci 2008;266(1-2):204-215.: Long-term dopaminomimetic therapy, not limited to levodopa, is complicated by the emergence of variations of motor response in a majority of PD patients. …The term “complex fluctuations”, previously known as “on/off” phenomenon or “yo-yo-ing”, was recently introduced to characterize patients with advanced disease who develop the most unpredictable of fluctuating states. * 我们可以通过一下几种措施来对运动并发症进行控制：改用控释剂型，增加剂量约30％；减少多巴胺用量；加用半衰期较长的多巴胺激动剂；加用COMTI类药物；寻找交叉点：取得较好疗效而不引起波动症状；增加服药次数，但是每日剂量应保持不变。 * The use of enteral infusion avoids deep troughs in plasma levodopa observed with conventional levodopa in patients with advanced PD, and is associated with reduced motor complications A 6-month, prospective, open-label study evaluated the effects of an enteral infusion of levodopa compared with conventional levodopa Eligible patients were diagnosed as having PD according to the London Brain Bank Criteria and were treated with only levodopa and carbidopa in stable dosages that had not been changed in the preceding 30 days Six patients received continuous duodenal levodopa infusion (250 mg/mL) during the waking hours (12 hours/day) infused at a rate o