早期PD的诊断及治疗进展.ppt

* * 这张幻灯提示我们: 应用普拉克索起始治疗的患者，在治疗第2年，发生运动并发症的患者比例比左旋多巴起始治疗组减少近一半；在治疗四年后，减少近30%，差距均具有非常明显的统计学意义。所以普拉克索可显著推迟运动并发症的发生。 * 这幅图表证明以普拉克索作为起始治疗可以显著减少剂末现象的发生。 普拉克索起始治疗，4年后发生剂末现象的风险比左旋多巴起始治疗组减少约25%。提示普拉克索可显著减少剂末现象的发生。 * 以往临床上对PD患者的治疗关注于对运动症状的改善，但往往忽略了PD患者的非运动症状的治疗，比如抑郁。但据统计，门诊帕金森病患者伴抑郁比例高达47-57%。意味着临床上每遇到2个帕金森病人，就有一人受到抑郁症状的困扰。但是对于帕金森伴抑郁患者，我们如再加用抗抑郁的药物，无疑是对病人精神和经济的额外负担。 而普拉克索则可以在治疗PD患者运动症状的同时，缓解PD患者伴发的抑郁症状，这与其高度选择性作用于D3受体相关。 * KEY POINTS: Both serotonin (5-HT) and norepinephrine (NE) are neurotransmitters that have ascending tracts to the cerebral cortex and limbic area, as well as descending tracts to the spinal cord1 The cell bodies for these tracts originate in major nuclei of the midbrain. For the central nervous system, the 5-HT cell bodies are located in the raphe nuclei and the largest cluster of NE cells are located in the locus coeruleus1 Each of these midbrain nuclei has ascending tracts, which project to brain regions thought to be involved in depressive symptoms, as well as ascending and descending tracts involved in pain suppression Decreased neurotransmission of 5-HT and NE is believed to be associated with depression2 5-HT- and NE-secreting neurons project upward from their respective nuclei in the brainstem, directly stimulating many areas of the brain Brain areas stimulated include the prefrontal cortex, which is involved in executive functions, and the limbic system which include anatomical structures involved in behavior, motivation, and emotion, such as the hippocampus, anterior cingulate cortex, hypothalamus, and amygdala REFERENCES: Mega MS, Cummings JL, Salloway S, Malloy P. The limbic system: An anatomic, phylogenetic, and clinical perspective. J Neuropsychiatry Clin Neurosci 1997;9:315-330. Hales RE, Yudofsky SC. Mood disorders. In: Textbook of Clinical Psychiatry. 4th ed. Arlington: American Psychiatric Publishing; 2003:479-486. * * * * 对于PD患者典型的震颤症状，普拉克索也有很好的疗效： 一项双盲、安慰剂对照的随机多中心研究证实，普拉克索可以显著改善早期和晚期PD患者的震颤评分。图表显示，普拉克索可以有效改善UPDRS的评分，对于早期和晚期PD患者均具有显著