课件：张振馨学习班讲义.ppt

* * Ergot dopamine agonists have been associated with the occurrence of pleuropulmonary, peritoneal and cardiac fibrosis. In particular, several studies and case reports suggest a causal relationship between the occurrence of drug-induced “restrictive” valvular heart disease and treatment with pergolide.1 Pergolide may induce fibrotic changes in leaflets and subvalvular apparatus that thicken, retract and stiffen valves, resulting in incomplete leaflet coaptation and valvular regurgitation.2 Valvular heart damage has also been reported with the ergot dopamine agonists bromocriptine and cabergoline.3 Recently, Peralta et al.4 assessed the frequency of valvular regurgitation by routine transthoracic echocardiography in 75 PD patients treated with pergolide (n = 29), cabergoline (n = 13), pramipexole or ropinirole (n = 33), and 49 age-matched nonparkinsonian controls. Patients treated with pergolide and cabergoline had higher frequencies of valvular regurgitation grades 2 and 3 (31% and 47%, respectively) compared with age-matched controls (13%), while there was no difference in the frequency of valvular regurgitation grades 2 and 3 between patients treated with non-ergot compounds (10%) and controls. In a case-control study Yamamoto et al.5 examined the occurrence of valvular heart disease as assessed by transthoracic echocardiography in 210 consecutive patients with PD. The frequency of valvulopathy was significantly higher in patients treated with cabergoline (68.8%, 11/16; affected patients/total) than in patient who did not receive any dopamine agonist (17.6%, 15/85). The adjusted odds ratio was significantly higher in patients treated with cabergoline (12.96, 95% CI* = 3.59 to 46.85), compared with patients who received pergolide (2.18, 95% CI = 0.90 to 5.30) and those treated with pramipexole (1.62, 95% CI = 0.45 to 5.87). The cumulative dose and treatment duration of cabergoline in the valvulopathy subgroup were significantly higher than in the subgroup with