摘要
目的观察血管性帕金森综合征(VP)对复方多巴的反应性以及多巴反应性与病变部位的相关性。方法临床诊断VP的患者共61例(VP组)进行急性阶梯性左旋多巴治疗试验,计算服用左旋多巴-苄丝肼后统一帕金森病(PD)评分量表(UPDRS)运动部分评分最大改善率。同期146例PD患者(PD组)作为对照。根据头颅MRI所示缺血性病灶部位,将VP组再分组,第1种分组:基底节区病变组(25例);白质病变组(21例);黑质病变组(3例);混合病变组(12例)。第2种分组:黑质纹状体通路病变组(28例);白质病变组(21例)。经t检验比较各组间UPDRS运动部分最大改善率。结果VP组和PD组的UPDRS运动部分平均最大改善率依次为(10.4±7.4)%和(40.1±14.9)%,两组差异有显著性意义(P<0.01)。VP各分组:基底节区病变组UPDRS改善率(23.2±11.3)%,高于白质病变组的(6.5±4.3)%,低于PD组(P<0.01)。黑质病变组UPDRS改善率为(35.4±8.7)%,但例数少无法进行统计学分析。黑质纹状体通路病变组UPDRS改善率(26.3±10.6)%,高于白质病变组,但低于PD组(P<0.01)。结论VP组由于不同的病变部位,对复方多巴有不同的反应性;以累及黑质、基底节等黑质纹状体通路病变为主的VP对复方多巴有一定的反应性,而以白质病变为主的对复方多巴反应较差。可根据MRI提示的病变部位决定是否应用复方多巴治疗VP患者。
Objective To investigate the relationship between dopa responsiveness and the type of vascular lesion in vascular parkinsonism（VP）. Methods Sixty-one patients with vascular parkinsonism were divided into different groups according to the type of vascular lesion： 1. status lacunaris in the striatum; 2. lacunar infarction in substantia nigra; 3. confluent white matter hypefintensity signals;4, mixed type. These patients and those with Parkinson＇s disease（PD） received acute levodopa challenge test with consecutive dosages of oral levodopa/benserazide （100/25 mg, 150/37.5 mg, 200/50 mg） in three days. The maximum improvement of UPDRS part Ⅲ scores was compared between different groups of VP and those of PD. Results As a whole the improvement of UPDRS part Ⅲ scores in VP was lower than that in PD at 200/50 mg dosage （10.4 ± 7.4% vs 40.1 ±14.9 % ）. The improvement of UPDRS part Ⅲ scores in VP patients with status laeunaris in the striaturn or substantia nigra was higher than that in VP patients with confluent white matter hypefintensity signals at 200/50 mg dosage （26.3 ± 10.6 % vs 6.5 ± 4.3 %, P 〈 0.01 ）. Conclusion These results suggest that a substantial number of patients with clinically suspected VP may respond to dopaminergie therapy, especially those with lesions in or close to the nigrostfiatal pathway.
出处
《中华老年心脑血管病杂志》
CAS
北大核心
2007年第1期42-44,共3页
Chinese Journal of Geriatric Heart,Brain and Vessel Diseases
关键词
帕金森病
左旋多巴
纹状体黑质变性
诊断
Parkinson disease
levodopa
stfiatonigral degeneration
diagnosis
