左旋多巴治疗帕金森病发生剂末现象的相关因素

目的 探讨左旋多巴治疗帕金森病发生剂末现象的相关因素。方法 收集帕金森病患者临床资料，通过统计学分析对比分析剂末现象发生的相关因素。结果 剂末现象的发生与性别、年龄、教育年限、体重、毒药物接触史、吸烟史、饮酒史、高蛋白饮食、脑血管病史无关（P>0.05）。发生剂末现象的患者发病年龄早，病程长，左旋多巴起始、终点剂量高，左旋多巴用药时间长，疾病进展阶段（H&Y分期）高，统一帕金森病评分量表第三部分（UPDRSⅢ）评分高，汉密尔顿焦虑评分（HAMA）评分高（P<0.05）。其中发病年龄、左旋多巴起始剂量、H&Y分期、焦虑是发生剂末现象的独立影响因素（P<0.05）；独立预测因素分别为H&Y分期、HAMA评分、发病年龄、左旋多巴起始剂量（P<0.05）。H&Y分期具有较好的敏感度和特异度（80.9%）。随治疗时间的增长，中晚期患者剂末现象发生风险高（P<0.05）。结论 多种因素影响左旋多巴临床治疗中发生剂末现象。

Related factors for levodopa-related wearing-off in Parkinson's disease

Objective To investigate related factors for levodopa-related wearing-off in Parkinson's disease (PD).Methods The clinical data of PD patients were collected, and a statistical analysis was performed to investigate the factors for wearing-off.Results The occurrence of wearing-off was not associated with sex, age, years of education, body weight, a contact history of poisons and drugs, smoking history, drinking history, high-protein diet, and a history of cerebrovascular diseases (all P>0.05). The patients who experienced wearing-off tended to have an earlier age of onset, a longer course of disease, higher initial and terminal doses of levodopa, a longer duration of levodopa medication, a higher H&Y stage, and higher scores of Unified Parkinson's Disease Rating Scale-Ⅲ and Hamilton Anxiety Scale (HAMA) (P<0.05). Age of onset, initial dose of levodopa, H&Y stage, and anxiety were independent influencing factors for wearing-off (P<0.05), and H&Y stage, HAMA score, age of onset, and initial dose of levodopa were independent predictive factors (P<0.05). H&Y stage had good sensitivity and specificity (80.9%). The risk of wearing-off in advanced patients increased over the time of treatment.Conclusions Many factors may influence the development of wearing-off during levodopa treatment.