血管性帕金森综合征多巴反应异质性的队列研究

目的 研究基于病变部位的血管性帕金森综合征（vascular parkinsonism，VP）亚型队列的多巴反应性差异。
方法 对41例VP和45例帕金森病（Parkinson’s disease，PD）患者在基线和2年期随访时进行急性左旋多巴试验评测患者的多巴反应性。将VP组按照磁共振（magnetic resonance imaging，MRI）显示的病变部位分型。对VP各亚型和PD组在基线、2年期随访的多巴反应性进行了比较。应用一致性检验评价基线急性左旋多巴试验对2年期随访时多巴反应性的预测价值。
结果 在基线以及2年期随访时，VP组中基底节病变亚组的多巴反应性程度和急性左旋多巴试验阳性率均高于白质病变亚组，但低于PD组（P<0.05）。2年期随访时VP总体以及基底节病变亚组的多巴反应性低于基线（P<0.05）；白质病变亚组的多巴反应性与基线的差异无统计学意义（P>0.05）。VP组基线急性左旋多巴试验结果与2年期随访时急性左旋多巴试验结果的一致性有统计学意义，kappa值为0.438（P<0.05）；其中白质病变组的阳性预测率和阴性预测率分别为0和100%；基底节病变组的阳性预测率和阴性预测率分别为14.3%和100%。
结论 VP的基底节病变亚组和白质病变亚组的急性多巴反应性随病程进展有不同的变化特征。

The Heterogeneity of Dopa-responsiveness in Vascular Parkinsonism Subtypes: a Cohort Study

【Abstract】 Objective To investigate the heterogeneity of dopa-responsiveness in vascular Parkinsonism subtypes in a perspective cohort.Methods Forty one patients with vascular parkinsonism (VP) and forty five patients with Parkinson’s disease (PD) underwent acute levodopa test to assess the dopa-responsiveness at baseline and two years later. The patients with VP were divided into subtypes according to vascular lesion on Magnetic resonance imaging (MRI). The dopa-responsiveness was compared between VP subtypes and those with PD.Results The magnitude of dopa-responsiveness and positive rate of levodopa test in VP subtype of basal ganglia lacunes were significantly higher than those of VP subtype of white matter hyperintentisty (WMH) at baseline and two years later (P<0.05). The magnitude of dopa-responsiveness in VP subtype of basal ganglia lacunes decreased significantly from baseline to two years later (P<0.05).There was no significant change in VP subtype of WMH in same period of follow-up (P>0.05). The outcomes of levodopa test in baseline had concordance with those of two years later (Kappa=0.438, P<0.05). The positive predictive value (PPV) and negative predictive value (NPV) was 0 and 100% in VP subtype of WMH. The PPV and NPV was 14.3% and 100% in VP subtype of basal ganglia lacunes.Conclusion These results suggest the different change of dopa-responsiveness in VP subtype according to vascular lesion.