受体功能成像结合临床功能筛选早期治疗帕金森病药物研究

目的比较左旋多巴-苄丝肼、培高利特、司来吉兰治疗帕金森病的疗效,观察其对纹状体突触后多巴胺D2受体的作用,筛选出适合治疗早期帕金森病的药物。方法以接受苯海索治疗设为对照组。44例早期帕金森病患者,随机分为4组,每组11例,平行地接受左旋多巴-苄丝肼(左旋多巴-苄丝肼组)、培高利特(培高利特组)、司来吉兰(司来吉兰组)、苯海索(对照组)治疗13个月,观察治疗前、后纹状体突触后多巴胺D2受体131I-epidepride单光子发射型计算机断层扫描特异性/非特异性摄取,统一帕金森病量表分值的变化。结果(1)治疗13个月后,起病肢体对侧、同侧纹状体突触后131I-epidepride特异性摄取值:左旋多巴-苄丝肼组(0.64±0.22,0.67±0.24),培高利特组(1.09±0.25,1.03±0.15),司来吉兰组(1.11±0.06,1.05±0.26),对照组(0.98±0.37,0.99±0.10)。左旋多巴-苄丝肼组与对照组、其他两药物组相比有显著差异(均P<0.05);其他两药物组、对照组之间比较无显著差异(均P>0.05)。(2)统一帕金森病量表评分减少:左旋多巴-苄丝肼治疗组最明显,培高利特组、司来吉兰组次之。结论培高利特、司来吉兰对131I-epidepride摄取影响较小,可作为早期帕金森病患者的治疗药物。

Study on screening the suitable antiparkinsonian drugs for patients with early-stage Parkinson's disease by brain receptor functional imaging and clinical function

Objective To select the suitable antiparkinsonian drugs among levodopa-benserazide,pergolide and selegiline for patients with early-stage idiopathic Parkinson's disease by observing the effects on dopamine D_2 receptor.Methods The persons receiving trihexyphenidyl served as controls.Forty-four patients with early-stage idiopathic Parkinson's disease were recruited and randomized into levodopa-benserazide,pergolide,selegiline and trihexyphenidyl-treated groups.Each group contained 11 patients.The changes in Unified Parkinson's Disease Rating Scale(UPDRS) score as well as striatal specific/non-specific uptake of()~(131)I epidepride by single-photon-emission-computed tomography before and after drug therapy were compared respectively.Results (1)The values of specific uptake of()~(131)I epidepride in bilateral striatums after 13 months of treatment were as follows:levodopa-benserazide 0.64±0.22 and 0.67±0.24,pergolide 1.09±0.25 and 1.03±0.15,selegiline 1.11±0.06 and 1.05±0.26,controls 0.98±0.37 and 0.99±0.10.The significant changes in striatum specific/non-specific uptake of()~(131)I epidepride SPECT were observed in the levodopa-benserazide-treated group between before and after treatment,and there was significant difference in uptake between levodopa-benserazide group and the other groups.There were no significant differences between the other groups.(2)The most significant reduction in UPDRS was seen in levodopa-benserazide-treated group,and then in pergolide and selegiline groups.Conclusions Both pergolide and selegiline had milder effects on the specific uptake of()~(131)I epidepride and may be more suitable for the treatment of patients with early-stage Parkinson's disease.