治疗帕金森病的不同药物对基底节多巴胺能系统的影响

The Influence of Different Antiparkinsonian Drugs on Dopaminergic System in Basal Ganglion

目的:应用99mTc -TRODAT 1SPECT显像多巴胺转运体(DAT)和13 1I -epideprideSPECT显像多巴胺D2 受体,研究早期帕金森(PD)病人中用不同药物单一治疗14个月的随访情况。方法:72例早期(Hoehn&YahrⅠ～Ⅱ级)PD患者双盲、区组随机化方法分为4组,分别给予苯海索6mg·d-1(n =15 ) ;L 多巴制剂(美多巴2 5 0’,每天2 .5片) (n =2 2 ) ;L deprenyl(司来吉兰7.5mg·d-1) (n =2 2 ) ;多巴胺受体激动剂培高利特0 .5mg·d-1(n =13 )并随访14个月。分别在基线,随访7和14个月时,进行临床评分,同时以99mTc -TRODAT 1和13 1I -epidepride为配体,应用SPECT功能显像各组患者基底节区DAT和多巴胺D2 受体,比较不同治疗方案对基底节多巴胺能系统的影响情况。结果:99mTc -TRODAT 1SPECT显像结果显示,苯海索组和多巴制剂治疗组在治疗14个月后,基底节DAT均显著降低(P <0 .0 5 ) ,司来吉兰治疗组和多巴受体激动剂组在治疗7和14个月后,基底节区DAT虽有降低,但与基线比较无统计学意义(P >0 .0 5 )。随访14个月时,与对照组(苯海索组)比,仅受体激动剂组患者基底节区DAT值较高(P <0 .0 5 ) ,即减少程度最小。13 1I- epideprideSPECT显像结果显示,随访7和14个月时各组和基线比较均无显著差异,各组间亦无明显差异。结论:早期PD患者中。

Aim:To assess the dopaminergic degeneration after initial treatment with different medication within 14 months in early PD by using 99m Tc-TRODAT-1 SPECT imaging dopamine transporter and 131 I-epidepride SPECT imaging dopamine D_2 receptor. Methods:Seventy-two patients with early PD(Hoehn&Yahr Ⅰ～Ⅱ stage)were enrolled and assigned to four groups using a double-blind, randomized method. They were randomly prescribed with Antane(6 mg·d -1 )( n =15),Madopa 250'( L -dopa 500 mg·d -1 )( n =22), L -deprenyl(Selegiline 7.5 mg·d -1 )( n =22)and dopamine agonist(Pergolide 0.5 mg·d -1 )( n =13)within 14 months. Patients underwent 99m Tc-TRODAT-1 SPECT imaging dopamine transporter and 131 I-epidepride SPECT imaging dopamine D_2 receptor at baseline, subsequently while on therapy(7 months) and after 14 months follow-up. And at the same time, clinical scores were recorded by using the Unified Parkinson's Disease Rating Scale (UPDRS). Results: 99m Tc-TRODAT-1 SPECT imaging results (scans 3)showed significant decline in striatal DAT level( P <0.05)in the Antane group and the Madopa group compared with the baseline. But in the Selegiline group and the Dopamine agonist group , no significant decrease was found in striatal DAT level( P >0.05).The loss of 99m Tc-TRODAT-1 uptake in basal ganglion was significantly reduced only in the Dopamine agonist group compared with the control group(Antane)( P <0.05). 131 I-epidepride SPECT imaging results(scans 2and 3) showed no significant difference in dopamine D_2 receptor level compared with the baseline and no significant difference was found within the groups. Conclusion:The results suggest that dopamine agonist may be slower the rate of dopamine neuron degeneration to some extent and has potential neuroprotection in the early PD. Whether L -dopa has the toxic effect in PD still needs the further research.