帕金森病与帕金森综合征对多巴反应的研究

Acute dopaminergic responsiveness test in diagnosis of Parkinson＇s disease and Parkinsonian disorders

目的初步探讨帕金森病和帕金森综合征的急性多巴反应试验特点，为临床诊断和鉴别帕金森病提供方便、易行的诊断方法。方法总结60例帕金森病和帕金森综合征的患者[血管性帕金森综合征（VP）、多系统萎缩（MSA）和其他帕金森综合征]，均进行急性多巴递进反应试验，所用药物为多巴丝肼62．5、125、187．5、250、375mg，应用统一帕金森病评定量表（UPDRS）中运动部分，评价服药前及服药后1h临床改善情况，应用SPSS11．5统计软件行统计学分析。结果多巴丝肼剂量为62．5mg时，平均UPDRS评分改善率为11．3％，剂量为125mg时，平均UPDRS评分改善率为23．1％，剂量为187、5mg时，平均UPDRS评分改善率为29．4％，剂量为250mg时，平均UPDRS评分改善率为31．2％，剂量为375mg时，平均UPDRS评分改善率为34．3％；应用剂量为62．5mg多巴丝肼的急性多巴反应试验时，帕金森病与帕金森综合征诊断之间差异无统计学意义，应用剂量为125、187．5、250、375mg多巴丝肼的急性多巴反应试验时，分别以UPDRS评分运动部分，改善不小于23．1％、29．4％、31．2％、34．3％为诊断帕金森病指标标准，帕金森病与帕金森综合征诊断之间差异具有统计学意义。结论急性多巴反应试验与患者性别、年龄、HY分级无关，急性多巴反应试验是临床诊断和鉴别帕金森病的一种方便易行、重要的诊断方法。

Objective To investigate the features of acute dopaminergic responsiveness test in patients with Parkinsonian disorders, and to find a convenient approach of differential diagnosis of Parkinsonian disorders. Methods Sixty inpatients with Parkinson disease （PD） or Parkinson＇s syndrome, including vascular Parkinsonism （VP）, multiple system atrophy （MSA）, etc, were given the Levodopa and Benserazide tablets, containing levodopa of the doses of 62.5, 125 187.5,250, and 375 mg in a pattern of gradual acute DOPA test. The third part of the unified Parkinson＇s disease rating scale （UPDRS） was used to evaluate the development of PD symptom before and 1 hour after taking the medicine. The differences among the improvement rates were compared with one-way ANOVA test and post hoc multiple comparison by SSPS 11.5. Results The improvement rates after taking the Levodopa and Benserazide tablets were 11.3% for the dose of 62.5 mg, 23.1% for 125 mg, 29.4% for 187.5 mg, 31.2% for 250 mg, and 34.3% for 375 mg. When the dose was 65 mg there was no significant difference between the diagnoses of PD and Parkinsonism, however, when the doses were 125, 187.5, 250, and 375 mg, and the improvement rates ≥ 23.1%, 29.4% , 31. 2% , and 34. 3% were used as the indicators of diagnosis of PD, there were significant differences between the diagnoses of PD and Parkinson＇s syndrome. Conclusion Easy and convenient, acute dopaminergic responsiveness test is not associated with sex, age, and H-Y ranking, and is an important approach in differential diagnosis of Parkinsonian disorders.