恩他卡朋对左旋多巴治疗的帕金森病患者血浆同型半胱氨酸的影响

Effects of entacapone on plasma homocysteine in Parkinson＇s disease patients on levodopa

目的观察恩他卡朋对接受左旋多巴治疗的帕金森病（PD）患者血浆同型半胱氨酸（Hcy）水平的影响。方法采用横断面研究，设立L＋E组（同时接受左旋多巴和恩他卡朋治疗的原发性PD患者）、L组（只接受左旋多巴治疗的原发性PD患者）、L（-）组（从未接受过左旋多巴治疗的原发性PD患者）及对照组（无PD及其他神经系统疾患的人群），研究对象于2012年9月采用随机数字表法选白天津医科大学总医院神经内科PD专病门诊患者数据库和健康查体中心。每组初期入选60例，确定每个研究对象的亚甲基四氢叶酸还原酶（MTHFR）C677T基因型，并检测血浆Hcy及叶酸、维生素B12浓度。随后采用成组t检验、单因素方差分析和，检验进行统计分析，由SPSS11．5软件完成。结果240例初期入组的研究对象中98例为MTHFR677位点CC基因型携带者，被确定为最终研究对象。后续统计学分析发现各组间年龄、性别构成比、血浆叶酸和维生素B12浓度比较差异均无统计学意义；L＋E组PD病程[（96±21）个月]最长，其次为L组[（51±17）个月]，L（-）组[（21±6）个月]最短；L＋E组接受左旋多巴治疗时间[（77±22）个月]及每日左旋多巴有效剂量[（765．4-110）μmg]均高于L组[（42±14）个月，（673±73）mg]；血浆Hcy浓度L＋E组[（15．1±3．1）μmol／L]低于L组[（20．4±4．7）／μmol／L]，但仍高于L（-）组[（12．2±2．4）／~mol／L]和对照组[（9．1±2．2）I^mol／L]，L（一）组亦高于对照组。结论恩他卡朋在提高左旋多巴生物利用度的同时还部分缓解了后者造成的高同型半胱氨酸血症。

Objective To explore the effects of entacapone on the plasma level of homocysteine （Hcy） in Parkinson＇s disease （PD） patients on levodopa. Methods This cross-sectional study was made up of 4 groups, i.e. ＇ L ＋ E ＇ group （ primary PD patients on levodopa and entacapone ） , ＇ L＇ group （primary PD patients on levodopa alone） , ＇L（ - ） ＇ group （primary PD patients never on levodopa） and control group （people without PD or any other nervous system diseases）. They were randomly selected from the PD patient database of our department in September 2012. At the beginning, 60 cases were selected for each group. The C677T genotypes of methylenetetrahydrofolate reductase （MTHFR） were identified and the plasma concentrations of Hcy, folic acid and vitamin B12 detected in each subject. Then group t test, single factor analysis of variance and X2 test were used for statistical analysis by SPSS 11.5 software. Results Among 240 early subjects, 98 cases with CC genotype at 677 site of MTHFR gene were finally recruited. Statistical analysis revealed no differences in age, gender, plasma concentrations of folic acid and vitamin BI2 among the groups. The PD duration of ＇ L ＋ E＇ group （96 21 months） were the longest among 3 groups, followed by those of ＇L＇ group （51± 17 months） and ＇L（ -）＇ group （21 ±6 months）. The treatment duration and daily dose of levodopa in ＇ L ＋ E＇ group （77 ± 22 months, 765 ± 110 rag） were all higher than those in ＇ L＇ group （42 ± 14 months, 673± 73 rag）. The plasma Hcy concentrations of ＇ L ＋ E＇ group （15.1 ± 3.1 μmol/L） were lower than those of ＇L＇ group （20.4 ±4. 7 μmol/L）, but still higher than those of ＇ L（ - ） ＇ group （ 12. 2 ± 2.4 μmol/L） and control group （9. 1 ± 2. 2μmol/L）. The Hcy concentrations of ＇ L （ - ） ＇ group were also higher than those of control group. Conclusion Entacaponeincreases the bioavailability of levodopa and simultaneously alleviates partially its resulting hyperhomocysteinemia.