多巴丝肼联合恩他卡朋治疗帕金森病的临床效果

Clinical effect of Levodopa and Benserazide Hydrochloride combined with Entacapone in the treatment of Parkinson disease

目的探讨多巴丝肼联合恩他卡朋治疗帕金森病的效果。方法选取2014年1月~2016年6月于南京脑科医院(以下简称"我院")就诊的帕金森病患者102例,将其随机分为联合组和单药组,各51例。选取同期来我院体检的正常人51名为作对照组。单药组给予常规多巴丝肼治疗,联合组在单药组的基础上加用恩他卡朋,两组均治疗12周。比较两组疗效及治疗前后统一帕金森病评定量表(UPDRSⅢ)评分、日常生活活动能力量表(ADL)评分;治疗前后对两组患者进行运动诱发电位(MEP)检查,包括静息阈值(RMT)、皮质潜伏期(CL)、皮质静息期(CSP);观察两组患者治疗前后血浆同型半胱氨酸水平(Hcy)、血清中超氧化物歧化酶(SOD)、谷胱甘肽过氧化物酶(GSH-Px)和还原型谷胱甘肽(GSH)水平,并与对照组进行比较;比较两组左旋多巴(LD)峰浓度及多巴丝肼日均用量;记录两组治疗完成后半年内不良反应发生情况。结果联合组治疗后UPDRSⅢ、ADL评分均较治疗前显著降低,而RMT、CL、CSR则明显上升(P<0.05);单药组治疗后UPDRSⅢ评分较治疗前显著降低,而CL、CSR则明显上升(P<0.05);联合组治疗后UPDRSⅢ、ADL评分显著低于单药组,而RMT、CL和CSR均显著高于单药组(P<0.05)。治疗后单药组血浆Hcy显著高于联合组和对照组(P<0.05),且联合组也显著高于对照组(P<0.05);而单药组SOD、GSH和GSH-Px均显著低于联合组和对照组(P<0.05),且联合组也显著低于对照组(P<0.05)。联合组LD峰浓度显著高于单药组,而其多巴丝肼日均用量低于单药组,差异均有统计学意义(P<0.05)。同时联合组总有效率(84.3%)显著高于单药组(62.7%)(P<0.05),但其不良反应发生率(19.6%)与单药组(23.5%)比较差异无统计学意义(P>0.05)。结论多巴丝肼联合恩他卡朋治疗帕金森病能够使LD在体内的生物利用度更高,抑制血浆Hcy的异常升高,同时还能缓解氧自由基损害,疗效显著,值得推广。

Objective To investigate the effect of Levodopa and Benserazide Hydrochloride combined with Entacapone in the treatment of Parkinson disease. Methods One hundred and two patients with Parkinson disease treated in Nan- jing Brain Hospital （＂our hospital＂ for short） from January 2014 to June 2016 were selected and randomly divided into combined group and monotherapy group, with 51 cases in each group. Another 51 healthy persons taken body examination in our hospital were selected as control group. The monotherapy group was given conventional Levodopa and Benserazide Hydrochloride, on basis of which, the combined group was added with Entacapone, both groups were treated for 12 weeks. The efficacy and the scores of unified Parkinson disease rating scale Ⅲ （UPDRSm） and activities of daily living （ADL） before and after treatment in the two groups were compared. The motor evoked potential （MEP） of the two groups was detected before and after treatment, including relaxed motor threshold （RMT）, cortical latency （CL）, cortical silent period （CSP）; the levels of plasma homocysteine （Hcy）, serum superoxide dismutase （SOD）, glutathione peroxidase （GSH-Px） and reduced glutathione （GSH） of the two groups were observed before and after treatment, which were compared with control group; the peak concentration of Levodopa and average daily dosage of Levodopa and Benserazide Hydrochloride of the two groups were compared; the conditions of adverse reactions of the two groups were recorded after treatment treatment, the scores of for half years. Results After UPDRS Ⅲ, ADL in combined group were lower than those before treatment, while RMT, CL, CSR were increased compared with those before treatment （P 〈 0.05）; after treatment, the scores of UPDRS Ⅲ in monotherapy group were lower than those before treatment, while CL, CSR were increased （P 〈 0.05）; after treatment, the scores of UPDRS Ⅲ, ADL in combined group were lower than those of monotherapy group, while RMT, CL, CSR were all higher than those of control group （P 〈 0.05）. After treatment, the plasma Hcy in monotherapy group was higher than those of combined group and control group （P 〈 0.05）, while combined group was higher than control group （P 〈 0.05）; the levels of SOD, GSH and GSH-Px in monotherapy group were all lower than those of combined group and control group （P 〈 0.05）, while combined group was lower than control group （P 〈 0.05）. The peak concentration of LD in combined group was higher than that of monotherapy group, while average daily dosage of Levodopa and Benserazide Hydrochloride was lower than that of monotherapy group, the differences were all statistically significant （P 〈 0.05）. At the same time, the total effective rate in combined group （84.3%） was higher than that of monotherapy group （62.7%） （P 〈 0.05）, but the incidence of adverse reactions between combined group （19.6%） and monotherapy group （23.5%） had no statistically significant difference （P〉0.05）. Conclusion Levodopa and Benserazide Hydrochloride combined with Entacapone in the treatment of Parkinson disease can make the bioavailability of LD in vivo higher, inhibit the abnormal increase of plasma Hcy, relieve the damage of oxygen free radicals at the same time, with significant effects, which is worthy of promotion.