卡巴拉汀联合左旋多巴治疗帕金森病的临床研究

Clinical study on rivastigmine combined with levodopa in treatment of Parkinson disease

目的探讨卡巴拉汀联合左旋多巴治疗帕金森病的临床效果。方法选择2015年8月—2017年7月在北京市隆福医院就诊的帕金森病患者126例,随机分成对照组(63例)和治疗组(63例)。对照组口服左旋多巴片,初始剂量为250 mg/次,3次/d,随后依据患者病情和耐受程度,每5~7天增加剂量100~750 mg,最大剂量低于6 g,并分成4~6次服用。治疗组在对照组基础上口服重酒石酸卡巴拉汀胶囊,3 mg/次,2次/d。两组患者均连续治疗12周。比较治疗前后两组患者帕金森病评分量表(UPDRS)、自主神经症状量表(SCOPT-AUT)评分、临床痉挛指数(CSI)评分、多巴胺转运体(DAT)活性和生活质量评分。比较两组左旋多巴片的用量情况。结果治疗后,两组患者UPDRS评分和CSI各项指标评分较治疗前显著降低,SCOPT-AUT评分和WHO生存质量量表各领域得分均显著升高,同组比较差异具有统计学意义(P<0.05);且治疗组这些评分明显优于对照组(P<0.05)。治疗后,两组患者患侧DAT活性均较治疗前明显降低,同组比较差异具有统计学意义(P<0.05),但治疗组降低幅度小于对照组(P<0.05)。治疗后,对照组健侧DAT活性明显降低(P<0.05)。对照组患者每日左旋多巴片用量为0.75~5.85 g,平均用量(3.74±0.95)g;治疗组每日左旋多巴片用量为0.75~4.68g,平均用量(2.25±0.57)g,两组比较差异具有统计学意义(P<0.05)。结论卡巴拉汀联合左旋多巴治疗帕金森病可有效改善患者肌强直,疗效确切。

Objective To investigate the clinical effect of rivastigmine combined with levodopa in treatment of Parkinson disease. Methods Patients（126 cases） with Parkinson disease in Beijing Longfu Hospital from August 2015 to July 2017 were randomly divided into control（63 cases） and treatment（63 cases）. Patients in the control group were po administered with Levodopa Tablets, the initial dosage was 250 mg/time, three times daily, then increased by 100 — 750 mg for every 5 — 7 d based on patient＇s condition and tolerance, and the max dosage was less than 6 g for 4 — 6 times. Patients in the treatment group were po administered with Rivastigmine Hydrogen Tartrate Capsules on the basis of the control group, 3 mg/time, twice daily. Patients in two groups were treated for 12 weeks. After treatment, UPDRS, SCOPT-AUT and CSI scores, DAT activity and the quality of life in two groups before and after treatment were compared. The dosage of Levodopa Tablets in two groups was compared. Results After treatment, the UPDRS and CSI scores in two groups were significantly decreased, but the SCOPT-AUT and WHOQOL-BREF scores were significantly increased, and the difference was statistically significant in the same group（P〈0.05）. And these scores in the treatment group after treatment were significantly better than those in the control group（P〈0.05）. After treatment, the DAT activity of lesion side in two groups was significantly decreased, and there were differences in the same group（P〈0.05）. And the decreasing extant in the treatment group after treatment was significant lower than that in the control group（P〈0.05）. After treatment, the DAT activity of the other side in the control group was significantly decreased（P〈0.05）. The daily dosage of Levodopa Tablets in the control group was 0.75 — 5.85 g, and the average dosage was（3.74±0.95） g. The daily dosage of Levodopa Tablets in the treatment group was 0.75 — 4.68 g, and the average dosage was（2.25±0.57） g, and there were differences between two groups（P〈0.05）. Conclusion Rivastigmine combined with levodopa can effectively improve myotonic rigidity in treatment of parkinson disease with exact effect.