左旋多巴剂量与帕金森病异动症风险的相关性分析

Association between levodopa dose and dyskinesia in Parkinson's disease patients

目的探讨帕金森病(Parkinson's disease,PD)患者既往服用左旋多巴情况与异动症风险的相关性,并基于数据驱动方法分析PD患者左旋多巴每日最高安全剂量以及累积安全剂量。方法选择于2017年3～12月于我院住院的PD患者142例,将伴发异动症患者41例作为异动组,不伴异动症患者101例作为非异动组。logistic回归分析PD患者服用左旋多巴情况与异动症风险的相关性;利用分类决策树模型计算左旋多巴安全剂量。结果异动组病程、服用药物时间明显高于非异动组,发病年龄和体质量明显低于非异动组。异动组左旋多巴累积剂量和峰日剂量明显高于非异动组[(949.10±750.39)g vs (510.77±428.36)g,P<0.01;(639.81±363.87)mg/d vs(381.93±169.89)mg/d,P<0.01]。logistic回归分析显示,左旋多巴累积剂量和峰日剂量与PD异动症风险均具有相关性(OR=1.002,P=0.002;OR=1.006,P=0.000)。分类决策树模型预测提示,左旋多巴峰日剂量400.00mg/d、左旋多巴累积剂量609.75g为区分异动症与非异动症的安全剂量。结论左旋多巴峰日剂量和累积剂量与PD异动风险可能具有相关性。

Objective To study the association between levodopa dose and dyskinesia in Parkinson's disease(PD)patients and investigate the safe dose of levodopa with a low risk fordyskinesia.Methods One hundred and forty-two PD patients admitted to our hospital were divided into dyskinesia group(n=41)and dyskinesia-free group(n=101).Association between levodopa dose and dyskinesia was analyzed by logistic regression analysis.Safe dose of levodopa was calculated according to the decision tree classification model.Results Patients with dyskinesia tended to have a younger age at onset of PD,longer duration of disease and levodopa treatment,higher levodopa dose(peak levodopa daily dose:639.81±363.87 mg/d vs 381.93±169.89 mg/d,P<0.05;cumulative levodopa dose:949.10±750.39 g vs 510.77±428.36 g,P<0.05)than those without dyskinesia(P<0.05).Logistic regression analysis showed that levodopa-related factors were positively associated with dyskinesia in PD patients(cumulative levodopa dose:OR=1.002,P=0.002;peak levodopa daily dose:OR=1.006,P=0.000).Decision tree classification model indicated that levodopa doseat 400 mg/d was a safe dose for dyskinesia.Conclusion Both the peak levodopa daily dose and cumulative levodopa dose are positively associated with dyskinesia in PD patients.