帕金森病患者起始用药的横断面调查分析

Initial medication for de novo Parkinson’s disease: a cross-sectional study of 342 patients

摘要:

目的 国内对新发帕金森病（PD）患者起始用药缺乏相关调查。本研究横断面调查我国不同地区新发PD患者的起始药物选择，探讨现实用药的现状及影响因素。方法 收集2014年8月至2015年4月于航天中心医院门诊及北京天坛医院帕金森专病门诊就诊的PD患者342例，对性别、发病年龄、病程、起始用药的种类、H-Y分级等进行记录并分类。结果 发病年龄中位数为50.9岁，病程中位数为6.7年，平均改良H-Y分级为2.43级。起始药物选择存在4种类型，即左旋多巴（LD）型，多巴胺受体激动剂（DA）型，LD＋DA型，non-LD并non-DA型。左旋多巴是最主要的起始药物，达到51.8%，且在青年型患者中（＜40岁起病），左旋多巴仍是首要的选择药物（占41.0%），与其他研究存在一定差异。但近5年内新发PD患者中，DA型作为起始药物选择有增多趋势，考虑与指南更新有关。结论 左旋多巴目前仍是临床上不同年龄段新发PD患者起始药物的最主要选择。

Abstract:

Objective Till now, there is lack of evidence on the initial medication for patients with de novo Parkinson’s disease (PD) in China. We aimed to explore the status and influencing factors of the medication by a cross-sectional study about the selection of initial medication for the patients from different regions. Methods Clinical data of 342 PD patients from the Outpatient Department of the Aerospace Central Hospital and the Specialized PD Clinic of Beijing Tiantan Hospital from August 2014 to April 2015 were collected in this study. Their gender, age of onset, disease duration, type of initial medication, and Hoehn-Yahr staging score were recorded and classified. Results The cohort had a median onset age of 50.9 years, median duration of 6.7 years, and an average Hoehn-Yahr staging score of 2.43. For them, there were 4 types of initial drugs, that is, levodopa (LD), dopamine agonist (DA), LD＋DA, and non-LD and non-DA. The first one was the most commonly used as initial drug in the study, accounting for 51.8%. What’s more, it was still the first choice (41.0%) for the young onset patients (age of onset younger than 40 years; this finding was different from other studies). But in recent 5 years, there was a trend of using DA as initial option for de novo PD patients, which may be due to the update of guideline. Conclusion LD is still the main first option for initial medication in de novo PD patients at variable ages in clinical practice.