左旋多巴剂量与帕金森病异动症风险的相关性分析
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摘要
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.
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.
引文
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[12]陈慧敏,李芳菲,郜丽妍,等.帕金森病异动症危险因素及左旋多巴安全剂量的数据驱动分析[J].中华老年心脑血管病杂志,2017,19(8):789-792.DOI:10.3969/j.issn.1009-0126.2017.08.002.
[2]Ahlskog JE,Muenter MD.Frequency of levodopa-related dyskinesias and motor fluctuations as estimated from the cumulative literature[J].Mov Disord,2001,16(3):448-458.DOI:10.1002/mds.2001.03.
[3]Stocchi F,Rascol O,Kieburtz K,et al.Olanow,initiating levodopa/carbidopa therapy with and without entacapone in early Parkinson disease:the STRIDE-PD study[J].Ann Neurol,2010,68(1):18-27.DOI:10.1002/ana.22060.
[4]Warren Olanow C,Kieburtz K,Rascol O,et al.Factors predictive of the development of levodopa-induced dyskinesia and wearing-off in Parkinson's disease[J].Mov Disord,2013,28(8):1064-1071.DOI:10.1002/mds.25364.
[5]Daneault JF,Carignan B,Sadikot AF,et al.Drug-induced dyskinesia in Parkinson's disease.Should success in clinical management be a function of improvement of motor repertoire rather than amplitude of dyskinesia[J]?BMC Med,2013,11:76.DOI:10.1186/1741-7015-11-76.
[6]Scott NW,Macleod AD,Counsell CE.Motor complications in an incident Parkinson's disease cohort[J].Eur J Neurol,2016,23(2):304-312.DOI:10.1111/ene.12751.
[7]Tomlinson CL,Stowe R,Patel S,et al.Systematic review of levodopa dose equivalency reporting in Parkinson's disease[J].Mov Disord,2010,25(15):2649-2653.DOI:10.1002/mds.23429.
[8]Goetz CG,Tilley BC,Shaftman SR,et al.Movement Disorder Society-sponsored revision of the Unified Parkinson's Disease Rating Scale(MDS-UPDRS):scale presentation and clinimetric testing results[J].Mov Disord,2008,23(15):2129-2170.DOI:10.1002/mds.22340.
[9]Ray Chaudhuri K,Poewe W,Brooks D.Motor and nonmotor complications of levodopa:phenomenology,risk factors,and imaging features[J].Mov Disord,2018,33(6):909-919.DOI:10.1002/mds.27386.
[10]Cilia R,Akpalu A,Sarfo FS,et al.The modern pre-levodopa era of Parkinson's disease:insights into motor complications from sub-Saharan Africa[J].Brain,2014,137(Pt 10):2731-2742.DOI:10.1093/brain/awu195.
[11]Mudali D,Teune LK,Renken RJ,et al.Classification of Parkinsonian syndromes from FDG-PET brain data using decision trees with SSM/PCA features[J].Comput Math Methods Med,2015,2015:136921.DOI:10.1155/2015/136921.
[12]陈慧敏,李芳菲,郜丽妍,等.帕金森病异动症危险因素及左旋多巴安全剂量的数据驱动分析[J].中华老年心脑血管病杂志,2017,19(8):789-792.DOI:10.3969/j.issn.1009-0126.2017.08.002.