【摘要】 目的分析原发性帕金森病(PD)患者剂末现象临床特点及影响因素,分析肠道菌群干预对剂末现象的影响。方法选取2016年5月-2019年10月南京市六合区人民医院诊治的采用多巴丝肼片治疗的PD患者173例,根据WOQ-9调查表分为剂末现象阳性患者和阴性患者,分析可能的影响因素;将剂末现象阳性PD患者采用随机数字表法分为观察组和对照组。观察组予基础治疗加用三联活菌制剂调理肠道菌群,对照组予基础治疗加用安慰剂,比较2组剂末现象改善情况。结果 173例PD患者中剂末现象阳性患者76例,阴性患者97例,与阴性患者比较,剂末现象阳性患者发病年龄较小、左旋多巴累计疗程及等效日剂量较大,医院焦虑抑郁量表焦虑分表(HAD-A)评分、Bristol粪便性状量表(BSFS)评分及便秘患者生活质量量表(PAC-QOL)评分均较高(P<0.01)。以剂末现象与否为因变量,研究因素为自变量,多因素Logistic回归分析,左旋多巴等效累计疗程(OR=1.262,P<0.01)及等效日剂量(OR=1.107,P<0.05)为其独立危险因素。第4周末及第8周末,观察组开期时间长于干预前和对照组(P<0.05),关期时间短于干预前和对照组(P<0.05)。观察组第4周末统一帕金森病评定量表运动部分(UPDRS-Ⅲ)评分低于干预前和对照组(P<0.05)。结论肠道菌群干预可改善PD患者多巴丝肼治疗中出现的剂末现象,可能有增强多巴丝肼对运动症状的疗效,但远期影响仍有待研究。更多还原

【Abstract】 Objective To analyze the clinical characteristics and influencing factors of the wearing-off in patients with primary Parkinson′ s disease( PD), and to analyze the influence of intestinal flora intervention on the wearing-off.Methods A total of 173 PD patients who were treated in the Nanjing Liuhe District People′s Hospital from May 2016 to October 2019 were selected. According to the WOQ-9 questionnaire, the patients were divided into positive and negative patients. Analyzed the possible influencing factors. The wearing-off in patients with PD were divided into observation group and control group by random number table method. The observation group was given basic treatment plus triple living bacteria preparation to regulate intestinal flora, and the control group was given basic treatment plus placebo. The improvement of the final phenomenon of the two groups was compared.Results Among 173 wearing-off in patients with PD, 76 were positive and97 were negative. Compared with negative patients, the age of onset of patients with positive end-of-dose phenomenon was younger, the cumulative treatment course and equivalent daily dose of levodopa were larger, the Hospital Anxiety and Depression Scale Anxiety Score(HAD-A) score, the Bristol Stool Traits Scale(BSFS) score and the Constipation Patient Quality of Life Scale(PAC-QOL) score were all higher(P< 0. 01). In multivariate Logistic regression analysis, the cumulative equivalent course of levodopa(OR= 1. 262,P< 0. 01) and equivalent daily dose(OR= 1. 107,P< 0. 05) were considered as independent risk factors. In the 4 th and 8 th weekend, the opening time of observation group were longer than baseline and control group(P< 0. 05), and the closing time were shorter than before intervention and control group(P< 0. 05). At the end of 4 th week, the UPDRS-Ⅲ score of observation group was lower than that of before intervention and control group(P< 0. 05).Conclusion Intestinal microflora intervention can improve the wearing-off of PD patients during the treatment of dopamine serazine, and may enhance the efficacy of dopamine serazine on motor symptoms, but the long-term effects remain to be studied.更多还原