神经损伤与功能重建2025，Vol.20Issue(10)：564-568,595,6.DOI:10.16780/j.cnki.sjssgncj.20250842
多巴胺能及抗胆碱能药物对帕金森病震颤的疗效比较及药物反应的影响因素分析
Comparison of Efficacy between Dopaminergic and Anticholinergic Drugs for Tremor in Parkinson's Disease and Analysis of Factors Influencing Drug Response
摘要
Abstract
Objective:To compare the efficacy of dopaminergic(levodopa)and anticholinergic(benzhexol)medications in the treatment of tremor in patients with Parkinson's disease(PD),and to evaluate the factors influencing response to these two medications in patients with resting tremor.Methods:A prospective study enrolled 141 patients with PD presenting with tremor,recruited at Beijing Tiantan Hospital between December 2021 and March 2024.On two consecutive mornings in a fasting state,participants underwent pharmacological challenge tests with levopoda and benzhexol.Resting,postural,intentional and kinetic tremors in patients with PD were evaluated using the Part III of the Unified Parkinson's Disease Rating Scale(UPDRS-III)and the Fahn-Tolosa-Marin Tremor Rating Scale(TRS).Tremor power across different contexts was analyzed via electromyography(EMG).The study compared improvement rates in tremor scale scores and absolute changes in tremor power following administration of each drug.Univariate and multiple linear regression analyses were employed to identify factors associated with drug response in resting tremor.Results:Levopoda outperformed benzohexol in improving all tested PD tremor types:resting(UPDRS-III P=0.003;TRS P=0.007),postural(TRS P<0.001),intentional(TRS P=0.002),and kinetic(TRS P<0.001).It also achieved greater reductions in tremor power during resting,resting+task,postural,and weight conditions(all P<0.05 v.s.benzohexol).Regression analyses indicated that better responses to levopoda for resting tremor were associated with higher rigidity-bradykinesia(β=0.215,P=0.033)and anxiety scores(β=0.211,P=0.015).Presence of dyskinesia enhanced response to levopoda(β=0.300,P=0.001)but diminished response to benzohexol(β=-0.357,P<0.001).Worse responses to both drugs for resting tremor occurred in patients with higher kinetic tremor scores(levopoda β=-0.276,P=0.007;benzohexol β=-0.195,P=0.024).Conclusion:Dopaminergic medications are the preferred treatment for tremor in PD,particularly for patients with dyskinesia,and for those with severe bradykinesia,rigidity,and anxiety.The benefit of adding anticholinergic agents to treat dopamine-resistant resting tremor may be smaller in patients with pronounced kinetic tremor.关键词
帕金森病/震颤/多巴胺能/抗胆碱能/药物反应Key words
Parkinson's disease/tremor/dopaminergic/anticholinergic agents/medication response分类
医药卫生引用本文复制引用
曹双双,崔雨沙,苏东宁,冯涛..多巴胺能及抗胆碱能药物对帕金森病震颤的疗效比较及药物反应的影响因素分析[J].神经损伤与功能重建,2025,20(10):564-568,595,6.基金项目
国家自然科学基金项目(通过外周神经调控对PD震颤脑能量活动的体感反馈机制研究,No.82271459) （通过外周神经调控对PD震颤脑能量活动的体感反馈机制研究,No.82271459）
山东省医药卫生科技项目(多巴胺能及抗胆碱能药物对帕金森病震颤的疗效分析及生理复杂度研究,No.202303071501) （多巴胺能及抗胆碱能药物对帕金森病震颤的疗效分析及生理复杂度研究,No.202303071501）
潍坊市卫健委科研项目(帕金森病静止性震颤的多巴胺能及胆碱能药物反应分型及标记物研究,No.WFWSJK-2025-072) （帕金森病静止性震颤的多巴胺能及胆碱能药物反应分型及标记物研究,No.WFWSJK-2025-072）
潍坊市青年医学人才托举工程资助 （）
