■帕金森病(PD)通常进展缓慢,但推迟治疗是否会加速进展仍存在争议。
■确定多巴胺能替代治疗开始时间与PD临床症状严重程度之间的相关性,包括运动和非运动症状。
■PD患者分为155名从头诊断的患者和165名接受多巴胺替代疗法的PD患者。患者的基本特征包括性别、年龄,发病年龄,疾病持续时间,和多巴胺能替代治疗开始的时间。我们使用MDS-UPDRS评分来评估运动症状的严重程度,我们还使用量表来评估非运动症状的严重程度,如认知,心情,睡眠,和生活质量。
■症状发作与开始药物治疗之间的平均时间为31.0(22.5)个月。在调整了年龄之后,性别,发病年龄,和疾病持续时间,我们发现,与治疗组相比,在病程相似(F=8.7,p=0.0034)的新生组,MDS-统一帕金森病评定量表(UPDRS)-III评分增加更快.从头PD组在疾病持续时间内进展到H-Y评分3的累积发生率在50个月内为39.7%,在100个月内为92.2%,而在治疗组中,这种累积发生率在50个月内为15.5%,100个月为51.4%,150个月为81.5%。从头PD组患者的累积发生率高于治疗组(p=0.001),这表明未经治疗的患者更有可能进展到晚期。症状发作,症状发作和治疗开始之间的时间,年龄,性别,疾病持续时间解释了运动症状MDS-UPDRS-III评分总变异的28.95%。在药物幼稚的患者中,从症状发作到开始治疗的时间可解释运动症状的MDS-UPDRS-III评分总变异的20.1%(t=6.15,p<0.001).
■我们研究中的这些数据表明,早期多巴胺能替代治疗在PD患者中发挥了积极作用,而多巴胺能替代延迟治疗可能对PD患者的运动症状和非运动状态有害。认识PD的早期症状和早期诊断对治疗具有重要意义。
UNASSIGNED: Parkinson\'s disease (PD) generally progresses slowly, but it is controversial whether delaying treatment accelerates the progression.
UNASSIGNED: Determine the correlation between the time of dopaminergic replacement treatment initiation and the severity of clinical symptoms in PD, including motor and non-motor symptoms.
UNASSIGNED: PD patients were divided between 155 people who were diagnosed de novo and 165 PD patients receiving dopamine replacement therapy. Basic patient characteristics included gender, age, age at onset, disease duration, and the time of dopaminergic replacement treatment initiation. We used MDS-UPDRS scores to evaluate the severity of motor symptoms and we also used the scale to assess the severity of non-motor symptoms such as cognition, mood, sleep, and quality of life.
UNASSIGNED: The mean time between symptom onset and the initiation of drug treatment was 31.0 (22.5) months. After adjusting for age, sex, age at onset, and disease duration, we found that the MDS-Unified Parkinson\'s Disease Rating Scale (UPDRS)-III score increased faster in the de novo group with a similar disease duration (F = 8.7, p = 0.0034) than the treatment group. The cumulative incidence of progression to H-Y score 3 in de novo PD group over disease duration was 39.7% in 50months and 92.2% in 100 months, while in treated group such cumulative incidence was 15.5% in 50 months, 51.4% in 100 months and 81.5% in 150 months. The cumulative incidence of patients in the de novo PD group was higher than that in the treated group (p = 0.001), suggesting that untreated patients were more likely to progress to the advanced stages. Symptoms onset, the time between symptom onset and treatment initiation, age, sex, and disease duration explained 28.95% of the total variation in the MDS-UPDRS-III score for motor symptoms. In drug-naïve patients, the time between symptom onset and treatment initiation explained 20.1% of the total variation in the MDS-UPDRS-III score for motor symptoms (t = 6.15, p < 0.001).
UNASSIGNED: These data in our study showed that early dopaminergic replacement treatment have played a positive role in PD patients, while dopaminergic replacement delayed treatment might be detrimental to motor symptoms and non-motor state of PD patient. Recognizing early stage symptoms of PD and early diagnosis are of great significance to treatment.