美多巴对老年血管性帕金森病合并阵发性心房颤动的影响

摘要

目的 探讨美多巴对老年血管性帕金森病(VPD)合并阵发性心房颤动(PAF)的疗效及其对自主神经功能的影响. 方法 采用随机同期对照实验方法,选取60岁以上VPD合并PAF患者50例,根据患者治疗前24 h动态心电图平均基础窦性心率分为窦性心动过缓组15例,定义为24 h动态心电图窦性心律平均心率小于60次/min ,合并VPD+ PAF ;其余正常心率的VPD+ PAF患者数字抽签随机分为心率正常组20例和对照组15例.对照组给予常规治疗,其余两组在常规治疗方案基础上加用美多巴治疗,疗程12周. 3组分别在治疗前1 d 、治疗后4周、12周进行帕金森病统一评分量表第三部分即运动部分(U PDRS-3)评分及疗效评价,分别进行动态心电图、心率变异性、超声心动图及血浆乙酰胆碱(ACH)浓度检测,3组患者治疗2周后行心房颤动(AF)发生频次检测. 结果 心动过缓组、正常心率组U PDRS-3评分与治疗前比较,治疗后4周、12周下降(P＜0.05) ;对照组治疗后12周较治疗前下降(P＜0.05) ;与对照组比较,心动过缓组、正常心率组治疗后4周、12周U PDRS-3评分下降(均 P＜0.05) .心动过缓组和正常心率组治疗总有效率86.7%(13例) 、85.0%(17例)均高于对照组53.3%(8例)(P＜0.05).心动过缓组、正常心率组ACH浓度与治疗前比较,治疗后4周、12周降低(均 P＜0.05) ;与对照组比较,心动过缓组、正常心率组 AF发作频次均降低(P＜0.05). 结论 美多巴能降低中枢性迷走神经张力,控制VPD合并 PAF患者症状,减少房颤发作频次;心率变异性指标及ACH水平具有作为临床监测VPD患者美多巴疗效的指标的潜能.%Objective To investigate the efficacy of Madopar on vascular parkinsonism with paroxysmal atrial fibrillation(VPD+ PAF)in elderly patients and its effect on the autonomic nervous system. Methods We recruited 50 patients aged over 60 with VPD + PAF into this randomized controlled trial.Based on sinus rhythm recorded by 24 hour ambulatory electrocardiogram ,individuals with an average heart rate below 60 times per minute were assigned into a sinus bradycardia group (n＝15)and those with a normal average heart rate were randomly assigned into a normal rate group (n＝20)or a control group (n＝ 15)by drawing lots.The control group was given routine care for 12 weeks ,while the other two groups were treated with Madopar plus routine care for 12 weeks. The three groups were examined using UPDRS-3 ,dynamic electrocardiogram ,heart rate variability , echocardiography ,and plasma acetylcholine(ACH)levels 1 day before treatment ,4 weeks and 12 weeks after treatment ,and atrial fibrillation frequency 2 weeks after treatment. Results UPDRS-3 scores decreased significantly in the sinus bradycardia group and the normal rate group after treatment for 4 weeks and 12 weeks ,compared with those before treatment (P＜0.05) ;UPDRS-3 scores in the control group did not show statistically significant changes at week 4 after treatment but decreased significantly at week 12(P＜0.05).UPDRS-3 scores in the sinus bradycardia group and the normal rate group were lower than those in the control group after treatment for 4 weeks and 12 weeks(P＜0.05). The total effectiveness rates in the sinus bradycardia group (86.7%,n＝13)and the normal rate group(85.0%,n＝17)were higher than the rate in the control group(53.3%,n＝8)(P＜0.05).Ach levels in the sinus bradycardia group and the normal rate group significantly decreased after treatment for 4 weeks and 12 weeks ,compared with before-treatment levels ,but no significant difference was observed between before-and after-treatment levels in the control group. Frequencies of AF in the sinus bradycardia group(5.6 ± 3.5)and the normal rate group(5.2 ± 4.1)were significantly lower than in the control group(8.4 ± 5.2)(P＜0.05). Conclusions Madopar can depress vagus nerve activity ,relieve VPD+ PAF symptoms ,and reduce the frequency of AF ;Heart rate variability and ACH level are potential predictors of clinical efficacy of Madopar in VPD patients.