[1]李　青,赵盼盼,徐志秀,等.氯氮平联合多巴丝肼治疗帕金森病并睡眠障碍的临床效果[J].新乡医学院学报,2020,37(12):1138-1142.[doi:10.7683/xxyxyxb.2020.12.008]
　LI Qing,ZHAO Panpan,XU Zhixiu,et al.Clinical effect of clozapine combined with levodopa and benserazide hydrochloride tablets in the treatment of Parkinson′s disease with sleep disorders[J].Journal of Xinxiang Medical University,2020,37(12):1138-1142.[doi:10.7683/xxyxyxb.2020.12.008]
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氯氮平联合多巴丝肼治疗帕金森病并睡眠障碍的临床效果
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《新乡医学院学报》[ISSN:1004-7239/CN:41-1186/R]

卷:
37
期数:
2020年12
页码:
1138-1142
栏目:
临床研究
出版日期:
2020-12-05

文章信息/Info

Title:
Clinical effect of clozapine combined with levodopa and benserazide hydrochloride tablets in the treatment of Parkinson′s disease with sleep disorders
作者:
李　青1; 2; 3; 赵盼盼1; 2; 3; 徐志秀1; 2; 3; 赵建华1; 2; 3; 袁　彬1; 2; 3; 吉四辈1; 2; 3; 白宏英4
（1.新乡医学院第一附属医院神经内科，河南　卫辉　453100；2.河南省神经修复重点实验室，河南　卫辉　453100；3.河南省老年性痴呆神经修复国际联合实验室，河南　卫辉　453100；4.郑州大学第二附属医院神经内科，河南　郑州　450014）
Author(s):
LI Qing1; 2; 3; ZHAO Panpan1; 2; 3; XU Zhixiu1; 2; 3; ZHAO Jianhua1; 2; 3; YUAN Bin1; 2; 3; JI Sibei1; 2; 3; BAI Hongying4
(1.Department of Neurology,the First Affiliated Hospital of Xinxiang Medical University,Weihui 453100,Henan Province,China；2.Henan Key Laboratory of Neural Regeneration,Weihui 453100,Henan Province,China；3.Henan Joint International Research Laboratory of Neurorestoratology for Senile Dementia,Weihui 453100,Henan Province,China；4.Department of Neurology,the Second Affiliated Hospital of Zhengzhou University,Zhengzhou 450014,Henan Province,China）
关键词:
氯氮平; 帕金森病; 睡眠障碍; 阿普唑仑; 临床疗效
Keywords:
clozapine; Parkinson′s disease; sleep disorders; alprazolam; clinical efficacy
分类号:
R971
DOI:
10.7683/xxyxyxb.2020.12.008
文献标志码:
A
摘要:
目的　观察氯氮平联合多巴丝肼治疗帕金森病（PD）并睡眠障碍患者的临床疗效和安全性。方法　选择2018年5月至2020年5月新乡医学院第一附属医院收治的72例PD并睡眠障碍患者为研究对象，采用随机数字表法将患者分为对照组和观察组，每组36例。所有患者试验期间均给予满意剂量的多巴丝肼片；观察组给予氯氮平片，起始剂量6.25 mg，每日1次，睡前口服，根据临床改善及耐受性每次增加6.25 mg，最大剂量25.00 mg，总疗程4周；对照组给予阿普唑仑片，起始剂量0.2 mg，每日1次，睡前口服，根据临床改善和耐受性每次增加0.2 mg，最大剂量0.8 mg，总疗程4周。应用帕金森病统一评定量表第三部分（UPDRS-Ⅲ）评价2组患者治疗前、治疗后的运动评分，应用匹兹堡睡眠量表（PSQI）评价2组患者治疗前、后睡眠障碍严重程度，应用爱泼沃斯嗜睡量表（ESS）评价2组患者治疗前、后白天嗜睡情况，比较2组治疗总有效率及治疗过程中不良反应发生情况。结果　2组患者治疗前运动评分及PSQI、ESS评分比较差异无统计学意义（P>0.05）；2组患者治疗后运动评分及PSQI、ESS评分均显著低于治疗前 （P<0.05）。观察组患者治疗后运动评分及PSQI、ESS评分显著低于对照组 （P<0.05）。对照组患者总有效率为63.89%（23/36）；观察组患者总有效率为88.89%（32/36），观察组患者总有效率显著高于对照组 （χ2=6.237，P<0.05）。治疗过程中，对照组患者不良反应发生率为25.00%（9/36），观察组患者不良反应发生率为5.56% （2/36）；观察组患者不良反应发生率显著低于对照组（χ2= 5.258，P<0.05）。结论　氯氮平联合多巴丝肼可有效改善PD并睡眠障碍患者的运动症状，改善睡眠质量，且无明显不良反应，安全性好。
Abstract:
Objective　To observe the clinical efficacy and safety of clozapine combined with levodopa and benserazide hydrochloride tablets in the treatment of Parkinson′s disease(PD) with sleep disorders.Methods　A total of 72 patients of PD with sleep disorders admitted to the First Affiliated Hospital of Xinxiang Medical University from May 2018 to May 2020 were selected as study subjects.They were divided into control group and observation group by random number table method,with 36 patients in each group.All patients were given a satisfactory dose of levodopa and benserazide hydrochloride tablets during the trial.The patients in the observation group took the clozapine tablets orally before going to bed at an initial dose of 6.25 mg once a day,6.25 mg was increased each time according to clinical improvement condition and drug tolerance,and the maximum dose was 25.00 mg,the total course of treatment was 4 weeks.The patients in the control group were given alprazolam tablets orally before going to bed at the initial dose of 0.2 mg,once a day,0.2 mg was increased each time according to clinical improvement condition and drug tolerance,and the maximum dose was 0.8 mg;the total course of treatment was 4 weeks.The motor function of patients in the two groups was evaluated by the third part of unified Parkinson disease rating scale(UPDRS-Ⅲ) before and after treatment;the severity of sleep disorders of patients in the two groups was evaluated by Pittsburgh sleep quality index (PSQI) before and after treatment;the daytime sleepiness of patients in the two groups was evaluated by Epworth sleepiness scale (ESS) before and after treatment.The total effective rate and the occurrence of adverse reactions during the treatment were compared between the two groups.Results　There was no significant difference in the motor function scores,PSQI and ESS scores of patients between the two groups before treatment(P>0.05);the motor function scores,PSQI and ESS scores of patients after treatment were significantly lower than those before treatment in the two groups(P<0.05).The motor function scores,PSQI and ESS scores of patients in the observation group were significantly lower than those in the control group after treatment(P<0.05).The total effective rates of patients in the control group and the observation group were 63.89%(23/36) and 88.89%(32/36),respectively;the total effective rates of patients in the observation group was significantly higher than that in the control group(χ2=6.237，P<0.05).During the treatment,the incidence of adverse reactions of patients in the control group and the observation group was 25.00%(9/36)and 5.56%(2/36) ,respectively;the incidence of adverse reactions in the observation group was significantly lower than that in the control group(χ2=5.258,P<0.05).Conclusion　Clozapine combined with levodopa and benserazide hydrochloride tablets can effectively improve the motor symptoms and sleep quality of patients with PD and sleep disorder,and without obvious adverse reactions;this treatment method has good safety.

参考文献/References:

［1］　贾建平，陈生弟，崔丽英，等.神经病学［M］.8版.北京：人民卫生出版社，2018：328-331.
［2］　GRIMES D，FITZPATRICK M，GORDON J，et al.Canadian guideline for Parkinson disease［J］.CMAJ，2019，191（36）：E989-E1004.
［3］　FALUP-PECURARIU C，DIACONU .Sleep dysfunction in Parkinson′s disease［J］.Int Rev Neurobiol，2017，133（5）：719-742.
［4］　TITOVA N，CHAUDHURI K R.Nonmotor Parkinson′s and future directions［J］.Int Rev Neurobiol，2017，134：1493-1505.
［5］　魏全福.小剂量氯氮平治疗帕金森病合并睡眠障碍的疗效观察［J］.世界睡眠医学杂志，2020，7（7）：1136-1137.
［6］　中华医学会神经病学分会帕金森病及运动障碍学组，中国医师协会神经内科医师分会帕金森病及运动障碍专业.中国帕金森病的诊断标准（2016版）［J］.中华神经科杂志，2016，49（4）：268-271.
［7］　高和.《国际睡眠障碍分类》（第三版）慢性失眠障碍的诊断标准［J］.世界睡眠医学杂志，2018，5（5）：555-557.
［8］　MOVEMENT DISORDER SOCIETY TASK FORCE ON RATING SCALES FOR PARKINSON′S DISEASE.The Unified Parkinson′s Disease Rating Scale (UPDRS): status and recommendations［J］.Mov Disord,2003,18(7):738-750.
［9］　GOETZ C G，TILLEY B C，SHAFTMAN S R，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.
［10］　MOLLAYEVA T，THURAIRAJAH P，BURTON K，et al.The Pittsburgh sleep quality index as a screening tool for sleep dysfunction in clinical and non-clinical samples：a systematic review and meta-analysis［J］.Sleep Med Rev，2016，25（2）：52-73.
［11］　JOHNS M W.A new method for measuring daytime sleepiness：the Epworth sleepiness scale［J］.Sleep，1991，14（6）：540-545.
［12］　梁建庆.帕金森病的发病机制、诊断标准及治疗策略［J］.解放军医学杂志，2018，43（8）：631-635.
［13］　BRAAK H，DEL TREDICI K.Neuropathological staging of brain pathology in sporadic Parkinson′s disease：separating the wheat from the chaff［J］.J Parkinsons Dis，2017，7（s1）：S71-S85.
［14］　孙莉，马荣莉，匡春俊，等.帕金森病认知障碍的中西医研究进展［J］.湖北中医药大学学报，2019，21（2）：119-122.
［15］　KATUNINA E，TITOVA N.The epidemiology of nonmotor symptoms in Parkinson′s disease （cohort and other studies）［J］.Int Rev Neurobiol，2017，133（2）：91-110.
［16］　李煜，郭艳红，杨丽娟.重复经颅磁刺激改善帕金森患者认知对步态的影响［J］.世界中医药，2019，14（12）：3389-3393.
［17］　ARMSTRONG M J，OKUN M S.Diagnosis and treatment of Parkinson disease：a review［J］.JAMA，2020，323（6）：548-560.
［18］　RUI Z，QINGLING C，XINYUE Z，et al.The related factors of sleep benefit in Parkinson′s disease：a systematic review and meta-analysis［J］.PLoS One，2019，14（3）：e0212951.
［19］　YLIKOSKI A，MARTIKAINEN K，SIEMINSKI M，et al.Sleeping difficulties and health-related quality of life in Parkinson′s disease［J］.Acta Neurol Scand，2017，135（4）：459-468.
［20］　BOLLU P C，SAHOTA P.Sleep and Parkinson disease［J］.Mo Med，2017，114（5）：381-386.
［21］　ALBERS J A，CHAND P，ANCH A M.Multifactorial sleep disturbance in Parkinson′s disease［J］.Sleep Med，2017，35（7）：41-48.
［22］　LIU C F，WANG T，ZHAN S Q，et al.Management recommendations on sleep disturbance of patients with Parkinson′s disease［J］.Chin Med J，2018，131（24）：2976-2985.
［23］　中华医学会神经病学分会帕金森病及运动障碍学组，中国医师协会神经内科医师分会帕金森病及运动障碍学组.中国帕金森病治疗指南（第四版）［J］.中华神经科杂志，2020，53（12）：973-986.
［24］　FERREIRA T，PRABHAKAR S，KHARBANDA P S.Sleep disturbances in drug nave Parkinson′s disease （PD）patients and effect of levodopa on sleep［J］.Ann Indian Acad Neurol，2014，17（4）：416-419.
［25］　中华医学会神经病学分会帕金森病及运动障碍学组，中国医师协会神经内科医师分会帕金森病及运动障碍学组.帕金森病非运动症状管理专家共识（2020）［J］.中华医学杂志，2020，100（27）：2084-2091.
［26］　张鹏，李雁鹏，吴惠涓，等.中国成人失眠诊断与治疗指南（2017版）［J］.中华神经科杂志，2018，51（5）：324-335.
［27］　RIOS ROMENETS S，CRETI L，FICHTEN C，et al.Doxepin and cognitive behavioural therapy for insomnia in patients with Parkinson′s disease：a randomized study［J］.Parkinsonism Relat Disord，2013，19（7）：670-675.
［28］　JURI C，CHAN P，TAPIA J，et al.Quetiapine for insomnia in Parkinson′s disease：results from an open-label trial［J］.Clin Neuropharmacol，2005，28（4）：185-187.
［29］　张敏，朱海清，鲍智颖，等.小剂量氯氮平治疗帕金森病合并睡眠障碍的疗效观察［J］.中国实用神经疾病杂志，2018，21（1）：62-64.
［30］　YAW T K，FOX S H，LANG A E.Clozapine in Parkinsonian rest tremor：a review of outcomes，adverse reactions，and possible mechanisms of action［J］.Mov Disord Clin Pract，2015，3（2）：116-124.
［31］　SCHULTE P F J，BOGERS J，BOND-VEERMAN S R T，et al.Moving forward with clozapine［J］.Acta Psychiatr Scand，2020，142（2）：75-77.

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更新日期/Last Update: 2020-12-05