本文選題：左旋多巴 + 同型半胱氨酸�。� 參考：《山東大學(xué)》2017年碩士論文

【摘要】：背景帕金森病(Parkinson's disease,PD)是一種中樞神經(jīng)退行性疾病,以運(yùn)動(dòng)障礙為主要臨床特點(diǎn)。由于PD的發(fā)病具有年齡依賴性,隨著我國(guó)逐漸進(jìn)入老齡化社會(huì),PD患者的人數(shù)也將逐漸增加,已成為威脅老年人健康的重大臨床問(wèn)題。眾所周知,左旋多巴是治療PD患者的最常用藥物,但有關(guān)研究顯示長(zhǎng)期服用左旋多巴會(huì)引起血漿同型半胱氨酸水平的升高。目前,同型半胱氨酸被認(rèn)為是導(dǎo)致心血管疾病發(fā)病的危險(xiǎn)因素,與心血管疾病發(fā)生密切相關(guān)。因此,我們推測(cè)長(zhǎng)期服用左旋多巴治療的PD患者可能處于罹患心腦血管疾病的危險(xiǎn)之中。為此,本研究旨在探討左旋多巴治療組與非治療組PD患者同型半胱氨酸水平的變化及其對(duì)心血管疾病的影響。研究目的檢測(cè)左旋多巴治療組與非治療組PD患者血漿中同型半胱氨酸水平,通過(guò)超聲心動(dòng)圖獲取評(píng)價(jià)心血管功能的相關(guān)參數(shù),驗(yàn)證左旋多巴長(zhǎng)期治療PD患者,是否會(huì)出現(xiàn)心血管功能的改變,這種改變與同型半胱氨酸的升高是否相關(guān)。研究方法收集于2014年1月至2016年12月在山東省立醫(yī)院神經(jīng)內(nèi)科住院的PD患者96例,其中服用左旋多巴治療超過(guò)1年的患者有53例,作為左旋多巴治療組;未服用者有43例,作為左旋多巴非治療組。其中排除合并有冠心病、高血壓、糖尿病、先天性心臟病、心衰、慢性阻塞性肺病、房顫、起搏器植入、風(fēng)濕性心瓣膜病、心臟瓣膜置換的患者。結(jié)果通過(guò)分析發(fā)現(xiàn)長(zhǎng)期服用左旋多巴治療的PD患者同型半胱氨酸的水平明顯升高(15.38±5.43和11.79±3.65;P0.001);另外相比未進(jìn)行治療的PD患者,左旋多巴治療后的患者二尖瓣舒張?jiān)缙谒俣?E峰,cm/s)明顯降低(82.64±13.87和66.43 ±9.86;P=0.002),E/A 的比值也明顯下降(1.02±0.26和0.82± 0.19;P = 0.034),說(shuō)明長(zhǎng)期進(jìn)行左旋多巴治療的患者心臟早期舒張功能下降。另外,我們的數(shù)據(jù)也發(fā)現(xiàn)同型半胱氨酸的水平與E峰值及E/A的比值呈負(fù)相關(guān)性(r =-0.551,p0.01和r =-0.549,p0.01),說(shuō)明左旋多巴可能通過(guò)同型半胱氨酸的升高引起心臟早期舒張功能下降。結(jié)論及意義本研究結(jié)果發(fā)現(xiàn)長(zhǎng)期服用左旋多巴治療的PD患者血漿同型半胱氨酸的水平明顯升高,這與之前的研究是相一致的。并且超聲心動(dòng)圖檢測(cè)發(fā)現(xiàn)該組患者二尖瓣舒張?jiān)缙谒俣燃癊/A的比值明顯下降,說(shuō)明患者的心臟早期舒張功能有一定程度的下降。另外,我們的數(shù)據(jù)也發(fā)現(xiàn)同型半胱氨酸的水平與E峰值及E/A的比值呈負(fù)相關(guān)性,說(shuō)明左旋多巴可能通過(guò)同型半胱氨酸的升高引起心臟早期舒張功能下降。因此,長(zhǎng)期服用左旋多巴治療的患者可能有罹患心血管疾病的風(fēng)險(xiǎn)。
[Abstract]:Background Parkinsonian disease (PDD) is a degenerative disease of central nervous system, characterized by dyskinesia. As the incidence of PD is age-dependent, the number of PD patients will increase gradually with the aging society in China, which has become a major clinical problem threatening the health of the elderly. It is well known that levodopa is the most commonly used drug in the treatment of PD patients, but studies have shown that long-term administration of levodopa can increase plasma homocysteine levels. At present, homocysteine is considered to be a risk factor for cardiovascular disease and is closely related to cardiovascular disease. Therefore, we speculate that PD patients who take long-term levodopa may be at risk of cardiovascular and cerebrovascular disease. The aim of this study was to investigate the changes of homocysteine levels in PD patients and their effects on cardiovascular disease. Objective to detect plasma homocysteine levels in patients with PD treated with and without levodopa, and to obtain parameters for evaluating cardiovascular function by echocardiography to verify the long-term treatment of PD patients with levodopa. Whether changes in cardiovascular function occur and whether these changes are associated with an increase in homocysteine. Methods from January 2014 to December 2016, 96 PD patients were enrolled in the Department of Neurology, Shandong Provincial Hospital, including 53 patients who had been treated with levodopa for more than one year as the levodopa treatment group, and 43 patients who were not. As a levodopa treatment group. Patients with coronary heart disease, hypertension, diabetes, congenital heart disease, heart failure, chronic obstructive pulmonary disease, atrial fibrillation, pacemaker implantation, rheumatic heart valve disease, heart valve replacement are excluded. Results the levels of homocysteine in PD patients treated with levodopa for a long period of time were significantly increased by 15.38 鹵5.43 and 11.79 鹵3.65, P 0.001, respectively. The mitral early diastolic velocities of patients treated with levodopa were significantly decreased by 82.64 鹵13.87 and 66.43 鹵9.86P 0.002 / A, respectively, and the ratio of E / A was significantly decreased by 1.02 鹵0.26 and 0.82 鹵0.19 (P = 0.034), indicating that the early diastolic function of patients treated with L-dopa for a long time was decreased. In addition, we also found that homocysteine levels were negatively correlated with E peak and E / A ratios, suggesting that L-dopa may cause early cardiac diastolic decline through the elevation of homocysteine. Conclusion and significance this study found that plasma homocysteine levels were significantly increased in PD patients treated with long term levodopa, which was consistent with previous studies. The early diastolic velocity of mitral valve and the ratio of E / A were obviously decreased by echocardiography, which indicated that the early diastolic function of the patients was decreased to some extent. In addition, our data also found that homocysteine levels were negatively correlated with E peak and E / A ratio, suggesting that L-dopa may cause early diastolic dysfunction through the elevation of homocysteine. As a result, patients who take long-term levodopa may be at risk of cardiovascular disease.
【學(xué)位授予單位】：山東大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R742.5

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