悉尼帕金森病多中心研究：10年病程及死亡率
The sydney multicentre study of Parkinson's disease: progression and mortality at 10 years.
作者信息
Hely M A, Morris J G, Traficante R, Reid W G, O'Sullivan D J, Williamson P M
机构信息
Department of Neurology, Westmead Hospital, Sydney, Australia.
出版信息
J Neurol Neurosurg Psychiatry. 1999 Sep;67(3):300-7. doi: 10.1136/jnnp.67.3.300.
OBJECTIVES
To report on a 10 year follow up of patients with idiopathic Parkinson's disease, particularly with respect to mortality and the effect of early treatment with bromocriptine.
METHODS
The patients are from the 149 new patients recruited for a double blind, randomised study of low dose levodopa-carbidopa versus low dose bromocriptine. Patients were examined neurologically at least yearly. Neuropsychological examinations were performed at 0, 3, 5, and 10 years. Mortality and cause of death in these patients were compared with the Australian population using standardised mortality ratios (SMRs). Mortality and disease progression were compared by sex and treatment group. Predictors of death within 10 years, nursing home admission, and progression in Columbia score of >/=20 points were examined by logistic regression analysis.
RESULTS
Thirteen patients were excluded as having atypical Parkinsonism and six were lost to follow up. All available patients have been followed up for 10 years. Fifty patients (38%) were dead by 10 years and 63 by the last follow up. The SMR was 1.58 for all patients (p<0. 001). There was no significant difference in SMRs between the sexes. The mean duration of disease until death was 9.1 years. Parkinson's disease was thought to have contributed substantially to the death of 30 patients. The most common cause of death was pneumonia. Women progressed at a similar rate to men until 8 years, when the severity of their disease as measured by Hoehn and Yahr stage became greater (p<0.05). Older age of onset correlated with increased risk of death but the SMR was increased even in those aged <70 years (SMR 1.80, p=0.03). Early use of bromocriptine did not reduce mortality or slow progression of disease. One quarter of all patients had been admitted to nursing homes by 10 years. Only four patients were still employed.
CONCLUSIONS
Mortality in Parkinson's disease remains increased despite low dose levodopa-carbidopa therapy and no additional benefit was gained from early use of bromocriptine. Duration of disease was similar to that in the era before levodopa.
目的
报告特发性帕金森病患者的10年随访情况，尤其关注死亡率以及早期使用溴隐亭治疗的效果。
方法
患者来自149名新招募的患者，这些患者参与了一项低剂量左旋多巴 - 卡比多巴与低剂量溴隐亭的双盲随机研究。患者每年至少进行一次神经学检查。在0、3、5和10年时进行神经心理学检查。使用标准化死亡率比（SMR）将这些患者的死亡率和死亡原因与澳大利亚人群进行比较。按性别和治疗组比较死亡率和疾病进展情况。通过逻辑回归分析检查10年内死亡、入住养老院以及哥伦比亚评分进展≥20分的预测因素。
结果
13名患者因患有非典型帕金森症被排除，6名患者失访。所有可获得的患者均已随访10年。到10年时，50名患者（38%）死亡，到最后一次随访时为63名。所有患者的SMR为1.58（p<0.001）。性别之间的SMR无显著差异。直至死亡的疾病平均持续时间为9.1年。据认为帕金森病是30名患者死亡的主要原因。最常见的死亡原因是肺炎。女性在8年之前与男性的疾病进展速度相似，8年时用Hoehn和Yahr分期衡量其疾病严重程度变得更高（p<0.05）。发病年龄较大与死亡风险增加相关，但即使在年龄<70岁的患者中SMR也有所增加（SMR 1.80，p = 0.03）。早期使用溴隐亭并未降低死亡率或减缓疾病进展。到10年时，所有患者中有四分之一已入住养老院。只有4名患者仍在工作。
结论
尽管采用低剂量左旋多巴 - 卡比多巴治疗，帕金森病患者的死亡率仍然较高，且早期使用溴隐亭未获得额外益处。疾病持续时间与左旋多巴时代之前相似。
Zotero 插件