Pöpperl G, Tatsch K, Ruzicka E, Storch A, Gasser T, Schwarz J
Department of Nuclear Medicine, University of Munich, Germany.
J Neural Transm (Vienna). 2004 Aug;111(8):1041-52. doi: 10.1007/s00702-004-0147-6. Epub 2004 May 12.
Putative neurotoxic actions of levodopa and neuroprotective effects of dopamine agonists, as indicated by laboratory and animal studies, provide the rationale to study their effect on the progression of Parkinson's disease. Aim of this pilot study was to compare the effects of monotherapy with the dopamine agonist alpha-dihydroergocryptine (DEC) versus monotherapy with levodopa on nigrostriatal dopaminergic neurons as measured with dopamine transporter (DAT) SPECT. 25 PD patients (H&Y stages 1 to 2.5) entered this study and were treated in a randomized fashion either with DEC (101+/-39 mg) or levodopa (369+/-51 mg) monotherapy. 16/25 patients (8 per group) terminated the study after 52 weeks. In each patient SPECT investigations with [123I]IPT were performed at baseline and after 52 weeks to assess changes of specific DAT binding over time. Changes in clinical symptoms were assessed by UPDRS score. The mean annual decline rate in striatal IPT-binding was lower in the DEC group (8.4%) compared to the levodopa group (10.4%). The difference was most accentuated in the putamen (DEC: 7.3%; levodopa: 16.2%; p = 0.16). Due to the small sample size and the relatively short observation period, however, group differences did not reach a statistical significant level. The results of this pilot study suggest that as compared to levodopa monotherapy DEC may have beneficial effects on decline of dopamine transporter binding similar to those recently described for pramipexole.
实验室和动物研究表明，左旋多巴的潜在神经毒性作用以及多巴胺激动剂的神经保护作用，为研究它们对帕金森病进展的影响提供了理论依据。这项初步研究的目的是比较多巴胺激动剂α-二氢麦角隐亭（DEC）单药治疗与左旋多巴单药治疗对黑质纹状体多巴胺能神经元的影响，采用多巴胺转运体（DAT）单光子发射计算机断层扫描（SPECT）进行测量。25例帕金森病患者（ Hoehn-Yahr分级1至2.5级）进入本研究，并以随机方式接受DEC（101±39毫克）或左旋多巴（369±51毫克）单药治疗。25例患者中有16例（每组8例）在52周后终止研究。对每位患者在基线和52周后进行[123I]异碘普明SPECT检查，以评估特定DAT结合随时间的变化。通过统一帕金森病评定量表（UPDRS）评分评估临床症状的变化。与左旋多巴组（10.4%）相比，DEC组纹状体异碘普明结合的年平均下降率较低（8.4%）。这种差异在壳核中最为明显（DEC组：7.3%；左旋多巴组：16.2%；p = 0.16）。然而，由于样本量小且观察期相对较短，两组差异未达到统计学显著水平。这项初步研究的结果表明，与左旋多巴单药治疗相比，DEC可能对多巴胺转运体结合的下降具有有益作用，类似于最近报道的普拉克索的作用。
