Dupuy D, Lesbre J P, Gérard P, Andrejak M, Godefroy O
Dept. of Neurology and Laboratoire de Neurosciences Fonctionnelles, (UMR CNRS 8160), Service de Neurologie, Hôpital Nord, 80054 Amiens, France.
J Neurol. 2008 Jul;255(7):1045-8. doi: 10.1007/s00415-008-0839-1. Epub 2008 Jun 16.
Valvular heart abnormalities have been reported in patients with Parkinson's disease (PD) treated with pergolide. However, the incidence and severity of these abnormalities vary from study to study and their course after drug withdrawal has not been systematically assessed.
To estimate the frequency and severity of valvular heart abnormality and its possible reversibility after drug withdrawal in a case-control study.
All PD patients in the Amiens area treated with pergolide were invited to attend a cardiologic assessment including transthoracic echocardiography. Thirty PD patients participated in the study. A second echocardiography was performed (median interval: 13 months) after pergolide withdrawal (n=10 patients). Controls were age- and sex-matched non-PD patients referred to the cardiology department.
Compared to controls, aortic regurgitation (OR: 3.1; 95% IC: 1.1-8.8) and mitral regurgitation (OR: 10.7; 95% IC: 2.1-53) were more frequent in PD patients (tricuspid: NS). The number of affected valves (n=2.4+/-0.7) and the sum of regurgitation grades (n=2.8+/-1.09) were higher (p=0.008 and p=0.006, respectively) in the pergolide group. Severity of regurgitation was not correlated with pergolide cumulative dose. A restrictive pattern of valvular regurgitation, suggestive of the role of pergolide, was observed in 12/30 (40%) patients including two with heart failure. Pergolide was discontinued in 10 patients with valvular heart disease, resulting in a lower regurgitation grade (p=0.01) at the second transthoracic echocardiography and the two patients with heart failure returned to nearly normal clinical examination. This study supports the high frequency of restrictive valve regurgitation in PD patients treated with pergolide and reveals that a significant improvement is usual when the treatment is converted to non-ergot dopamine agonists.
已有报道称，使用培高利特治疗的帕金森病（PD）患者存在心脏瓣膜异常。然而，这些异常的发生率和严重程度在不同研究中有所不同，且停药后的病程尚未得到系统评估。
在一项病例对照研究中，评估心脏瓣膜异常的频率和严重程度及其停药后的可逆性。
邀请亚眠地区所有接受培高利特治疗的PD患者参加包括经胸超声心动图在内的心脏评估。30名PD患者参与了研究。在停用培高利特后（n = 10名患者）进行了第二次超声心动图检查（中位间隔时间：13个月）。对照组为年龄和性别匹配的转诊至心脏科的非PD患者。
与对照组相比，PD患者中主动脉瓣反流（比值比：3.1；95%可信区间：1.1 - 8.8）和二尖瓣反流（比值比：10.7；95%可信区间：2.1 - 53）更为常见（三尖瓣反流：无显著差异）。培高利特组中受影响瓣膜的数量（n = 2.4 ± 0.7）和反流分级总和（n = 2.8 ± 1.09）更高（分别为p = 0.008和p = 0.006）。反流严重程度与培高利特累积剂量无关。在12/30（40%）的患者中观察到瓣膜反流的限制性模式，提示培高利特的作用，其中包括两名心力衰竭患者。10名患有心脏瓣膜病的患者停用了培高利特，在第二次经胸超声心动图检查时反流分级降低（p = 0.01），两名心力衰竭患者的临床检查恢复至接近正常。本研究支持接受培高利特治疗的PD患者中限制性瓣膜反流的高发生率，并表明转换为非麦角多巴胺激动剂治疗时通常会有显著改善。
