Feng Tao, Li Wei, Lu Linlong, Wang Yilong, Shi Weixiong, Zhang Jianguo, Wang Yongjun, Chan Piu
Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
Parkinsonism Relat Disord. 2009 Jun;15(5):354-8. doi: 10.1016/j.parkreldis.2008.08.010. Epub 2008 Nov 14.
The aim of this study was to establish a new stepwise type of acute challenge test with incremental doses of levodopa/benserazide, and verify its predictive value in follow-up diagnoses and outcomes of deep-brain stimulation (DBS) in treated patients with parkinsonism.
Prospective cohort study.
The optimal cutoff points for UPDRS-III improvement in these stepwise levodopa tests. In this study, we established acute challenge tests with incremental doses of levodopa/benserazide (100/25mg, 150/37.5mg, 200/50mg and 300/75 mg) in treated patients with parkinsonism (n=175). The receiver operating characteristic (ROC) curves were plotted to compare peak UPDRS-III improvement of PD patients (n=112) with that of non-PD parkinsonism patients (n=63). The point on the ROC curve with the highest Youden index was defined as the optimal cutoff point in motor improvement for differential diagnoses. The results of the new tests were compared with follow-up diagnoses and the outcomes of DBS.
The optimal cutoff points for UPDRS-III improvement with maximal Youden Indices on ROC curves from the tests, with the four incremental doses of levodopa/benserazide, were 12.2% (100/25mg), 22.3% (150/37.5mg), 27.9% (200/50mg) and 33.4% (300/75 mg). The test showed significant correlation with follow-up diagnosis and the outcomes of DBS (P of Kappa <0.01).
The results suggested that the new acute stepwise levodopa challenge test is a useful tool for the diagnosis of PD.
本研究旨在建立一种新的左旋多巴/苄丝肼递增剂量的急性激发试验，并验证其在帕金森病患者深部脑刺激（DBS）后续诊断及预后中的预测价值。
前瞻性队列研究。
这些逐步左旋多巴试验中统一帕金森病评定量表第三部分（UPDRS-III）改善的最佳截断点。在本研究中，我们对175例接受治疗的帕金森病患者进行了左旋多巴/苄丝肼递增剂量（100/25mg、150/37.5mg、200/50mg和300/75mg）的急性激发试验。绘制受试者工作特征（ROC）曲线，比较帕金森病患者（n=112）与非帕金森病帕金森综合征患者（n=63）的UPDRS-III峰值改善情况。将ROC曲线上约登指数最高的点定义为鉴别诊断运动改善的最佳截断点。将新试验结果与后续诊断及DBS结果进行比较。
在四项左旋多巴/苄丝肼递增剂量试验的ROC曲线上，具有最大约登指数的UPDRS-III改善的最佳截断点分别为12.2%（100/25mg）、22.3%（150/37.5mg）、27.9%（200/50mg）和33.4%（300/75mg）。该试验与后续诊断及DBS结果显示出显著相关性（Kappa检验P<0.01）。
结果表明，新的急性逐步左旋多巴激发试验是诊断帕金森病的有用工具。
