Pharmaceutical Unit, Sakura Medical Center, Toho University, Sakura, Japan.
J Neurol Sci. 2012 Aug 15;319(1-2):86-8. doi: 10.1016/j.jns.2012.05.010. Epub 2012 May 25.
Whereas delayed gastric emptying is believed to be a causative factor for producing delayed-on and motor fluctuation in Parkinson's disease (PD), few studies have directly measured levodopa pharmacodynamics and gastric emptying together. In order to determine the relationship, we measured these two parameters in a single PD patients cohort.
Thirty-one patients with PD were enrolled in the study. They were 11 men and 20 women; age, 68.1 ± 7.8 years; disease duration, 4.2 ± 3.8 years; Unified Parkinson's Disease Rating Scale Part 3 Motor Score 18.37 ± 8.60; bowel movement <3 times a week in 20; all taking 301 mg ± 94 mg/day levodopa/carbidopa. All patients underwent levodopa pharmacokinetic study and the gastric emptying study using (13)C-octanoic acid expiration breath test. Statistical analysis was performed by Student's t-test and Mann-Whitney's U test.
Pharmacokinetic study showed that the plasma levodopa peak was at 2 hours in 42% (13/31 patients) whereas at 1 hour in 58% (18/31 patients), total of 50.7 ± 16.4 min (mean ± standard deviation) in all 31 patients. The gastric emptying study showed that T(max) ((13)C)>60 min was more common in patients with a plasma levodopa peak at 2 hours (14/18, 69%) than in those with a plasma levodopa peak at 1 hour (4/13, 22%) (p<0.05), total of 50.7 ± 16.4 min in all 31 patients.
We found a significant relationship between levodopa pharmacokinetics and gastric emptying in PD patients, suggesting that delayed gastric emptying is a causative factor for producing delayed-on in PD. Therefore, studies of improved gastric emptying in order to ameliorate delayed-on in PD are warranted.
胃排空延迟被认为是导致帕金森病（PD）迟发性运动障碍和运动波动的一个原因，但很少有研究直接测量左旋多巴的药效动力学和胃排空。为了确定这种关系，我们在一组 PD 患者中同时测量了这两个参数。
研究纳入了 31 例 PD 患者，其中男 11 例，女 20 例；年龄 68.1±7.8 岁；病程 4.2±3.8 年；统一帕金森病评定量表第 3 部分运动评分 18.37±8.60；每周排便<3 次者 20 例；均服用左旋多巴/卡比多巴 301±94mg/d。所有患者均行左旋多巴药代动力学研究和（13）C-辛酸呼气试验胃排空研究。采用 Student's t 检验和 Mann-Whitney's U 检验进行统计学分析。
药代动力学研究显示，42%（13/31 例）患者的血浆左旋多巴峰在 2 小时，58%（18/31 例）患者的血浆左旋多巴峰在 1 小时，所有 31 例患者的总时间为 50.7±16.4min（均数±标准差）。胃排空研究显示，T(max)（13）C＞60min 在血浆左旋多巴峰在 2 小时的患者中更为常见（18/18，69%），而在 1 小时的患者中则较少见（13/13，22%）（p＜0.05），所有 31 例患者的总时间为 50.7±16.4min。
我们发现 PD 患者的左旋多巴药代动力学和胃排空之间存在显著关系，提示胃排空延迟是 PD 迟发性运动障碍的一个原因。因此，有必要研究改善胃排空以改善 PD 的迟发性运动障碍。
