帕金森病冲动控制障碍的纵向分析。
Longitudinal analysis of impulse control disorders in Parkinson disease.
机构信息
From the Assistance Publique Hôpitaux de Paris (J.-C.C., F.C.-D., L.L., C.B., D.G., S.K., G.M., H.Y., A.B., M.V.); Sorbonne Université (J.-C.C., F.C.-D., L.L., C.B., D.G., S.K., G.M., H.Y., A.B., M.V.); INSERM (J.-C.C., F.C.-D., L.L., C.B., D.G., S.K., G.M., H.Y., A.B., M.V.), Institut du cerveau et de la Moelle, Centre d'Investigation Clinique Neurosciences, NS-PARK/FCRIN Network; CNRS (J.-C.C., F.C.-D., L.L., C.B., D.G., S.K., G.M., H.Y., A.B., M.V.); Departments of Neurology and Genetics (J.-C.C., F.C.-D., L.L., C.B., D.G., S.K., G.M., H.Y., A.B., M.V.), Hôpital Pitié-Salpêtrière, Paris; CESP (F.A., A.E.), Faculte de médecine, Université Paris-Sud; Faculte de médecine (F.A., A.E.), UVSQ, Institut National de la Santé et de la Recherche Médicale, Université Paris-Saclay, Villejuif; University of Toulouse 3 (O.R., C.B.-C., F.O.-M), Centre Hospitalo-Universitaire de Toulouse and INSERM; Centre d'Investigation Clinique CIC1436 (O.R., C.B.-C., F.O.-M), NS-PARK/FCRIN Network, Départements de Neurosciences et de Pharmacologie Clinique, NeuroToul COEN Center, Toulouse; Department of Neurology (F.D., A.-R.M.), NS-PARK/FCRIN Network, Centre Hospitalo-Universitaire de Clermont-Ferrand; Department of Neurology (P.D.), NS-PARK/FCRIN Network, Centre Hospitalo-Universitaire de Nantes; Department of Neurology (F.B.), Hôpital Foch, Suresnes; Department of Neurology (J.-P.B.), Fondation Rothschild, Paris; Department of Neurology (F.P.), Centre Hospitalier de Versailles; Université Versailles Saint Quentin en Yvelines et Paris Saclay (F.P.), Versailles; Department of Neurology (V.M.), Centre Hospitalo-Universitaire Saint-Antoine, Paris, France; and Department of Health Care Management (P.-C.L.), College of Health Technology, National Taipei University of Nursing and Health Sciences, Taiwan.
出版信息
Neurology. 2018 Jul 17;91(3):e189-e201. doi: 10.1212/WNL.0000000000005816. Epub 2018 Jun 20.
OBJECTIVE
To investigate the longitudinal dose-effect relationship between dopamine replacement therapy and impulse control disorders (ICDs) in Parkinson disease (PD).
METHODS
We used data from a multicenter longitudinal cohort of consecutive patients with PD with ≤5 years' disease duration at baseline followed up annually up to 5 years. ICDs were evaluated during face-to-face semistructured interviews with movement disorder specialists. Generalized estimating equations and Poisson models with robust variance were used to study the association between several time-dependent definitions of dopamine agonist (DA) use, taking dose and duration of treatment into account, and ICDs at each visit. Other antiparkinsonian drugs were also examined.
RESULTS
Among 411 patients (40.6% women, mean age 62.3 years, average follow-up 3.3 years, SD 1.7 years), 356 (86.6%) took a DA at least once since disease onset. In 306 patients without ICDs at baseline, the 5-year cumulative incidence of ICDs was 46.1% (95% confidence interval [CI] 37.4-55.7, DA ever users 51.5% [95% CI 41.8-62.1], DA never users 12.4% [95% CI 4.8-30.0]). ICD prevalence increased from 19.7% at baseline to 32.8% after 5 years. ICDs were associated with ever DA use (prevalence ratio 4.23, 95% CI 1.78-10.09). Lifetime average daily dose and duration of treatment were independently associated with ICDs with significant dose-effect relationships. Similar analyses for levodopa were not in favor of a strong association. ICDs progressively resolved after DA discontinuation.
CONCLUSION
In this longitudinal study of patients with PD characterized by a high prevalence of DA treatment, the 5-year cumulative incidence of ICDs was ≈46%. ICDs were strongly associated with DA use with a dose-effect relationship; both increasing duration and dose were associated with ICDs. ICDs progressively resolved after DA discontinuation.
CLINICALTRIALSGOV IDENTIFIER
NCT01564992.
目的
探讨帕金森病（PD）中多巴胺替代疗法与冲动控制障碍（ICD）之间的纵向剂量-效应关系。
方法
我们使用了一项多中心纵向队列研究的数据，该研究纳入了基线时病程≤5 年的连续 PD 患者，并在 5 年内每年进行随访。ICD 通过运动障碍专家的面对面半结构化访谈进行评估。采用广义估计方程和泊松模型（考虑治疗剂量和时间），研究了几种时间依赖性的多巴胺激动剂（DA）使用定义与每次就诊时 ICD 之间的关联。还检查了其他抗帕金森病药物。
结果
在 411 名患者（40.6%为女性，平均年龄 62.3 岁，平均随访时间 3.3 年，SD 1.7 年）中，有 356 名（86.6%）自疾病发作以来至少使用过一次 DA。在基线时无 ICD 的 306 名患者中，ICD 的 5 年累积发生率为 46.1%（95%CI 37.4-55.7，曾使用 DA 者为 51.5%[95%CI 41.8-62.1]，从未使用 DA 者为 12.4%[95%CI 4.8-30.0]）。ICD 的患病率从基线时的 19.7%增加到 5 年后的 32.8%。ICD 与曾使用 DA 相关（患病率比 4.23，95%CI 1.78-10.09）。终生平均日剂量和治疗持续时间与 ICD 独立相关，存在显著的剂量-效应关系。对左旋多巴的类似分析并不支持两者之间存在很强的关联。DA 停药后 ICD 逐渐缓解。
结论
在这项对 PD 患者进行的纵向研究中，患者以高比例的 DA 治疗为特征，ICD 的 5 年累积发生率约为 46%。ICD 与 DA 使用密切相关，且存在剂量效应关系；剂量和时间的增加都与 ICD 相关。DA 停药后 ICD 逐渐缓解。
临床试验注册号
NCT01564992。
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