幽门螺杆菌根除改善晚期帕金森病患者的运动波动：一项前瞻性队列研究（HP-PD 试验）。
Helicobacter pylori eradication improves motor fluctuations in advanced Parkinson's disease patients: A prospective cohort study (HP-PD trial).
机构信息
Faculty of Medicine, Division of Neurology, Department of Internal Medicine, Thammasat University, Pathumthani, Thailand.
Faculty of Medicine, Department of Internal Medicine, Gastroenterology Unit, Thammasat University, Pathumthani, Thailand.
出版信息
PLoS One. 2021 May 4;16(5):e0251042. doi: 10.1371/journal.pone.0251042. eCollection 2021.
BACKGROUND
Helicobacter pylori (HP) is a bacterium associated with many gastrointestinal (GI) diseases and has shown a high prevalence in Parkinson's disease (PD). As HP-associated GI dysfunction could affect L-dopa (levodopa) absorption, HP eradication might improve the clinical response and decrease motor fluctuations.
METHODS
A prospective cohort study was conducted on the clinical symptoms of PD patients with motor fluctuations. The 13C-urea breath test was used to diagnose a current HP infection. All patients with HP infection received a 2-week regimen of triple therapy. The changes in the Unified Parkinson's Disease Rating Scale (UPDRS) motor score, L-dopa onset time, wearing-off symptoms, mean daily on-off time, GI symptom scores, and quality of life score were measured at baseline and at a 6-week follow-up.
RESULTS
A total of 163 PD patients were assessed, of whom 40 were enrolled. Fifty-five percent of the enrolled patients (22/40) had a current HP infection, whereas HP eradication was identified in 17 of 22 (77.3%) patients who received eradication therapy. Patients with HP eradication showed a significant decrease in daily 'off' time (4.0 vs. 4.7 h, p = 0.040) and an increase in daily 'on' time (11.8 vs. 10.9 h, p = 0.009). Total wearing-off score (4.4 vs. 6.0, p = 0.001) and the GI symptom score (8.1 vs. 12.8, p = 0.007) were significantly improved. There was no significant improvement in L-dopa onset time, UPDRS motor score, or quality of life score.
CONCLUSIONS
HP eradication leads to significant clinical improvement in the symptoms of PD. Eradication of HP not only increases the total daily 'on' time but also decreases wearing-off symptoms and improves GI symptoms.
背景
幽门螺杆菌（HP）与许多胃肠道（GI）疾病有关，在帕金森病（PD）中也有很高的患病率。由于 HP 相关的 GI 功能障碍可能会影响左旋多巴（L-多巴）的吸收，因此 HP 根除可能会改善临床反应并减少运动波动。
方法
对有运动波动的 PD 患者的临床症状进行了一项前瞻性队列研究。使用 13C-尿素呼气试验诊断当前的 HP 感染。所有 HP 感染的患者均接受了为期 2 周的三联疗法。在基线和 6 周随访时，测量统一帕金森病评定量表（UPDRS）运动评分、L-多巴起始时间、开-关现象、平均每日开-关时间、GI 症状评分和生活质量评分的变化。
结果
共评估了 163 名 PD 患者，其中 40 名入组。入组患者中有 55%（22/40）存在当前的 HP 感染，而接受根除治疗的 22 名患者中有 17 名（77.3%）HP 被根除。HP 根除的患者每日“关”时间显著减少（4.0 与 4.7 h，p = 0.040），每日“开”时间显著增加（11.8 与 10.9 h，p = 0.009）。总开-关评分（4.4 与 6.0，p = 0.001）和 GI 症状评分（8.1 与 12.8，p = 0.007）也显著改善。L-多巴起始时间、UPDRS 运动评分或生活质量评分无显著改善。
结论
HP 根除可显著改善 PD 症状。HP 的根除不仅增加了每日总“开”时间，而且减少了开-关现象，改善了 GI 症状。
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