Chia L G, Cheng F C, Kuo J S
Section of Neurology, Taichung Veterans General Hospital, Taiwan, ROC.
J Neurol Sci. 1993 Jun;116(2):125-34. doi: 10.1016/0022-510x(93)90316-q.
Ten free monoamines and their metabolites in plasma and cerebrospinal fluid (CSF) were simultaneous measured in 6 levodopa-untreated (LU), 18 levodopa-treated (LT) and 37 levodopa-withdrawn (LW) Chinese patients with Parkinson's disease (PD) and 26 controls. We found that the levels of these substances in LW patients were not significantly different from those in LU patients. In LU- and LW-PD patients, CSF epinephrine (EPI) was higher (P < 0.05) than that of the controls. 3-methoxy-DOPA (3-OMDOPA) might not inhibit the accumulation of 3,4-dihydroxyphenylalanine (DOPA) and dopamine metabolites in CSF. Levodopa treatment might change the dopaminergic and serotoninergic neuronal systems, but not the noradrenergic or adrenergic neuronal systems, in CNS of PD patients. Benserazide (a peripheral decarboxylase inhibitor) in Madopar might decrease the levels of serotonin (5-HT) and norepinephrine (NE), but not those of DOPA and homovanillic acid (HVA), in plasma. HVA, NE and EPI in plasma were not good indices for those in CSF. Otherwise, our results were consistent with some other studies by showing a significantly lower level (P < 0.01) of HVA in CSF of LU- and LW-PD patients than that of the controls, while no difference for NE, 3-methoxy-4-hydroxyphenylglycol (MHPG), 5-hydroxyindole acetic acid (5-HIAA) or 3-OMDOPA was noted. The severity of clinical disability was related to the deficiency of CSF HVA and DOPAC in LU- and LW-PD patients; however, there was no relationship between clinical symptoms of tremor, rigidity-bradykinesia, autonomic dysfunction, dementia, depression or levodopa-induced dyskinesia and CSF monoamines or their metabolites.
在6例未接受左旋多巴治疗（LU）、18例接受左旋多巴治疗（LT）和37例停用左旋多巴（LW）的中国帕金森病（PD）患者以及26名对照者中，同时测定了血浆和脑脊液（CSF）中的10种游离单胺及其代谢产物。我们发现，LW患者中这些物质的水平与LU患者相比无显著差异。在LU和LW-PD患者中，脑脊液肾上腺素（EPI）高于对照组（P<0.05）。3-甲氧基多巴（3-OMDOPA）可能不会抑制脑脊液中3,4-二羟基苯丙氨酸（DOPA）和多巴胺代谢产物的蓄积。左旋多巴治疗可能会改变PD患者中枢神经系统中的多巴胺能和5-羟色胺能神经元系统，但不会改变去甲肾上腺素能或肾上腺素能神经元系统。美多芭中的苄丝肼（一种外周脱羧酶抑制剂）可能会降低血浆中5-羟色胺（5-HT）和去甲肾上腺素（NE）的水平，但不会降低DOPA和高香草酸（HVA）的水平。血浆中的HVA、NE和EPI并非脑脊液中相应物质的良好指标。此外，我们的结果与其他一些研究一致，显示LU和LW-PD患者脑脊液中的HVA水平显著低于对照组（P<0.01），而NE、3-甲氧基-4-羟基苯乙二醇（MHPG）、5-羟基吲哚乙酸（5-HIAA）或3-OMDOPA则无差异。LU和LW-PD患者的临床残疾严重程度与脑脊液中HVA和3,4-二羟基苯乙酸（DOPAC）的缺乏有关；然而，震颤、强直-运动迟缓、自主神经功能障碍、痴呆、抑郁或左旋多巴诱发的运动障碍等临床症状与脑脊液单胺及其代谢产物之间并无关联。
