甲氧氯普胺所致迟发性运动障碍和急性锥体外系运动障碍的患病率。

The prevalence of metoclopramide-induced tardive dyskinesia and acute extrapyramidal movement disorders.

作者信息

Ganzini L, Casey D E, Hoffman W F, McCall A L

机构信息

Portland Veterans Affairs Medical Center, OR 97207.

出版信息

Arch Intern Med. 1993 Jun 28;153(12):1469-75.

PMID:8512437

Abstract

BACKGROUND

Metoclopramide hydrochloride, a neuroleptic dopamine receptor antagonist used to treat gastric ailments, is reported to cause extrapyramidal movement disorders. The goals of this study were (1) to determine the prevalence and severity of tardive dyskinesia and acute extrapyramidal movement syndromes including akathisia, acute dystonia, and drug-induced parkinsonism in metoclopramide-treated patients and (2) to compare the prevalence and severity of tardive dyskinesia in metoclopramide-treated diabetics and nondiabetics.

METHODS

From a list of metoclopramide-treated patients received from the Portland (Ore) Veterans Affairs Medical Center pharmacy, 53 patients met inclusion criteria and 51 (96%) agreed to participate. Controls consisted of a convenience sample drawn from the Portland Veterans Affairs Medical Center Outpatient Clinic who were matched to subjects on age (+/- 10 years), gender, and presence or absence of diabetes. Of 61 potential controls contacted, 51 (84%) agreed to participate. Metoclopramide-treated subjects and controls were seen by a rater who was "blind" to all diagnoses and treatments. The rater performed a standardized examination used to elicit signs and symptoms of tardive dyskinesia and acute extrapyramidal movement syndromes.

RESULTS

The relative risk for tardive dyskinesia was 1.67 (95% confidence interval, 0.93 to 2.97), and the relative risk for drug-induced parkinsonism was 4.0 (95% confidence interval, 1.5 to 10.5). Metoclopramide-treated patients had significantly greater severity of tardive dyskinesia, drug-induced parkinsonism, and subjective akathisia than controls. Use of metoclopramide was associated with impairment in ambulation and increased use of benzodiazepines. Metoclopramide-treated diabetics had significantly greater severity of tardive dyskinesia than metoclopramide-treated nondiabetics.

CONCLUSIONS

Metoclopramide use is associated with a significantly increased prevalence and severity of several extrapyramidal movement disorders.

摘要

背景

盐酸甲氧氯普胺是一种用于治疗胃部疾病的抗精神病性多巴胺受体拮抗剂，据报道会引起锥体外系运动障碍。本研究的目的是：（1）确定接受甲氧氯普胺治疗的患者中迟发性运动障碍和急性锥体外系运动综合征（包括静坐不能、急性肌张力障碍和药物性帕金森症）的患病率和严重程度；（2）比较接受甲氧氯普胺治疗的糖尿病患者和非糖尿病患者中迟发性运动障碍的患病率和严重程度。

方法

从俄勒冈州波特兰退伍军人事务医疗中心药房提供的接受甲氧氯普胺治疗的患者名单中，53名患者符合纳入标准，51名（96%）同意参与。对照组为从波特兰退伍军人事务医疗中心门诊抽取的便利样本，根据年龄（±10岁）、性别以及是否患有糖尿病与研究对象进行匹配。在联系的61名潜在对照中，51名（84%）同意参与。由一名对所有诊断和治疗情况“不知情”的评估者对接受甲氧氯普胺治疗的研究对象和对照进行检查。评估者进行了一项标准化检查，以引出迟发性运动障碍和急性锥体外系运动综合征的体征和症状。

结果

迟发性运动障碍的相对风险为1.67（95%置信区间，0.93至2.97），药物性帕金森症的相对风险为4.0（95%置信区间，1.5至10.5）。接受甲氧氯普胺治疗的患者在迟发性运动障碍、药物性帕金森症和主观静坐不能方面的严重程度明显高于对照组。使用甲氧氯普胺与行走功能受损和苯二氮䓬类药物使用增加有关。接受甲氧氯普胺治疗的糖尿病患者迟发性运动障碍的严重程度明显高于接受甲氧氯普胺治疗的非糖尿病患者。