Roos R A, Jongen J C, van der Velde E A
Department of Neurology, Leiden University, The Netherlands.
Mov Disord. 1996 May;11(3):236-42. doi: 10.1002/mds.870110304.
We determined the variables associated with the progression and duration of illness of patients with Parkinson's disease (PD) and investigated the cause of death. In 474 patients with parkinsonism, who visited the Academic Hospital between January 1, 1960 and August 31, 1993, we did a survival analysis with the following covariates: age at onset, initial symptom (tremor or rigidity/hypokinesia), age at reaching Hoehn and Yahr stage III, dementia-free period, and levodopa treatment. A total of 345 patients with parkinsonism fulfilled the criteria of idiopathic PD; 258 of them were still alive on the closing date of this study. There were significantly more men than women (1.43:1). Medical advice was sought in an earlier stage by men and by patients with tremor as presenting symptom. For patients with rigidity/hypokinesia as first symptom, the duration of illness until reaching Hoehn and Yahr stage III was shorter than for patients starting with tremor alone. If the initial symptom is tremor, patients develop dementia less frequently and later after onset than when tremor is not involved. Reaching Hoehn and Yahr stage III and developing dementia both, limit the patient's survival time. The mortality risk for a patient was found to be increased from the moment levodopa treatment was started as compared to those patients who had not yet started with the treatment. The effect of levodopa on survival could not be disentangled from effects of other factors related to the start of levodopa treatment.
我们确定了与帕金森病（PD）患者病情进展和病程相关的变量，并调查了其死亡原因。在1960年1月1日至1993年8月31日期间就诊于学术医院的474例帕金森综合征患者中，我们对以下协变量进行了生存分析：发病年龄、初始症状（震颤或强直/运动迟缓）、达到 Hoehn 和 Yahr Ⅲ期的年龄、无痴呆期以及左旋多巴治疗情况。共有345例帕金森综合征患者符合特发性PD的标准；其中258例在本研究截止日期时仍存活。男性患者明显多于女性患者（比例为1.43:1）。男性以及以震颤为首发症状的患者更早寻求医疗建议。对于以强直/运动迟缓为首发症状的患者，达到 Hoehn 和 Yahr Ⅲ期的病程比仅以震颤为首发症状的患者短。如果初始症状是震颤，患者发生痴呆的频率低于且发病时间晚于不伴有震颤的情况。达到 Hoehn 和 Yahr Ⅲ期以及发生痴呆均会缩短患者的生存时间。与尚未开始治疗的患者相比，患者从开始使用左旋多巴治疗起死亡风险就会增加。左旋多巴对生存的影响无法与左旋多巴治疗开始时的其他相关因素的影响区分开来。
