Micieli G, Martignoni E, Cavallini A, Pacchetti C, Rossi F, Horowski R, Nappi G
Dept of Neurology, C. Mondino Foundation, University of Pavia; Italy.
Funct Neurol. 1996 Nov-Dec;11(6):317-25.
In this study, we compared the haemodynamic and biochemical effects of bromocryptine to those of lisuride, in L-Dopa stable responder parkinsonian (PD) patients. Nineteen PD patients were admitted to the study. A double-blind, parallel group, randomized study was performed. Patients were randomly chosen to receive lisuride or bromoryptine. Both drugs were administered in increasing dosages until a maximum of either 0.6 mg lisuride or 7.5 mg bromocryptine was reached. The following tests were carried out: periprandial study, tilt table test and cardiovascular tests (sustained handgrip test, deep-breathing, lying-to-standing and Valsalva manoeuvre). During the tests, systolic and diastolic blood pressure and heart rate were monitored with an automatic sphyngomanometer. Blood samples for catecholamine assay were taken during tilt table test. In basal conditions 70% of the randomly chosen men in the bromocryptine group showed significant orthostatic hypotension (OH), while only one subject in the lisuride group demonstrated comparable OH values. The deepest derangement of orthostatic regulation was observed in the lisuride group but it should not be attributed to the greater hypotensive effects of this drug. Infact, the cardiopressor effects of bromocryptine may well be "masked" by the alteration detected in baseline conditions. Only bromocryptine significantly reduced supine and orthostatic NE plasma levels on the 14th day of therapy. Neither bromocryptine nor lisuride significantly altered periprandial blood pressure values. In conclusion, this study demonstrates that lisuride and bromocryptine are well tolerated as far as the analysis of the development of hypotensive effects is concerned. Further, more sophisticated study, with other agents that block the peripheral and/or central effects of dopamine-agonists in PD patients should be conducted in order better to define the precise role of these types of agents and the potential cardiopressor risks in these subjects.
在本研究中，我们比较了溴隐亭与麦角乙脲对左旋多巴反应稳定的帕金森病（PD）患者的血流动力学和生化影响。19名PD患者纳入本研究。进行了一项双盲、平行组、随机研究。患者被随机选择接受麦角乙脲或溴隐亭治疗。两种药物均逐渐增加剂量给药，直至达到最大剂量，麦角乙脲为0.6mg，溴隐亭为7.5mg。进行了以下测试：餐周研究、倾斜试验和心血管测试（持续握力试验、深呼吸、平卧位到站立位及瓦尔萨尔瓦动作）。测试期间，使用自动血压计监测收缩压、舒张压和心率。在倾斜试验期间采集血样用于儿茶酚胺测定。在基础状态下，溴隐亭组中70%随机选择的男性出现明显的体位性低血压（OH），而麦角乙脲组只有1名受试者有类似的OH值。在麦角乙脲组观察到体位调节最严重的紊乱，但这不应归因于该药物更大的降压作用。事实上，溴隐亭的强心作用很可能被基线状态下检测到的改变所“掩盖”。仅溴隐亭在治疗第14天显著降低仰卧位和体位性去甲肾上腺素血浆水平。溴隐亭和麦角乙脲均未显著改变餐周血压值。总之，就降压作用发展的分析而言，本研究表明麦角乙脲和溴隐亭耐受性良好。此外，应使用其他阻断PD患者多巴胺激动剂外周和/或中枢作用的药物进行更复杂的研究，以便更好地确定这类药物的确切作用以及这些受试者潜在的强心风险。
