早期莱沃多巴治疗对帕金森病患者死亡率的影响
Amir H Talebi1, Sirwan K L Darweesh1, Bas R Bloem1
1Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Center of Expertise for Parkinson & Movement Disorders, Nijmegen, The Netherlands.
Movement disorders clinical practice
|August 2, 2024
概括
在帕金森病 (PD) 早期开始服用利沃多巴并不会改变死亡率或并发症风险. 这项研究分析了超过29,000名PD患者的数据,以评估早期与非早期的乐伏多巴启动的影响.
科学领域:
- 神经学 神经学
- 临床药理学 临床药理学
- 流行病学 流行病学
背景情况:
- 在新诊断的帕金森病 (PD) 患者中,启动勒沃多巴治疗的最佳时间尚不清楚.
- 关于早期使用勒沃多巴在PD管理中的长期影响的数据有限.
研究的目的:
- 为了确定在帕金森病 (PD) 中早期启动利沃多巴是否会推迟死亡率.
- 调查早期乐伏多巴对设备辅助疗法需求的影响.
- 评估早期莱沃多巴与PD相关并发症的发生率之间的关联,包括因跌倒引起的伤害.
主要方法:
- 利用全国范围的荷兰医院索赔数据,从2012年至2020年.
- 将新诊断的PD患者分为"早期发起者" (2年内使用levodopa) 和"非早期发起者".
- 使用边际结构模型和Poisson回归来比较结果,使用国家死亡登记册数据.
主要成果:
- 分析了29943名PD患者 (平均年龄为71.6岁);24847名早期和5096名非早期的勒沃多巴发起者.
- 在早期和非早期发起者之间,死亡风险没有显著差异 (RR 1.04,95% CI 0.92-1.19).
- 在早期启动者中观察到设备辅助治疗的风险比较高 (3.19,95% CI 2.56-5.80),但与PD相关并发症没有关联 (IRR 1.00,95% CI 0.96-1.05).
结论:
- 在帕金森病 (PD) 早期启动利沃多巴并不会改变死亡率或PD相关并发症的发生.
- 该研究表明,早期的勒沃多巴不会加速或推迟PD患者的不良结果.
- 不能完全排除可能由未测量影响死亡率的因素造成的潜在残留混.
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