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目的:建立急性左旋多巴负荷试验用于鉴别新发帕金森病(PD)与新发帕金森综合征(PDS)患者,并筛选评价指标的临界值。方法:选择89例有PD样表现但未服用过左旋多巴的患者,根据临床诊断分为PD组(n=48)和PDS组(n=41),进行了急性左旋多巴/卡比多巴(100/25mg)试验。根据两组患者统一PD评分运动分量表(UPDRS-III)评分的平均最大改善率进行比较,并建立受试者工作特征(ROC)曲线,以该曲线上最大Youden指数对应的运动评分最大改善率作为临界值。结果:PD组在服用左旋多巴-卡比多巴后的平均UPDRS-III评分平均最大改善率高于PDS组,差异有统计学意义(P<0.01)。建立的ROC曲线在鉴别PD和PDS差异具有统计学意义,ROC曲线下面积为0.827(P<0.01),对应上网UPDRS运动评分改善率的最佳临界值为12.45%(Youden指数0.565,敏感度80.9%,特异度75.6%)。结论:急性左旋多巴-卡比多巴试验可作为PD疗效和诊断的一种辅助参考方法。
OBJECTIVE: To establish an acute levodopa load test for differentiating patients with newly diagnosed Parkinson disease (PD) and newly diagnosed Parkinsonism (PDS) and to screen the critical value of the evaluation index. Methods: Eighty-nine patients with PD-like appearance but without levodopa were enrolled and divided into PD group (n = 48) and PDS group (n = 41) according to clinical diagnosis. Acute levodopa / Pakistan (100 / 25mg) test. According to the average maximum rate of improvement of the UPDRS-III score of the two groups of patients, the ROC curves of the subjects were established, and the maximal rate of improvement of the motor score corresponding to the maximum Youden index As a critical value. Results: The mean improvement rate of average UPDRS-III score in PD group after taking levodopa-carbidopa was higher than that in PDS group (P <0.01). The established ROC curve was statistically significant in differentiating between PD and PDS, with an area under the ROC curve of 0.827 (P <0.01). The best cut-off value of UPDRS score was 12.45% (Youden index 0.565, sensitivity 80.9 %, Specificity 75.6%). Conclusion: Acute levodopa-carbidopa test can be used as an adjunct to PD efficacy and diagnosis.