左旋多巴致不良反应文献分析
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摘要
目的探讨左旋多巴引起不良反应的规律及特点,为临床安全合理用药提供依据。方法检索1974年1月至2018年10月Elsevier、 PubMed、中国知网和维普数据库中有关左旋多巴引发不良反应的文献报道,对患者的性别、年龄、不良反应发生时间、临床表现及不良反应处理及转归等进行统计分析。结果共筛选出有效个案报道44篇,计60例患者,其中男性36例,女性24例,年龄51～80岁患者发生率较高(45例, 75%)。左旋多巴引起不良反应多发生在用药1个月以内(40例, 67%);损害的系统-器官以胃肠道(21例, 35%)、中枢及外周神经(17例, 28%)为主,主要表现为恶心、呕吐、便秘、厌食、失眠、嗜睡、头晕、头痛等。结论左旋多巴引起的不良反应以男性多见,早期以胃肠系统、中枢及外周神经系统损害和心率及心律紊乱患者较多,应引起临床高度重视。
AIM To analyze the general patterns and characteristics of adverse drug reactions induced by levodopa and provide reference for clinical medication. METHODS Through searching the Elsevier, PubMed,CNKI, and VIP database, the case reports about adverse reactions induced by levodopa from January 1974 to October 2018 were collected. The patients' gender, age, adverse reaction times, clinical manifestation, and treatment and outcome of adverse reactions were analyzed. RESULTS A total of 44 papers about adverse drug reactions induced by levodopa were screened and 60 patients were included, men for 36 cases, women for 24 patients. The age of 51-80 had a higher incidence rate( 45 cases, 75%). High incidence occurred within 1 month(40 cases, 67%). Gastrointestinal tract(21 cases, 35%) and central and peripheral nerves(17 cases,28%) were the main injured system-organ, and the main symptoms were nausea, vomiting, constipation,anorexia, insomnia, drowsiness, dizziness, headache, etc. CONCLUSION Adverse reactions caused by levodopa are more common in males. In early, patients with damage of gastrointestinal system and central and peripheral nervous system and heart rate disorder as well as arrhythmia are more common, which should be paid more attention in clinic.
AIM To analyze the general patterns and characteristics of adverse drug reactions induced by levodopa and provide reference for clinical medication. METHODS Through searching the Elsevier, PubMed,CNKI, and VIP database, the case reports about adverse reactions induced by levodopa from January 1974 to October 2018 were collected. The patients' gender, age, adverse reaction times, clinical manifestation, and treatment and outcome of adverse reactions were analyzed. RESULTS A total of 44 papers about adverse drug reactions induced by levodopa were screened and 60 patients were included, men for 36 cases, women for 24 patients. The age of 51-80 had a higher incidence rate( 45 cases, 75%). High incidence occurred within 1 month(40 cases, 67%). Gastrointestinal tract(21 cases, 35%) and central and peripheral nerves(17 cases,28%) were the main injured system-organ, and the main symptoms were nausea, vomiting, constipation,anorexia, insomnia, drowsiness, dizziness, headache, etc. CONCLUSION Adverse reactions caused by levodopa are more common in males. In early, patients with damage of gastrointestinal system and central and peripheral nervous system and heart rate disorder as well as arrhythmia are more common, which should be paid more attention in clinic.
引文
[1]刘疏影,陈彪.帕金森病流行现状[J].中国现代神经疾病杂志, 2016, 16(2):98-101.
[2]刘慧,陈晨,王晓平.左旋多巴在帕金森病以外的临床应用[J].中华临床医师杂志:电子版, 2013, 7(22):150-152.
[3]向宏华,张先芬,周颖.左旋多巴/苄丝肼致手脚痉挛1例[J].医药导报, 2009, 28(9):1188.
[4]蒋国会,王子军,周晓丽,等.左旋多巴诱导舞蹈样运动障碍3例[J].第三军医大学学报, 2010, 32(3):237-245.
[5]叶金朝,叶菲.美多巴及金刚烷胺诱发精神分裂症及下肢水肿病案分析[J].药物流行病学杂志, 2002, 11(4):219-220.
[6]丁熙.多巴丝肼片与吡贝地尔缓释片联用致体位性低血压1例[J].中国执业药师, 2014, 11(12):52-56.
[7]国家药品监督管理局.日本提示含左旋多巴药品的闭角型青光眼风险[EB/OL].(2016-09-08)[2017-08-02]. http://www.nmpa.gov.cn/WS04/CL2156/318896.html.
[8]王红星,杨晓苏,张乐,等.帕金森病撤药恶性综合征(附1例报告)[J].中风与神经疾病杂志, 2011, 28(8):731-734.
[9]张俊,陈海亮,张捷.帕金森病患者发病年龄与临床异质性分析[J].中国实用神经疾病杂志, 2012, 15(7):38-39.
[10]葛芳芳,张振馨.小剂量左旋多巴启动治疗早期帕金森病的研究[J].中国临床神经科学, 2013, 21(2):178-181.
[11] FAHN S, OAKES D, SHOULSON I, et al. Levodopa and the progression of Parkinson’s disease[J]. N Engl J Med, 2004, 351(24):2498-2508.
[12]李汉君,黄自文,何庆赞.左旋多巴致快速心房颤动2例[J].中级医刊, 1996, 31(5):44.
[13]王玉华,王保才,贺东勇.美多巴导致严重意识障碍2例[J].中国实用医药, 2013, 8(20):198-199.
[14]侯光友,肖树文,曹全斌.左旋多巴致心房颤动1例[J].中国实用内科杂志, 1998, 18(8):507.
[15] van GERPEN JA, KUMAR N, BOWER JH, et al. Levodopaassociated dyskinesia risk among Parkinson disease patients in Olmsted County, Minnesota, 1976-1990[J]. Arch Neurol, 2006,63(2):205-209.
[16] Parkinson Study Group CALM Cohort Investigators. Long-term effect of initiating pramipexole vs levodopa in early Parkinson disease[J]. Arch Neurol, 2009, 66(5):563-570.
[17]李芳,陈先文.谷氨酸能递质系统在左旋多巴诱发异动症形成机制中的作用[J].临床神经病学杂志, 2010, 23(4):308-310.
[18]中华医学会神经病学分会帕金森病及运动障碍学组.中国帕金森病治疗指南(第三版)[J].中华神经科杂志, 2014, 47(6):1-6.
[19]张玮.多巴丝肼片致血小板减少二例[J].中国药物与临床,2010, 10(11):1216.
[20]秦贵军.药源性高尿酸血症[J].药品评价, 2015, 12(7):19-22.
[21] CHAPUIS S, OUCHCHANE L, METZ O, et al. Impact of the motor complications of Parkinson's disease on the quality of life[J]. Mov Disord, 2005, 20(2):224-230.
[22]赵丽姣,于会艳,金莹,等.左旋多巴治疗帕金森病所致高同型半胱氨酸血症的研究[J].中华老年多器官疾病杂志, 2015,14(9):668-672.
[2]刘慧,陈晨,王晓平.左旋多巴在帕金森病以外的临床应用[J].中华临床医师杂志:电子版, 2013, 7(22):150-152.
[3]向宏华,张先芬,周颖.左旋多巴/苄丝肼致手脚痉挛1例[J].医药导报, 2009, 28(9):1188.
[4]蒋国会,王子军,周晓丽,等.左旋多巴诱导舞蹈样运动障碍3例[J].第三军医大学学报, 2010, 32(3):237-245.
[5]叶金朝,叶菲.美多巴及金刚烷胺诱发精神分裂症及下肢水肿病案分析[J].药物流行病学杂志, 2002, 11(4):219-220.
[6]丁熙.多巴丝肼片与吡贝地尔缓释片联用致体位性低血压1例[J].中国执业药师, 2014, 11(12):52-56.
[7]国家药品监督管理局.日本提示含左旋多巴药品的闭角型青光眼风险[EB/OL].(2016-09-08)[2017-08-02]. http://www.nmpa.gov.cn/WS04/CL2156/318896.html.
[8]王红星,杨晓苏,张乐,等.帕金森病撤药恶性综合征(附1例报告)[J].中风与神经疾病杂志, 2011, 28(8):731-734.
[9]张俊,陈海亮,张捷.帕金森病患者发病年龄与临床异质性分析[J].中国实用神经疾病杂志, 2012, 15(7):38-39.
[10]葛芳芳,张振馨.小剂量左旋多巴启动治疗早期帕金森病的研究[J].中国临床神经科学, 2013, 21(2):178-181.
[11] FAHN S, OAKES D, SHOULSON I, et al. Levodopa and the progression of Parkinson’s disease[J]. N Engl J Med, 2004, 351(24):2498-2508.
[12]李汉君,黄自文,何庆赞.左旋多巴致快速心房颤动2例[J].中级医刊, 1996, 31(5):44.
[13]王玉华,王保才,贺东勇.美多巴导致严重意识障碍2例[J].中国实用医药, 2013, 8(20):198-199.
[14]侯光友,肖树文,曹全斌.左旋多巴致心房颤动1例[J].中国实用内科杂志, 1998, 18(8):507.
[15] van GERPEN JA, KUMAR N, BOWER JH, et al. Levodopaassociated dyskinesia risk among Parkinson disease patients in Olmsted County, Minnesota, 1976-1990[J]. Arch Neurol, 2006,63(2):205-209.
[16] Parkinson Study Group CALM Cohort Investigators. Long-term effect of initiating pramipexole vs levodopa in early Parkinson disease[J]. Arch Neurol, 2009, 66(5):563-570.
[17]李芳,陈先文.谷氨酸能递质系统在左旋多巴诱发异动症形成机制中的作用[J].临床神经病学杂志, 2010, 23(4):308-310.
[18]中华医学会神经病学分会帕金森病及运动障碍学组.中国帕金森病治疗指南(第三版)[J].中华神经科杂志, 2014, 47(6):1-6.
[19]张玮.多巴丝肼片致血小板减少二例[J].中国药物与临床,2010, 10(11):1216.
[20]秦贵军.药源性高尿酸血症[J].药品评价, 2015, 12(7):19-22.
[21] CHAPUIS S, OUCHCHANE L, METZ O, et al. Impact of the motor complications of Parkinson's disease on the quality of life[J]. Mov Disord, 2005, 20(2):224-230.
[22]赵丽姣,于会艳,金莹,等.左旋多巴治疗帕金森病所致高同型半胱氨酸血症的研究[J].中华老年多器官疾病杂志, 2015,14(9):668-672.