中国神经再生研究(英文版)

中国神经再生研究(英文版) ›› 2021, Vol. 16 ›› Issue (12): 2475-2478.doi: 10.4103/1673-5374.313061

• 原著:脊髓损伤修复保护与再生 • 上一篇    下一篇

血管紧张素转化酶抑制剂和AT1受体阻滞剂可减少左旋多巴诱发运动障碍的发生


  

  • 出版日期:2021-12-15 发布日期:2021-05-15

Potential protective role of ACE-inhibitors and AT1 receptor blockers against levodopa-induced dyskinesias: a retrospective case-control study

Elena Contaldi1, 2, *, Luca Magistrelli1, 3, Anna V. Milner1, Marco Cosentino4, 5, Franca Marino4, 5, Cristoforo Comi1, 4   

  1. 1Movement Disorders Centre, Neurology Unit, Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy; 2PhD Program in Medical Sciences and Biotechnology, University of Piemonte Orientale, Novara, Italy; 3PhD Program in Clinical and Experimental Medicine and Medical Humanities, University of Insubria, Varese, Italy; 4Center of Research in Medical Pharmacology, University of Insubria, Varese, Italy; 5Center for Research in Neuroscience, University of Insubria, Varese, Italy
  • Online:2021-12-15 Published:2021-05-15
  • Contact: Elena Contaldi, MD, contaldie@yahoo.it.

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摘要：

越来越多的证据表明，降压药血管紧张素转化酶抑制剂/血管紧张素II 1型受体阻滞剂可能会影响多巴胺和黑质纹状体途径中的肾素-血管紧张素系统之间的复杂相互作用，从而影响帕金森病中左旋多巴诱发的运动障碍的发展。此次回顾性病例对照研究纳入在诺瓦拉大学医院“ Maggiore dellaCarità”登记的特发性帕金森病患者的病历信息来分析血管紧张素转化酶抑制剂/血管紧张素II 1型受体阻滞剂是否与左旋多巴诱发的运动障碍的减少相关，其中患有运动障碍（PwD组）的帕金森病患者47例，与之匹配的非运动障碍帕金森病对照者（NoD组）47例。NoD组血管紧张素转化酶抑制剂/血管紧张素II 1型受体阻滞剂者25例（53.2％），未使用者22例（46.8％）；在PwD组中，血管紧张素转化酶抑制剂/血管紧张素II 1型受体阻滞剂使用者明显少于未使用者，分别为11例（23.4％）和36例（76.6％）（P = 0.003）。二元logistic回归分析显示，在控制了震颤显性表型、左旋多巴等效日剂量、Hoehn-Yahr分级为3-4级和疾病持续时间之后，血管紧张素转化酶抑制剂/血管紧张素II 1型受体阻滞剂的使用是运动障碍发生率较低的重要预测指标（OR = 0.226，95％CI：0.080-0.636，P = 0.005）。因此，研究表明，血管紧张素转化酶抑制剂/血管紧张素II 1型受体阻滞剂的使用可以减少帕金森病患者左旋多巴诱发的运动障碍的发生。

https://orcid.org/0000-0002-0218-5251 (Elena Contaldi)

Abstract: Growing evidence has highlighted that angiotensin-converting enzyme (ACE)-inhibitors (ACEi)/AT1 receptor blockers (ARBs) may influence the complex interplay between dopamine and the renin-angiotensin system in the nigrostriatal pathway, thus affecting the development of levodopa-induced dyskinesia in Parkinson’s disease (PD). In the present study, we analyzed whether the use of this class of medication was associated with a reduced occurrence of levodopa-induced dyskinesia, using electronically-stored information of idiopathic PD patients enrolled at Novara University Hospital “Maggiore della Carità”. We conducted a retrospective case-control study identifying PD patients with dyskinesias (PwD; n = 47) as cases. For each PwD we selected a non-dyskinetic control (NoD), nearly perfectly matched according to sex, Unified Parkinson’s Disease Rating Scale (UPDRS) part III score, and duration of antiparkinsonian treatment. Binary logistic regression was used to evaluate whether dyskinesias were associated with ACEi/ARBs use. Ninety-four PD patients were included, aged 72.18 ± 9 years, with an average disease duration of 10.20 ± 4.8 years and 9.04 ± 4.9 years of antiparkinsonian treatment. The mean UPDRS part III score was 18.87 ± 7.6 and the median HY stage was 2. In the NoD group, 25 (53.2%) were users and 22 (46.8%) non-users of ACEi/ARBs. Conversely, in the PwD group, 11 (23.4%) were users and 36 non-users (76.6%) of this drug class (Pearson chi-square = 8.824, P = 0.003). Concerning general medication, there were no other statistically significant differences between groups. After controlling for tremor dominant phenotype, levodopa equivalent daily dose, HY 3-4, and disease duration, ACEi/ARBs use was a significant predictor of a lower occurrence of dyskinesia (OR = 0.226, 95% CI: 0.080–0.636, P = 0.005). Therefore, our study suggests that ACEi/ARBs may reduce levodopa-induced dyskinesia occurrence and, thanks to good tolerability and easy management, represent a feasible choice when dealing with the treatment of hypertension in PD patients. The study was approved by the Ethics Committee of Novara University Hospital “Maggiore della Carità” (CE 65/16) on July 27, 2016.

Key words: angiotensin-converting enzyme inhibitors, AT1 receptor blockers, dyskinesias, hypertension, levodopa, motor complications, neuroinflammation, Parkinson’s disease, renin-angiotensin system

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