Central acute D2 stimulation worsens bladder function in patients with mild Parkinson's disease
Central acute D2 stimulation worsens bladder function in patients with mild Parkinson's disease
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DOI：
10.1016/s0022-5347(05)00058-3
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发表时间：
2006-01-01
影响因子：
6.6
通讯作者：
Agrò, EF
中科院分区：
文献类型：
--
作者：
Brusa, L;Petta, F;Agrò, EF
目的：D1和D2多巴胺受体在LUT行为中的不同作用已在动物实验中得到证实。特别是D2选择性激动剂和D1选择性拮抗剂似乎使有意识大鼠的膀胱容量减少。这一发现从未在人体研究中得到证实。因此，在本研究中，我们研究了D1和D2激动剂/拮抗剂对PD患者LUT行为的作用。材料与方法：对87例轻度PD患者进行评估。患者在关闭状态下和口服250 mg LD后进行尿动力学研究（膀胱术和会阴底肌电图的压力流研究）。在70例患者中，在以下条件之一下进行第三次尿动力学评估：同时口服250 mg LD和60或120 mg口服多潘立酮（D2外周拮抗剂）；同时给予250毫克口服LD和25、50或150毫克肌注l -舒匹利（D2中枢和外周拮抗剂）。评估了几种尿动力学参数，并比较了不同条件下获得的结果。结果：单纯LD加重了逼尿肌过度活动：特别是第一尿感、不自主逼尿肌收缩阈值（反射容积）和膀胱容量的降低。l -舒必利（中枢和外周D2拮抗剂）以剂量依赖的方式共同施用抵消了恶化。多潘立酮（外周D2拮抗剂）共给药未能确定相同的对抗作用。结论：根据我们的研究结果，中枢性急性D2刺激似乎是轻度PD患者膀胱容量减少和逼尿肌过度活动恶化的原因。
Purpose: The different roles of D1 and D2 dopamine receptors in LUT behavior have been demonstrated in animal studies. In particular D2 selective agonists and D1 selective antagonists seem to produce a reduction of the bladder capacity in conscious rats. This finding has never been confirmed in human studies. Thus, in this study we investigated the role of D1 and D2 agonists/antagonists on LUT behavior in patients with PD.Materials and Methods: A total of 87 patients with mild PD were evaluated. Patients were evaluated with urodynamic studies (cystometry followed by a pressure flow study with perineal floor electromyography) performed in off status and after oral administration of 250 mg of LD. In 70 patients a third urodynamic evaluation was conducted in one of the following conditions: after simultaneous administration of 250 mg oral LD and 60 or 120 mg oral domperidone (D2 peripheral antagonist); after simultaneous administration of 250 mg oral LD and 25, 50 or 150 mg intramuscular L-sulpiride (D2 central and peripheral antagonist). Several urodynamic parameters were evaluated and results obtained in different conditions compared.Results: LD alone worsened detrusor overactivity: in particular, a reduction of first urinary sensation, involuntary detrusor contraction threshold (reflex volume) and bladder capacity was observed. L-sulpiride (central and peripheral D2 antagonist) coadministration counteracted the worsening in a dose dependent manner. Domperidone (peripheral D2 antagonist) coadministration failed to determine the same counteraction.Conclusions: According to our results, a central acute D2 stimulation seems to be responsible of a reduction of bladder capacity with worsening of detrusor overactivity in patients with mild PD.