Antimicrobial Surveillance in Idiopathic Parkinsonism: Indication-Specific Improvement in Hypokinesia Following Helicobacter pylori Eradication and Non-Specific Effect of Antimicrobials for Other Indications in Worsening Rigidity
Antimicrobial Surveillance in Idiopathic Parkinsonism: Indication-Specific Improvement in Hypokinesia Following Helicobacter pylori Eradication and Non-Specific Effect of Antimicrobials for Other Indications in Worsening Rigidity
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DOI：
10.1111/hel.12035
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发表时间：
2013-06-01
期刊：
影响因子：
4.4
通讯作者：
Bjarnason, Ingvar
中科院分区：
文献类型：
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作者：
Dobbs, Sylvia M.;Charlett, Andre;Bjarnason, Ingvar
背景：在一项安慰剂对照试验中，根除幽门螺杆菌后，特发性帕金森综合征的运动功能减退改善，但屈肌强直恶化。方法我们调查了66例特发性帕金森综合征患者在中位1.9年（四分位距0.4，3.5）内所有抗菌药物处方的效果。最初的螺杆菌筛查之后（阳性）进行胃活检。小肠细菌过度生长的连续乳果糖氢呼气试验（364次试验）监测了鼓励液体摄入和散装/渗透性泻药的需要。我们测量了运动功能减退（58例患者401次自由步行速度下的平均步长评估）和上肢屈肌僵硬（49例患者396次评估）。结果在成功根除幽门螺杆菌（1/2例）但未失败（2例）后，整个组（包括接受左旋多巴治疗的患者）、核心组（仅接受较长t1/2抗帕金森病药物治疗或未治疗的患者）和未治疗组的步幅增加（每例p= 0.001）。抗帕金森病药物越少，效果越大（未治疗组为19（95% CI，14，25）cm/年）。屈肌刚度不变。其他适应症的抗菌药物治疗（75个疗程）后，运动功能减退无变化。然而，屈肌刚度累积增加。核心组仅在第一疗程后增加（（10（0，20）%/年，p=.05）），但在第二个疗程后，整个、核心和未治疗（18（6，31）、33（19，48）和29（12，48）%/年; p= 0.002，0.001和0.001），并且在第三次（17（2，34），23（8，41）和38（15，65）%/年; p= 0.02，0.003和0.001）之后进一步。最初，66例中有40例乳果糖氢呼气试验阳性。阳性率随时间下降（59（46，75）%/年，p= 0.001），螺杆菌阳性率倾向于较低（28（8，104）%，p= 0.06），但与其他抗生素干预无关。结论抗微生物剂治疗后运动功能减退的改善似乎是根除螺杆菌所独有的。尽管乳果糖氢呼气试验阳性减少，但在其他适应症的连续抗菌剂暴露后，硬度增加。
Background Following Helicobacter pylori eradication in a placebo-controlled trial, the hypokinesia of idiopathic parkinsonism improved but flexor rigidity worsened. Methods We surveyed the effect of all antimicrobial prescriptions in 66 patients with idiopathic parkinsonism over a median of 1.9 (interquartile range 0.4, 3.5) years. Initial Helicobacter screening was followed (where positive) by gastric biopsy. Serial lactulose hydrogen breath tests (364 tests) for small intestinal bacterial overgrowth monitored the need to encourage fluid intake and bulk/osmotic laxatives. We measured hypokinesia (401 assessments of mean stride length at free walking speed in 58 patients) and upper limb flexor rigidity (396 assessments in 49). Results Following successful H.pylori eradication (12 cases) but not failed (2), stride increased in entire group (including those receiving levodopa), core group (those receiving only longer-t1/2 antiparkinsonian medication or untreated) and untreated (p=.001 each case). The effect was greater with less antiparkinsonian medication (19 (95% CI, 14, 25) cm/year in untreated). Flexor rigidity was unchanged. Following antimicrobials for other indications (75 courses), hypokinesia was unchanged. However, flexor rigidity increased cumulatively. It increased in core group only after a first course (by (10 (0, 20)%/year, p=.05)), but then in entire, core and untreated after a second course (18 (6, 31), 33 (19, 48) and 29 (12, 48)%/year respectively; p=.002, .001 and .001) and further still after a third (17 (2, 34), 23 (8, 41) and 38 (15, 65)%/year; p=.02, .003 and .001). Initially, 40/66 were lactulose hydrogen breath test positive. Odds for positivity fell with time (by 59 (46, 75)%/year, p=.001) and tended to be lower with Helicobacter positivity (28 (8, 104)%, p=.06), but were unrelated to other antimicrobial interventions. Conclusions Improved hypokinesia following antimicrobials appeared unique to Helicobacter eradication. Rigidity increased following successive antimicrobial exposures for other indications, despite diminishing lactulose hydrogen breath test positivity.