醋甲唑胺治疗正常压力脑积水患者5例分析

摘要
图/表
参考文献(25)
相关文章 (0)

全文: PDF (1028 KB) HTML (1 KB)
输出: BibTeX | EndNote (RIS)

摘要

目的研究醋甲唑胺（MTZ）对正常压力脑积水（NPH）患者治疗的有效性及安全性，探讨其作用机制，丰富NPH的治疗手段，拓宽MTZ应用新途径。方法收集中国医科大学航空总医院2019—2020年4例特发性正常压力脑积水（iNPH）和1例继发性正常压力脑积水（sNPH）患者。iNPH患者均符合2005年国际iNPH指南诊断标准，5例患者均完善单次腰穿放液试验阳性，且因各种原因不适宜或拒绝手术治疗，在征得患者及家属同意后，给予口服MTZ 25～50 mg，2次/d进行治疗。评价患者口服MTZ前后步态评分、认知评定、膀胱功能测定、头MRI检查、iNPH分级评分。口服MTZ后iNPH评分改善≥1分定义为有效，并密切观察药物不良反应，评估MTZ对NPH的有效性及安全性。结果 5例患者中4例有效，轻度改善1例，明显改善3例（2例iNPH和1例sNPH患者），表现为步态、认知或膀胱功能三方面改善。5例患者均未发现明确的MTZ相关的不良反应。结论 MTZ可能成为潜在的治疗NPH的药物之一，但仍需大样本随机对照试验进一步证实。

	服务

	把本文推荐给朋友
	加入我的书架
	加入引用管理器
	E-mail Alert
	RSS
	作者相关文章
	杨琼滑蓉蓉刘春艳刘星李熙宇邢岩

关键词 ：醋甲唑胺, 乙酰唑胺, 正常压力脑积水, 腰穿放液试验

Abstract：

Objective To study the effectiveness and safety of Methazolamide (MTZ) in the treatment of patients with normal pressure hydrocephalus (NPH), to explore its mechanism of action, to enrich NPH treatment methods, and to broaden new ways of MTZ application. Methods A total of four cases of idiopathic normal pressure hydrocephalus (iNPH) and one case of secondary normal pressure hydrocephalus (sNPH) were collected from 2019 to 2020 in Aviation General Hospital, China Medical University. All iNPH patients met the diagnostic criteria of the 2005 International iNPH Guidelines. The five patients were all tested positive for a single lumbar puncture and were not suitable for or refused surgical treatment for various reasons. After obtaining the consent of the patient and their family members, they were given oral MTZ 25-50 mg, two times per day for treatment. The gait score, cognitive assessment, bladder function measurement, head MRI examination, iNPH grading score before and after oral MTZ were evaluated. After oral administration of MTZ, an improvement in iNPH score is greater than or equal to one point was defined as effective, and adverse drug reactions could be closely observed to evaluate the effectiveness and safety of MTZ on NPH. Results Among the five patients, four case were effective, including one case was slightly improved, and three cases were improved significantly (two patients with iNPH and one patient with sNPH), showed improvements in gait, cognition or bladder function. None of the five patients found clear MTZ-related adverse reactions. Conclusion MTZ may become one of the potential drugs for the treatment of NPH, but it still needs to be further confirmed by large randomized controlled trials.

Key words： Methazolamide Acetazolamide Normal pressure hydrocephalus Cerebrospinal fluid tap test

基金资助:北京市自然科学基金资助项目（7202237）；
航空总医院重点疾病研究室科研项目（JB2019-015）；
北京神经变性病学会基金资助项目（BNDS201901）。

通讯作者: 邢岩（1970.10-），女，博士；研究方向：帕金森病、痴呆、运动神经元病等神经系统变性病及特发性正常压力脑积水。

作者简介: 杨琼（1987.6-），女，硕士；研究方向：脑血管疾病、神经变性疾病等。

引用本文:

杨琼滑蓉蓉刘春艳刘星李熙宇邢岩. 醋甲唑胺治疗正常压力脑积水患者5例分析[J]. 中国医药导报, 2020, 17(26): 53-56,74.
YANG Qiong HUA Rongrong LIU Chunyan LIU Xing LI Xiyu XING Yan. Study of Methazolamide in five patients with normal pressure hydrocephalus. 中国医药导报, 2020, 17(26): 53-56,74.

链接本文:

http://www.yiyaodaobao.com.cn/CN/ 或 http://www.yiyaodaobao.com.cn/CN/Y2020/V17/I26/53

[1] Hakim S，Adams RD. The special clinical problem of symptomatic hydrocephalus with normal cerebrospinal fluid pressure. Observations on cerebrospinal fluid hydrodynamics [J]. J Neurol Sci，1965，2（4）：307-327.
[2] Torsnes L，Blafjelldal V，Poulsen FR. Treatment and clinical outcome in patients with idiopathic normal pressure hydrocephalus--a systematic review [J]. Dan Med J，2014， 61（10）：A4911.
[3] Williams MA，Malm J. Diagnosis and Treatment of Idiopathic Normal Pressure Hydrocephalus [J]. Continuum （Minneap Minn），2016，22（2 Dementia）：579-599.
[4] Carrion E，Hertzog JH，Medlock MD，et al. Use of acetazolamide to decrease cerebrospinal fluid production in chronically ventilated patients with ventriculopleural shunts [J]. Arch Dis Child，2001，84（1）：68-71.
[5] Davson H，Luck CP. The effect of acetazoleamide on the chemical composition of the aqueous humour and cerebrospinal fluid of some mammalian species and on the rate of turnover of 24Na in these fluids [J]. J Physiol，1957，137（2）：279-293.
[6] Vogh BP. The relation of choroid plexus carbonic anhydrase activity to cerebrospinal fluid formation： study of three inhibitors in cat with extrapolation to man [J]. J Pharmacol Exp Ther，1980，213（2）：321-331.
[7] Aimard G，Vighetto A，Gabet JY，et al. Acetazolamide：an alternative to shunting in normal pressure hydrocephalus? Preliminary results [J]. Rev Neurol （Paris），1990，146（6/7）：437-439.
[8] Swenson ER. Pharmacology of acute mountain sickness：old drugs and newer thinking [J]. J Appl Physiol（1985），2016， 120（2）：204-215.
[9] Relkin N，Marmarou A，Klinge P，et al. Diagnosing idiopathic normal-pressure hydrocephalus [J]. Neurosurgery，2005，57（3 Suppl）：S4-S16.
[10] Ishikawa M，Hashimoto M，Mori E，et al. The value of the cerebrospinal fluid tap test for predicting shunt effectiveness in idiopathic normal pressure hydrocephalus [J]. Fluids Barriers CNS，2012，9（1）：1.
[11] Boon AJ，Tans JT，Delwel EJ，et al. Dutch normal pressure hydrocephalus study：baseline characteristics with emphasis on clinical findings [J]. Eur J Neurol，1997，4（1）：39-47.
[12] Yamada S，Ishikawa M，Miyajima M，et al. Timed up and go test at tap test and shunt surgery in idiopathic normal pressure hydrocephalus [J]. Neurol Clin Pract，2017，7（2）：98-108.
[13] Kubo Y，Kazui H，Yoshida T，et al. Validation of grading scale for evaluating symptoms of idiopathic normal-pressure hydrocephalus [J]. Dement Geriatr Cogn Disord，2008，25（1）：37-45.
[14] Maren TH. Carbonic anhydrase：chemistry，physiology，and inhibition [J]. Physiol Rev，1967，47（4）：595-781.
[15] Birzis L，Carter CH，and Maren TH Effects of acetazolamide on CSF pressure and electrolytes in hydrocephalus [J]. Neurology，1958，8（7）：522-528.
[16] Miyake H，Ohta T，Kajimoto Y，et al. Diamox（R） challenge test to decide indications for cerebrospinal fluid shunting in normal pressure hydrocephalus [J]. Acta Neurochir （Wien），1999，141（11）：1187-1193.
[17] Alperin N，Oliu CJ，Bagci AM，et al. Low-dose acetazolamide reverses periventricular white matter hyperintensities in iNPH [J]. Neurology，2014，82（15）：1347-1351.
[18] Ivkovic M，Reiss-Zimmermann M，Katzen H，et al. MRI assessment of the effects of acetazolamide and external lumbar drainage in idiopathic normal pressure hydrocephalus [J]. Fluids Barriers CNS，2015，12：9.
[19] Gao F，Zheng M，Hua Y，et al. Acetazolamide Attenuates Thrombin-Induced Hydrocephalus [J]. Acta Neurochir Suppl，2016，121：373-377.
[20] Visudhiphan P，Chiemchanya S. Hydrocephalus in tuberculous meningitis in children：treatment with acetazolamide and repeated lumbar puncture [J]. J Pediatr，1979，95（4）：657-660.
[21] Ameli PA，Madan M，Chigurupati S，et al. Effect of acetazolamide on aquaporin-1 and fluid flow in cultured choroid plexus [J]. Acta Neurochir Suppl，2012，113：59-64.
[22] Wang X，Figueroa BE，Stavrovskaya IG，et al. Methazolamide and melatonin inhibit mitochondrial cytochrome C release and are neuroprotective in experimental models of ischemic injury [J]. Stroke，2009，40（5）：1877-1885.
[23] Wang X，Zhu S，Pei Z，et al. Inhibitors of cytochrome C release with therapeutic potential for Huntington′s disease [J]. J Neurosci，2008，28（38）：9473-9485.
[24] Fossati S，Giannoni P，Solesio ME，et al. The carbonic anhydrase inhibitor methazolamide prevents amyloid beta-induced mitochondrial dysfunction and caspase activation protecting neuronal and glial cells in vitro and in the mouse brain [J]. Neurobiol Dis，2016，86：29-40.
[25] Tangamornsuksan W，Lohitnavy M. Association between HLA-B*5901 and methazolamide-induced Stevens-Johnson syndrome/toxic epidermal necrolysis： a systematic review and meta-analysis [J]. Pharmacogenomics J，2019，19（3）：286-294.