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[22/04/2026 01:30:39]http://www.medenosrce.net/arhimed/poglej.asp?id=164
KAJ SE ZGODI S POSTSINAPTICNIMI RECEPTORJI PRI PARKINSONIZMU?
Avtor: Vladimir Banic, Igor Mark
Mentor: doc. dr. Zvezdan Pirtošek
IZHODIŠCE: Parkinsonizem je obolenje osrednjega živcevja, kjer je motnja predvsem na nivoju nevrotransmitorjev. Na mestu živcnega stika je okvara lahko zgolj presinapticna ali kombinirana presinapticna in postsinapticna ter lahko prizadene tako motoricne kot nemotoricne (kognitivne, afektivne) zanke. Prizadetost motoricne zanke se kaže kot bradikineza, rigidnost, tremor; kognitivne zanke kot demenca in frontalni sindrom; prizadetost afektivne pa kot depresija. NAMEN: Namen naloge je bil opredeliti mesto okvare na receptorskem nivoju motoricne zanke kot presinapticno oziroma postsinapticno in dobljene farmakodinamske kategorije primerjati z uveljavljeno klinicno sliko parkinsonizma. Pri teh kategorijah sva ugotavljala tudi prizadetost nemotoricnih (kognitivnih in afektivnih) zank. HIPOTEZE: i) V vecletnem poteku parkinsonizma postsinapticni receptorji lahko: a) ostanejo neprizadeti, b) se ireverzibilno okvarijo, c) se okvarijo v toku bolezni, d) se reverzibilno okvarijo. ii) V primeru, ko sklepamo na dodatno postsinapticno okvaro v motoricni zanki, pricakujemo tudi bolj izrazite kognitivne motnje. iii) V primeru, ko sklepamo na dodatno postsinapticno okvaro v motoricni zanki, pricakujemo tudi bolj izrazite afektivne motnje. METODE: Raziskava je prospektivno historicna študija 22 bolnikov s parkinsonizmom, ki so bili pred tremi ali vec leti že enkrat testirani z apomorfinom (APO). Pri vseh sva pod nadzorom nevrologa najprej opravila orientacijski nevrološki pregled, nato pa s pomocjo Enotne lestvice za oceno simptomov in znakov parkinsonizma (ELPA) ocenila njihovo motoricno stanje. Z vprašalnikom sva pri bolnikih zatem ocenjevala morebitno depresivnost, kognitivni upad in kvaliteto življenja. Temu je sledilo še testiranje z apomorfinom, kjer sva motoricno odzivnost ocenjevala z ELPA. Na koncu sva primerjala rezultate obeh apomorfinskih testiranj. Za statisticno analizo sva uporabila Pearsonovo metodo korelacije in t-test za neodvisne vzorce. REZULTATI: Na podlagi apomorfinskega testa sva bolnike razdelila v skupino 1 (odzivni na APO) in skupino 2 (neodzivni na APO). Odzivnost vseh z izjemo enega pacienta se v casu med obema testiranjima ni spremenila. Skupini sta se statisticno razlikovali po trajanju bolezni, kvaliteti življenja, odmerku APO in motoricnem odgovoru nanj. Pearsonova metoda korelacije je pokazala statisticno znacilno (p<0.05) pozitivno povezavo med trajanjem bolezni in motoricnim stanjem pred apomorfinskim testiranjem, pa tudi negativno povezavo med depresivnostjo in kognitivnimi zmožnostmi. ZAKLJUCKI: Na osnovi rezultatov sva potrdila obstoj treh vzorcev postsinapticne okvare: 1. v toku bolezni ne pride do prizadetosti postsinapticnih struktur; 2. te so prizadete že v zacetku bolezni; 3. do izrazite postsinapticne okvare pride kasneje v toku bolezni. Prvi vzorec sovpada s klinicno diagnozo idiopatske parkinsonove bolezni, drugi in tretji pa z ne-idiopatskim (sekundarnim ali "plus") parkinsonizmom. Med skupino s presinapticno okvaro in skupino, ki ima hkrati tudi postsinapticno okvaro, ni razlik v kognitivni okvari, depresivnosti ali kvaliteti življenja.
[Abstract / English version]
KAJ SE ZGODI S POSTSINAPTICNIMI RECEPTORJI PRI PARKINSONIZMU?
Author: Vladimir Banic, Igor Mark
Mentor: doc. dr. Zvezdan Pirtošek
BACKGROUND: Parkinsonism is a central nervous system neurotransmitter disorder. Lesion can be either presynaptic or combined presynaptic-postsynaptic and it involves motor and non-motor pathways. The damage to the motor circuit results in bradykinesia, rigidity and tremor; the damage to the cognitive circuit results in dementia and frontal disorder; the damage to the affective circuit results in depression. AIM: The purpose of our research was to locate the site of the lesion in the CNS pharmacodynamically either as presynaptic or combined presynaptic-postsynaptic; to compare these pharmacodynamic categories to the established clinical classification; and to find out wheather these categories differ in non-motor (cognitive and affective) circuits involvement. HYPOTHESES: As the disease progresses over years postsynaptic receptors can: a) stay intact, b) remain irreversibly damaged, 3) get damaged later on, 4) be initially damaged, only to recover later on. When additional postsynaptic damage in the motor circuit exists, more profound cognitive impairment is expected. Similarly additional postsynaptic damage in the motor circuit exists, more profound affective impairment is expected. METHODS: The research has been set up as a prospective historical study of 22 parkinsonian patients, all of whom had been tested with apomorphine (APO) at least three years earlier. First, we examined patients neurologicaly under the supervision of the neurologist. Motor performance was assesed in all of them using the Unified Parkinson's Disease Rating Scale (UPDRS) in "off" state. All patients filled in several questionnaires assesing cognitive impairment, depression and quality of life. In the second part, apomorphine test was done and another UPDRS performed. Finally, the results of both tests were compared. For the statistical analysis independent-t-test in small samples and Pearson's correlation method were used. RESULTS: On the basis of APO test we separated the patients into group 1 (responsive to APO) and group 2 (unresponsive to APO). The responsiveness has not changed between the two tests, apart from one patient. The two groups statistically differed regarding length of disease, life quality, APO dosage and motor input after APO. Pearson's correlation method showed statistically significant (p<0.05) positive correlation between the length of disease and motor condition before APO test and negative correlation between depression and cognitive abilities. CONCLUSIONS: On the basis of the above results, we found that there are three patterns in the postsynaptic damage: 1. during the disease postsynaptic structures remain intact; 2. they are irreversibly affected at the beginning of the disease; 3. postsynaptic damage manifests itself in the later stages of the disease. The first pattern overlaps with the idiopathic parkinsonism, the second and the third with non-idiopathic (secondary or plus) parkinsonism. No difference was found between the two groups regarding cognitive impairment, depression and quality of life.