目的：比较多巴胺能及抗胆碱能药物对帕金森病震颤的疗效，分析影响药物反应性的相关因素。方 法：前瞻性纳入2021年12月至2024年3月在北京天坛医院就诊的帕金森病震颤患者141例，分别于连续2 日清晨空腹状态下行复方左旋多巴及苯海索冲击试验。通过统一帕金森病评定量表第Ⅲ部分（UPDRS-Ⅲ） 和Fahn-Tolosa-Marin震颤评定量表（TRS）评估PD静止性、姿势性、意向性和动作性震颤，通过肌电图震颤 分析评估不同情境下震颤功率。比较复方左旋多巴及苯海索对PD震颤量表评分的改善率及震颤功率的改 善值。采用单因素及多重线性回归分析静止性震颤药物反应的相关因素。结果：对PD静止性（UPDRS-Ⅲ: P=0.003; TRS: P=0.007）、姿势性（TRS: P＜0.001）、意向性（TRS: P=0.002）和动作性震颤（TRS: P＜0.001）评 分改善率，复方左旋多巴均高于苯海索；对静止、静止+任务、姿势以及持物状态下震颤功率改善值，复方左 旋多巴均大于苯海索（P＜0.05）。多重线性回归分析显示，PD静止性震颤患者对复方左旋多巴的反应与强 直迟缓（β=0.215, P=0.033）、焦虑（β=0.211, P=0.015）评分正相关；PD静止性震颤伴有异动症时对复方左旋多 巴反应好（β=0.300, P=0.001），对苯海索反应差（β=－0.357, P＜0.001）；PD动作性震颤评分越高，静止性震颤 对复方左旋多巴（β=－0.276, P=0.007）和苯海索（β=－0.195, P=0.024）反应均差。 结论：帕金森病震颤治疗 应优先选择多巴胺能药物，尤其是强直迟缓明显、伴有焦虑及异动症的患者。若静止性震颤患者对多巴胺 能药物反应差，同时伴有明显的动作性震颤，添加抗胆碱能药物的获益较小。

To compare the efficacy of dopaminergic (levodopa) and anticholinergic (benzhexol) medications in the treatment of tremor in patients with Parkinson’s disease (PD), and to evaluate the factors influencing response to these two medications in patients with resting tremor. Methods: A prospective study enrolled 141 patients with PD presenting with tremor, recruited at Beijing Tiantan Hospital between December 2021 and March 2024. On two consecutive mornings in a fasting state, participants underwent pharmacological challenge tests with levopoda and benzhexol. Resting, postural, intentional and kinetic tremors in patients with PD were evaluated using the Part III of the Unified Parkinson's Disease Rating Scale (UPDRS-III) and the Fahn-Tolosa-Marin Tremor Rating Scale (TRS). Tremor power across different contexts was analyzed via electromyography (EMG). The study compared improvement rates in tremor scale scores and absolute changes in tremor power following administration of each drug. Univariate and multiple linear regression analyses were employed to identify factors associated with drug response in resting tremor. Results: Levopoda outperformed benzohexol in improving all tested PD tremor types: resting (UPDRS-III P=0.003; TRS P=0.007), postural (TRS P<0.001), intentional (TRS P=0.002), and kinetic (TRS P<0.001). It also achieved greater reductions in tremor power during resting, resting + task, postural, and weight conditions (all P<0.05 v.s.benzohexol). Regression analyses indicated that better responses to levopoda for resting tremor were associated with higher rigidity-bradykinesia ( β =0.215, P=0.033) and anxiety scores ( β =0.211, P=0.015). Presence of dyskinesia enhanced response to levopoda ( β =0.300, P=0.001) but diminished response to benzohexol ( β =－0.357, P< 0.001). Worse responses to both drugs for resting tremor occurred in patients with higher kinetic tremor scores (levopoda β=－0.276, P=0.007; benzohexol β=－0.195, P=0.024). Conclusion: Dopaminergic medications are the preferred treatment for tremor in PD, particularly for patients with dyskinesia, and for those with severe bradykinesia, rigidity, and anxiety. The benefit of adding anticholinergic agents to treat dopamine-resistant resting tremor may be smaller in patients with pronounced kinetic tremor.