發(fā)布時(shí)間：2019-06-13 22:11

【摘要】：目的:通過比較治療前后帕金森病患者統(tǒng)一帕金森病評(píng)分量表(UPDRS)、簡(jiǎn)易精神狀態(tài)量表(MMSE)、蒙特利爾認(rèn)知評(píng)估量表(Mo CA)、功能獨(dú)立性評(píng)定量表(FIM)及中醫(yī)老年顫證功能障礙計(jì)分法(ZYLNCZ)積分變化及血漿同型半胱氨酸(HCY)、血清胱抑素C(Cys C)水平變化,同期對(duì)患者的血常規(guī)、肝腎功能、心電圖等進(jìn)行監(jiān)測(cè),對(duì)中藥復(fù)方帕寧,及帕寧聯(lián)合重復(fù)經(jīng)顱磁刺激術(shù)治療帕金森病輕度認(rèn)知功能障礙的臨床療效進(jìn)行觀察總結(jié),同時(shí)評(píng)估該治療方法的安全性。方法:將符合診斷與納入標(biāo)準(zhǔn)的90例肝腎陰虛型帕金森病輕度認(rèn)知功能障礙患者隨機(jī)分成三組,每組30例。三組患者均依據(jù)實(shí)際病情需要,予以多巴胺替代、抗氧化等基礎(chǔ)治療。A組在基礎(chǔ)治療上加用中藥復(fù)方帕寧聯(lián)合重復(fù)經(jīng)顱磁刺激術(shù),B組在基礎(chǔ)治療上加用中藥復(fù)方帕寧,C組予以基礎(chǔ)治療,療程為4周,分別在治療前后觀察并記錄UPDRS、MMSE、Mo CA、FIM、ZYLNCZ量表積分以及血漿HCY和血清Cys C水平變化情況,同時(shí)觀察有無不良反應(yīng)。結(jié)果:1.UPDRS:三組患者治療后UPDRS總評(píng)分均有不同程度下降,A、B兩組差異均有統(tǒng)計(jì)學(xué)意義(P0.05),C組差異無統(tǒng)計(jì)學(xué)意義(P0.05)。組間比較,三組間治療后量表積分差異均有統(tǒng)計(jì)學(xué)意義(P0.05)。UPDRSⅠ:治療后與療前積分比較,A組差異有顯著統(tǒng)計(jì)學(xué)意義(P0.01),B組與C組差異無統(tǒng)計(jì)學(xué)意義(P0.05)。組間比較:治療后,A組與B、C兩組差異具有顯著統(tǒng)計(jì)學(xué)意義(P0.01),B組與C組間差異無統(tǒng)計(jì)學(xué)意義(P0.05)。UPDRSⅡ:治療4周后,A組積分差異有顯著統(tǒng)計(jì)學(xué)意義(P0.01)。B組積分差異有統(tǒng)計(jì)學(xué)意義(P0.05)。C組積分差異無統(tǒng)計(jì)學(xué)意義(P0.05)。組間比較:三組UPDRSⅡ治療后量表評(píng)分差異均有統(tǒng)計(jì)學(xué)意義(P0.05)。UPDRSⅢ:組內(nèi)比較,A組與B組療后與療前積分比較,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。C組治療前后積分差異無統(tǒng)計(jì)學(xué)意義(P0.05)。組間比較:A、B、C三組間差異均有統(tǒng)計(jì)學(xué)意義(P0.05)。2.MMSE:治療后與治療前比較,A、B、C三組患量表積分差異均無統(tǒng)計(jì)學(xué)意義(P0.05)。3.Mo CA:治療前后組內(nèi)比較,A組與B組差異均有統(tǒng)計(jì)學(xué)意義(P0.05),C組差異無統(tǒng)計(jì)學(xué)意義(P0.05)。組間比較:三組患者治療后Mo CA分值差異均有統(tǒng)計(jì)學(xué)意義(P0.05)。4.FIM:(1)FIM(運(yùn)動(dòng)功能):組內(nèi)比較,A組與B組差異均具有統(tǒng)計(jì)學(xué)意義(P0.05),C組差異無統(tǒng)計(jì)學(xué)意義(P0.05)。組間兩兩比較,A、B、C三組間差異均有統(tǒng)計(jì)學(xué)意義(P0.05)。(2)FIM(認(rèn)知功能):經(jīng)4周治療后,A組與B組量表積分差異均有統(tǒng)計(jì)學(xué)意義(P0.05),C組差異無統(tǒng)計(jì)學(xué)意義(P0.05)。組間兩兩比較,三組積分差異均有統(tǒng)計(jì)學(xué)意義(P0.05)。5.ZYLNCZ:治療4周后,組內(nèi)比較,A組、B組量表積分差異有統(tǒng)計(jì)學(xué)意義(P0.05),C組積分差異無統(tǒng)計(jì)學(xué)意義(P0.05)。組間兩兩比較,三組間差異均有統(tǒng)計(jì)學(xué)意義(P0.05)。6.血漿HCY:組內(nèi)比較,A組與B組差異均有統(tǒng)計(jì)學(xué)意義(P0.05)。C組差異不存在統(tǒng)計(jì)學(xué)意義(P0.05)。治療后三組患者HCY水平差異有統(tǒng)計(jì)學(xué)意義(P0.05),組間兩兩比較,C組與A組,B組差異有統(tǒng)計(jì)學(xué)意義(P0.05),A組與B組間差異無統(tǒng)計(jì)學(xué)意義(P0.05)。7.血清Cys C:治療前后組內(nèi)比較,A組與B組差異具有統(tǒng)計(jì)學(xué)意義(P0.05)。C組差異無統(tǒng)計(jì)學(xué)意義(P0.05)。治療后組間兩兩比較,C組與A組、B組水平差異均存在統(tǒng)計(jì)學(xué)意義(P0.05),A組與B組間差異無統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論:(1)PD-MCI是帕金森病常見的非運(yùn)動(dòng)癥狀,而肝腎陰虛是其常見證候;(2)中藥復(fù)方帕寧聯(lián)合重復(fù)經(jīng)顱磁刺激術(shù)不僅可改善肝腎陰虛型帕金森病輕度認(rèn)知功能障礙患者認(rèn)知水平,亦可顯著改善其運(yùn)動(dòng)功能、精神、行為、情緒及日常生活活動(dòng)等癥狀;(3)帕寧聯(lián)合重復(fù)經(jīng)顱磁刺激術(shù)能夠改善PD患者認(rèn)知功能,其機(jī)制可能是通過降低血漿同型半胱氨酸與血清胱抑素C水平來實(shí)現(xiàn)的;(4)帕寧聯(lián)合重復(fù)經(jīng)顱磁刺激術(shù)的治法對(duì)大部分帕金森病輕度認(rèn)知功能障礙患者具有較好的安全性。
[Abstract]:Objective: To compare the patients with Parkinson's disease before and after treatment with the unified Parkinson's disease score scale (UPDRS), the Simple Mental State Scale (MMSE) and the Montreal Cognitive Assessment Scale (Mo CA). The function independence rating scale (FIM) and the function independence rating scale (ZYLNCZ) integral change and the plasma homocysteine (HCY), the serum cystatin C (Cys C) level changes, the blood routine, the liver and kidney function, the electrocardiogram and the like of the patient are monitored in the same period, The clinical effect of combination of traditional Chinese medicine compound paining and parainen combined with transcranial magnetic stimulation in the treatment of mild cognitive impairment of parkinson's disease was summarized, and the safety of the method was also evaluated. Methods:90 patients with mild cognitive impairment of liver and kidney yin deficiency type with the criteria of diagnosis and inclusion were randomly divided into three groups, each group of 30 cases. The three groups of patients were treated with dopamine replacement, anti-oxidation and other basic treatment according to the actual condition. The group A combined with the traditional Chinese medicine compound paining combined with the transcranial magnetic stimulation on the basic treatment, and the group B was treated with the traditional Chinese medicine compound paining and the group C on the basis of the basic treatment, and the course of treatment was 4 weeks. The changes of plasma HCY and serum Cys C levels were observed in the ZYLNCZ scale and the level of plasma HCY and serum Cys C, and there were no adverse reactions. Results:1. The total score of RRS in the group A and B was statistically significant (P0.05), and there was no significant difference between the two groups (P0.05). There was a significant difference in the scores of the three groups after treatment (P0.05). The difference between group A and group C was statistically significant (P0.01), and there was no significant difference between group B and group C (P0.05). There was no significant difference between group A and group B and C after treatment (P 0.01), and there was no significant difference between group B and group C (P0.05). There was a significant difference in group A (P0.01). There was no significant difference in group B (P0.05). There was no significant difference between group A and group B in group A and group B after treatment (P <0.05). There was no significant difference between group A and group B after treatment (P <0.05). 2. The difference of group A, B and C in group A, B and C was statistically significant (P0.05).2. MMSE: The difference between group A and group B in group A, B and C had no statistical significance after treatment (P0.05). There was no significant difference in group C (P0.05). 4. FIM: (1) FIM: (1) FIM (exercise function): The difference between group A and group B was of statistical significance (P0.05), and there was no statistical significance in group C (P0.05). The difference between groups A, B and C was statistically significant between the two groups (P0.05). (2) FIM (cognitive function): After 4 weeks of treatment, there was no significant difference between group A and group B (P0.05). There was no significant difference between group A and group B in group A and group B (P0.05). The difference between the three groups was statistically significant between the two groups (P0.05). There was no significant difference between group A and group B (P0.05) in plasma HCY: group A and group B (P0.05). There was a significant difference in the level of HCY in the three groups after treatment (P0.05). There was no significant difference between group C and group A and group B (P0.05), and there was no statistical difference between group A and group B (P0.05). Serum Cys C: The difference of group A and group B in group A and group B was statistically significant (P0.05). There was no significant difference between group C and group A and group B (P0.05), and there was no significant difference between group A and group B (P0.05). Conclusion: (1) PD-MCI is a common non-motion symptom of Parkinson's disease, and the yin-deficiency of the liver and the kidney is its common syndrome; (2) the combined repeated transcranial magnetic stimulation of the traditional Chinese medicine compound can not only improve the cognitive level of the patients with mild cognitive impairment of the liver and kidney yin deficiency type Parkinson's disease, (3) Pannin combined with transcranial magnetic stimulation can improve the cognitive function of PD patients, and the mechanism may be achieved by reducing plasma homocysteine and serum cystatin C level; (4) The treatment of paining combined with transcranial magnetic stimulation has better safety for patients with mild cognitive impairment in most of the patients with parkinson's disease.
【學(xué)位授予單位】：安徽中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R742.5

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