中药联合rTMS对PD-MCI的临床效用及对血浆HCY和血清Cys C水平的影响
发布时间：2019-06-13 22:11
【摘要】：目的:通过比较治疗前后帕金森病患者统一帕金森病评分量表(UPDRS)、简易精神状态量表(MMSE)、蒙特利尔认知评估量表(Mo CA)、功能独立性评定量表(FIM)及中医老年颤证功能障碍计分法(ZYLNCZ)积分变化及血浆同型半胱氨酸(HCY)、血清胱抑素C(Cys C)水平变化,同期对患者的血常规、肝肾功能、心电图等进行监测,对中药复方帕宁,及帕宁联合重复经颅磁刺激术治疗帕金森病轻度认知功能障碍的临床疗效进行观察总结,同时评估该治疗方法的安全性。方法:将符合诊断与纳入标准的90例肝肾阴虚型帕金森病轻度认知功能障碍患者随机分成三组,每组30例。三组患者均依据实际病情需要,予以多巴胺替代、抗氧化等基础治疗。A组在基础治疗上加用中药复方帕宁联合重复经颅磁刺激术,B组在基础治疗上加用中药复方帕宁,C组予以基础治疗,疗程为4周,分别在治疗前后观察并记录UPDRS、MMSE、Mo CA、FIM、ZYLNCZ量表积分以及血浆HCY和血清Cys C水平变化情况,同时观察有无不良反应。结果:1.UPDRS:三组患者治疗后UPDRS总评分均有不同程度下降,A、B两组差异均有统计学意义(P0.05),C组差异无统计学意义(P0.05)。组间比较,三组间治疗后量表积分差异均有统计学意义(P0.05)。UPDRSⅠ:治疗后与疗前积分比较,A组差异有显著统计学意义(P0.01),B组与C组差异无统计学意义(P0.05)。组间比较:治疗后,A组与B、C两组差异具有显著统计学意义(P0.01),B组与C组间差异无统计学意义(P0.05)。UPDRSⅡ:治疗4周后,A组积分差异有显著统计学意义(P0.01)。B组积分差异有统计学意义(P0.05)。C组积分差异无统计学意义(P0.05)。组间比较:三组UPDRSⅡ治疗后量表评分差异均有统计学意义(P0.05)。UPDRSⅢ:组内比较,A组与B组疗后与疗前积分比较,差异有统计学意义(P0.05)。C组治疗前后积分差异无统计学意义(P0.05)。组间比较:A、B、C三组间差异均有统计学意义(P0.05)。2.MMSE:治疗后与治疗前比较,A、B、C三组患量表积分差异均无统计学意义(P0.05)。3.Mo CA:治疗前后组内比较,A组与B组差异均有统计学意义(P0.05),C组差异无统计学意义(P0.05)。组间比较:三组患者治疗后Mo CA分值差异均有统计学意义(P0.05)。4.FIM:(1)FIM(运动功能):组内比较,A组与B组差异均具有统计学意义(P0.05),C组差异无统计学意义(P0.05)。组间两两比较,A、B、C三组间差异均有统计学意义(P0.05)。(2)FIM(认知功能):经4周治疗后,A组与B组量表积分差异均有统计学意义(P0.05),C组差异无统计学意义(P0.05)。组间两两比较,三组积分差异均有统计学意义(P0.05)。5.ZYLNCZ:治疗4周后,组内比较,A组、B组量表积分差异有统计学意义(P0.05),C组积分差异无统计学意义(P0.05)。组间两两比较,三组间差异均有统计学意义(P0.05)。6.血浆HCY:组内比较,A组与B组差异均有统计学意义(P0.05)。C组差异不存在统计学意义(P0.05)。治疗后三组患者HCY水平差异有统计学意义(P0.05),组间两两比较,C组与A组,B组差异有统计学意义(P0.05),A组与B组间差异无统计学意义(P0.05)。7.血清Cys C:治疗前后组内比较,A组与B组差异具有统计学意义(P0.05)。C组差异无统计学意义(P0.05)。治疗后组间两两比较,C组与A组、B组水平差异均存在统计学意义(P0.05),A组与B组间差异无统计学意义(P0.05)。结论:(1)PD-MCI是帕金森病常见的非运动症状,而肝肾阴虚是其常见证候;(2)中药复方帕宁联合重复经颅磁刺激术不仅可改善肝肾阴虚型帕金森病轻度认知功能障碍患者认知水平,亦可显著改善其运动功能、精神、行为、情绪及日常生活活动等症状;(3)帕宁联合重复经颅磁刺激术能够改善PD患者认知功能,其机制可能是通过降低血浆同型半胱氨酸与血清胱抑素C水平来实现的;(4)帕宁联合重复经颅磁刺激术的治法对大部分帕金森病轻度认知功能障碍患者具有较好的安全性。
[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.
【学位授予单位】：安徽中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R742.5
[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.
【学位授予单位】：安徽中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R742.5
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