温阳解郁法对肾虚肝郁型帕金森病抑郁患者的临床干预研究
发布时间：2018-09-10 07:03
【摘要】：背景:帕金森病(Parkinson's disease,PD)是一种中老年人常见的进行性神经系统退行性疾病,PD以静止性震颤、肌肉强直、运动迟缓及姿势异常等为主要运动症状,以抑郁、便秘、眠差、多汗等为主要的非运动症状,非运动症状中以抑郁最多见。据研究帕金森病抑郁(Parkinson's disease depression,PDD)多见于少动型和强直型。PDD与原发性抑郁有所不同,常见表现有淡漠、反应减慢、注意力缺乏、快感减少,而晨起烦躁、失败感较少出现。PDD目前以西药治疗为主,副反应较多,长期用药疗效减退,根据既往临床经验我们提出了 PDD "阳虚水寒木郁"的发病机制,并拟定了温阳解郁治法。据此运用中医辨证论治思维和中医药特色治疗优势,探索温阳解郁方法方药对PDD的治疗效果,对缓解患者的病情,改善其运动功能,提高其生活质量具有重要意义。目的:本研究旨在初步观察温阳解郁法辨治帕金森病抑郁的临床疗效和安全性,为进一步推广应用奠定基础。方法:选取主要来自于北京中医药大学第三附属医院门诊的86例肾虚肝郁型PDD患者,中药组44例,西药组42例。中药组:温阳解郁方,疗程12周;西药组:盐酸文拉法辛缓释胶囊,疗程12周。整个试验期间允许合并使用抗帕金森药物,应尽量保持用药种类和剂量不变;整个研究期间不允许合并使用其它任何抗精神病药、抗抑郁药、心境稳定剂、镇静安眠药物以及本方案所用中药以外的其它中药和中成药制剂。分别于治疗第0周、治疗第2周、治疗第12周使用生活质量量表(shortform 36 questionnaire,SF-36)、汉密尔顿抑郁量表(Hamilton Depression Scale,HAMD)、中医证候评定表(肾虚肝郁证)、帕金森病综合评分表(UPDRS Ⅱ、Ⅲ部分)进行评分,观察分值变化;以副反应量表(Treatment Emergent Symptom Scale,TESS)记录比较其不良反应。运用SPSS20.0统计分析软件进行数据分析,评价其疗效。计量资料以均数加减标准差(x土s)描述,采用t检验和秩和检验等方法,计数资料以频数、率描述,采用卡方检验和秩和检验等方法。P0.05时差异有统计学意义。结果:组内比较:中药组与西药组的SF-36、HAMD、中医证候评定表、帕金森病综合评分表(UPDRSⅡ、Ⅲ部分)评分较治疗前均有明显变化(P0.05);组间比较:在第12周时,中药组的SF-36、中医证候评定表、帕金森病综合评分表(UPDRSⅡ、Ⅲ部分)评分改善程度均大于西药组(P0.05),HAMD量表评分变化两组相当(P0.05);在第2周时,两组各项量表评分变化相当(P0.05)。TESS评分结果显示中药组副反应少于西药组(P0.05)。结论:温阳解郁法能够改善PDD患者的临床症状,改善其生活质量。温阳解郁中药改善PPD患者抑郁状态的效果与西药相同,但不良反应相对较少,值得在临床中推广。
[Abstract]:Background: Parkinson's disease (Parkinson's disease,PD) is a common progressive neurodegenerative disease in the elderly. The main symptoms of PD are quiescent tremor, muscular rigidity, motor retardation and abnormal posture. The main symptoms of PD are depression, constipation and poor sleep. Hyperhidrosis was the main non-motor symptom and depression was the most common non-motor symptom. Depression in Parkinson's disease (Parkinson's disease depression,PDD) is more common in oligokinetic type and ankylosis type. PDD is different from primary depression in common symptoms such as apathy, slow response, lack of attention, decreased pleasure, and irritability in the morning. There are few cases of failure. PDD is mainly treated with western medicine at present, with more side effects, and the long-term curative effect is decreased. According to the past clinical experience, we put forward the pathogenesis of "Yang deficiency and water cold wood depression" in PDD, and draw up the treatment method of warming yang depression. On the basis of this, it is of great significance to use the thinking of TCM differentiation and treatment and the advantages of characteristic treatment of Chinese medicine to explore the therapeutic effect of warming yang and relieving depression on PDD, to alleviate the patients' condition, to improve their motor function and to improve their quality of life. Objective: to observe the clinical efficacy and safety of treating Parkinson's disease depression with the method of warming yang and relieving depression, so as to lay a foundation for further application. Methods: 86 cases of PDD with kidney deficiency and liver depression were selected from the outpatient department of the third affiliated Hospital of Beijing University of traditional Chinese Medicine, 44 cases in the Chinese medicine group and 42 cases in the western medicine group. The traditional Chinese medicine group was treated with Wenyang Jieyu recipe for 12 weeks, and the western medicine group with venlafaxine hydrochloride sustained release capsule for 12 weeks. The combination of antiParkinson drugs should be allowed throughout the trial period, and the type and dosage of the drugs should be kept as constant as possible; no combination of any other antipsychotics, antidepressants, and mood stabilizers should be allowed throughout the study period. Sedative sleeping pills and other traditional Chinese medicines and proprietary Chinese medicines used in this scheme. Quality of life scale (shortform 36 questionnaire,SF-36), Hamilton Depression scale (Hamilton Depression Scale,HAMD), TCM Syndromes scale (Kidney deficiency and liver Depression Syndrome) and Parkinson's Disease Synthetical scale (UPDRS 鈪，
本文编号：2233731
[Abstract]:Background: Parkinson's disease (Parkinson's disease,PD) is a common progressive neurodegenerative disease in the elderly. The main symptoms of PD are quiescent tremor, muscular rigidity, motor retardation and abnormal posture. The main symptoms of PD are depression, constipation and poor sleep. Hyperhidrosis was the main non-motor symptom and depression was the most common non-motor symptom. Depression in Parkinson's disease (Parkinson's disease depression,PDD) is more common in oligokinetic type and ankylosis type. PDD is different from primary depression in common symptoms such as apathy, slow response, lack of attention, decreased pleasure, and irritability in the morning. There are few cases of failure. PDD is mainly treated with western medicine at present, with more side effects, and the long-term curative effect is decreased. According to the past clinical experience, we put forward the pathogenesis of "Yang deficiency and water cold wood depression" in PDD, and draw up the treatment method of warming yang depression. On the basis of this, it is of great significance to use the thinking of TCM differentiation and treatment and the advantages of characteristic treatment of Chinese medicine to explore the therapeutic effect of warming yang and relieving depression on PDD, to alleviate the patients' condition, to improve their motor function and to improve their quality of life. Objective: to observe the clinical efficacy and safety of treating Parkinson's disease depression with the method of warming yang and relieving depression, so as to lay a foundation for further application. Methods: 86 cases of PDD with kidney deficiency and liver depression were selected from the outpatient department of the third affiliated Hospital of Beijing University of traditional Chinese Medicine, 44 cases in the Chinese medicine group and 42 cases in the western medicine group. The traditional Chinese medicine group was treated with Wenyang Jieyu recipe for 12 weeks, and the western medicine group with venlafaxine hydrochloride sustained release capsule for 12 weeks. The combination of antiParkinson drugs should be allowed throughout the trial period, and the type and dosage of the drugs should be kept as constant as possible; no combination of any other antipsychotics, antidepressants, and mood stabilizers should be allowed throughout the study period. Sedative sleeping pills and other traditional Chinese medicines and proprietary Chinese medicines used in this scheme. Quality of life scale (shortform 36 questionnaire,SF-36), Hamilton Depression scale (Hamilton Depression Scale,HAMD), TCM Syndromes scale (Kidney deficiency and liver Depression Syndrome) and Parkinson's Disease Synthetical scale (UPDRS 鈪，
本文编号：2233731
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