重复经颅磁刺激联合左旋多巴治疗帕金森的临床研究

Study on Clinical Efficacy of Repeated Transcranial Magnetic Stimulation Combined with Levodopa in the Treatment of Parkinson Disease

目的:探讨重复经颅磁刺激联合左旋多巴治疗帕金森的临床研究。方法:选择2016年10月—2019年1月本院收治的帕金森患者176例,按治疗方式的不同分为对照组和治疗组,各88例。对照组予以左旋多巴片(250 mg,tid)治疗,治疗组在对照组基础上联合重复经颅磁刺激(rTMS)治疗。比较两组临床疗效、临床症状相关评分、炎症因子、氧化应激指标及相关神经递质的变化情况。结果:治疗后,治疗组临床总有效率高于对照组,差异有统计学意义(P<0.05);治疗后治疗组帕金森病评分量表(UPDRS)及汉密尔顿抑郁量表(HAMD)评分、肿瘤坏死因子(TNF-α)、白细胞介素(IL)-6、IL-β、丙二醛(MDA)水平均低于对照组,PD睡眠量表(PDSS)、蒙特利尔认知评估量表(MoCA)、精神状态量表(MMSE)评分、超氧化物歧化酶(SOD)、谷胱甘肽(GSH)水平高于对照组,差异有统计学意义(P<0.05);治疗后两组5-羟色胺(5-HT)、去甲肾上腺素(NE)及多巴胺(DA)水平高于对照组,且治疗组高于对照组,差异有统计学意义(P<0.05)。结论:rTMS联合左旋多巴可有效提升帕金森患者的临床疗效及相关临床症状评分,降低炎症反应,改善氧化应激因子及相关神经递质水平,具有临床推广意义。

Objective:To investigate the clinical study of repeated transcranial magnetic stimulation combined with levodopa in the treatment of Parkinson’s disease.Methods:176 patients with Parkinson’s disease admitted to our hospital from October 2016 to January 2019 were selected and divided into a control group and a treatment group according to different treatment methods,88 cases each.The patients in the control group were treated with levodopa tablets(250 mg,tid),and the patients in the treatment group were treated by repeated transcranial magnetic stimulation(rTMS)on the basis of the treatment in the control group.The clinical efficacy and changes in clinical symptoms-related scores,inflammatory factors,oxidative stress indexes and related neurotransmitters were compared between the two groups.Results:After treatment,the total clinical effective rate in the treatment group was higher than that in the control group,and the difference was statistically significant(P<0.05).After treatment,the scores of Unified Parkinson’s Disease Rating Scale(UPDRS)and Hamilton Depression Scale(HAMD)and the levels of tumor necrosis factor(TNF)-α,interleukin(IL)-6,IL-βand malondialdehyde(MDA)in the treatment group were lower than those in the control group,and the scores of PD Sleep Scale(PDSS),Montreal Cognitive Assessment Scale(MoCA)and Mini-Mental State Examination(MMSE)and the levels of superoxide dismutase(SOD)and glutathione(GSH)in the treatment group were higher than those in the control group,with statistically significant differences(P<0.05).After treatment,the levels of 5-hydroxytryptamine(5-HT),norepinephrine(NE)and dopamine(DA)in the two groups were higher than those in the control group,and the levels in the treatment group were higher than those in the control group,with statistically significant differences(P<0.05).Conclusion:rTMS combined with levodopa can effectively improve the clinical efficacy and clinical symptom scores of the patients with Parkinson’s disease,reduce inflammatory response,improve oxidative stress factors and related neurotransmitter levels,and has clinical significance.