低频重复经颅磁刺激治疗帕金森病自主神经功能障碍临床效果观察

Efficacy observation of low frequency repetitive transcranial magnetic stimulation treating autonomic dysfunction in Parkinson disease

目的观察低频重复经颅刺激（rTMS）治疗帕金森病自主神经功能障碍的临床效果。方法选择2014年5月至2015年9月于第四军医大学唐都医院住院的确诊帕金森病患者52例。完全随机分为rTMS组和对照组，各26例。rTMS组采用低频rTMS＋多巴丝肼片（0．25g／次，3次／d口服）治疗；对照组采用伪线圈rTMS＋多巴丝肼片（用法同rTMS组）治疗；2组均治疗1次／d，每次20min，连续10d，之后2组均继续服用多巴丝肼片治疗。比较2组患者治疗前及治疗后第10、30、90、180天帕金森病自主神经症状量表（SCOPA-AUT）、统一帕金森病评分表（UPDRS）评分结果。结果治疗前2组SCOPA—AUT及UPDRS评分比较，差异均无统计学意义（均P〉0．05）。治疗后对照组组内上述评分比较，差异均无统计学意义（均P〉0．05）；rTMS组治疗第30、90、180天后与治疗前比较，差异均有统计学意义[SCOPA-AUT：（13．5±2．1）、（12．6±2．2）、（15．3±2．9）分比（22．7±2．7）分，UPDRS：（40±9）、（21±8）、（32±8）分比（64±11）分]（均P〈0．05），同时rTMS组治疗第90天后SCOPA—AUT及UPDRS评分明显低于对照组，差异均有统计学意义[（12．6±2．2）分比（18．9±1．7）分、（21±8）分比（43±9）分]（均P〈0．01）。结论低频rTMS可有效改善帕金森病患者的自主神经功能障碍，且中期疗效明显优于近期疗效，而远期疗效有所反弹。

Objective To observe the clinical effect of low frequency repetitive transcranial magnetic stimulation （rTMS） on autonomic dysfunction in patients with Parkinson disease. Methods A total of 52 patients diagnosed of Parkinson disease from May 2014 to September 2015 in Tangdu Hospital of the Fourth Military Medical University were randomly divided into rTMS group and control group, with 26 eases in each group. The rTMS group had low frequency rTMS ＋ Levodopa and Benserazide tablets （0. 25 g/time, 3 times/d, oral） ; the control group had Pseudo-coil rTMS ＋ Levodopa and Benserazide tablets （ the same for rTMS group） ; the treatments were given 1 time/d, 20 minutes/time for 10 d, the 2 groups continued to take Levodopa and Benserazide tablets treatment. The Scale Outcomes in Parkinson Disease for Autonomic Symptoms （SCOPA-AUT） and Unified Parkinson Disease Rating Scale（UPDRS） were compared between 2 groups before and after treatment. Results SCOPA-AUT and UPDRS scores had no significant differences between groups before treatment（P 〉 0. 05 ）. SCOPA-AUT and UPDRS scores had no significant differences among different mearsuring time points in control group after treatment （ P 〉 0.05 ）. SCOPA-AUT and UPDRS scores on the 30th, 90th and 180th day after treatment start were significantly lower than those before treatment in rTMS group [ SCOPA-AUT ： （ 13.5 ± 2.1 ）, （ 12.6 ± 2.2 ）, （ 15.3 ± 2.9 ） scores vs （ 22.7 ± 2.7 ） scores ; UPDRS ： （ 40 ± 9 ） , （ 21 ± 8 ） , （ 32 ± 8 ） scores vs （ 64 ± 11 ） scores ] （ all P 〈 0.05 ）. SCOPA-AUT and UPDRS scores at the 90th day after treatment in rTMS group were significantly lower than those in control group[ （ 12.6 ± 2. 2） scores vs （18.9±1.7）seores, （21 ±8）scores vs（43 ±9）scores]（P〈0.01）. Conclusion Low frequency rTMS is effective for treating autonomic dysfunction in Parkinson disease; the mid-term efficacy is better than short-term and long-term results.