盐酸美金刚对老年帕金森性痴呆的疗效和血清IL-1β、IL-2、TNF-α、BDNF及EGF的影响

Clinical Efficacy of Memantine Hydrochloride for Elderly Patients with Parkinson Disease Dementia and Influence on Serum Inflammatory Factors,BDNF and EGF

目的:探讨盐酸美金刚对老年帕金森病性痴呆(PDD)的疗效及对血清炎症因子、脑源性神经营养因子(BDNF)和表皮生长因子(EGF)的影响。方法:86例老年PDD患者随机分为美金刚组与安慰剂组,两组均予以盐酸多奈哌齐片治疗,美金刚组在常规治疗基础上加用盐酸美金刚治疗,安慰剂组同时点服用安慰剂,疗程12周;比较两组治疗前及治疗后第4、8、12周时的蒙特利尔认知评估量表(Mo CA)评分、简易智能状态检查量表(MMSE)评分、Barthel指数(BI),同时检测血清脑源性神经营养因子(BDNF)、表皮生长因子(EGF)、白细胞介素1β(IL-1β)、白细胞介素-2(IL-2)及肿瘤坏死因子-α(TNF-α)水平。结果:治疗后4、8、12周时,美金刚组的MoCA、MMSE、BI评分及血清BDNF、EGF水平显著高于治疗前及安慰剂组(P<0.05),血清IL-1β、TNF-α水平显著低于治疗前及安慰剂组(P<0.05),两组IL-2均无明显变化(P>0.05);美金刚组的不良反应发生率为13.95%,与安慰剂组的6.98%比较差异无统计学意义(P>0.05)。结论:盐酸美金刚对老年PDD患者的认知功能及生活活动能力具有显著改善作用,其可能机制与抗炎和上调血清BDNF、EGF水平有关。

Objective： To investigate the efficacy of memantine hydrochloride for elderly patients with Parkinson＇s disease dementia（ PDD） and its influence on serum inflammatory factors,brain-derived neurotrophic factor（ BDNF） and epidermal growth factor（ EGF）. Methods： 86 cases of elderly patients with PDD were randomly divided into memantine group and placebo group. Both groups were treated with donepezil hydrochloride; the memantine group was treated with memantine hydrochloride on the basis of conventional treatment,and the placebo group was treated with placebo in the same way as memantine group for 12 weeks. The scores of Montreal Cognitive Assessment（ Mo CA）,Mini-Mental State Examination（ MMSE） and Barthel index（ BI） were measured before and after treatment in 4 th,8 th,12 th week; the serum levels of inflammatory factors（ IL-1β,IL-2 and TNF-α）,BDNF and EGF were detected. Results： In 4 th,8 th,12 th weeks after treatment,the scores of Mo CA,MMSE,BI and serum levels of BDNF and EGF in memantine group were significantly higher than those of the placebo group（ P 0. 05）; the serum levels of IL-1β and TNF-α were significantly lower than before treatment and placebo group（ P 0. 05）,but there was no significant deference of IL-2 between the two groups（ P 0. 05）. The adverse reaction rate was 13. 95% in memantine group,showed no significant deference with 6. 98% in the placebo group（ P 0. 05）. Conclusion： Memantine hydrochloride can effectively improve the cognition ability and life ability of patients with PDD,its mechanism may related to anti-inflammatory and up-regulation of serum BDNF and EGF.