丁苯酞联合银杏叶提取物治疗帕金森认知功能障碍的临床疗效及对危险因素的影响

Clinical efficacy of butylphthalide combined with ginkgo biloba extract in the treatment of Parkinson’s cognitive dysfunction and its influence on dangerous factors

目的分析帕金森患者合并认知功能障碍的危险因素,并观察丁苯酞联合银杏叶提取物对帕金森患者认知功能障碍的改善作用以及对相关因子的影响。方法选择2015年3月-2017年8月在保定市第三中心医院神经内科就诊的帕金森患者360例,根据蒙特利尔认知评估量表(MoCA)评分,117例归入认知障碍组,243例归入非认知障碍组。比较两组患者帕金森疾病评定量表(UPDRS)、MOCA、简易精神状态评价量表(MMSE)、日常生活活动能力量表(ADL)评分、Hoehn-Yahr(H-Y)分期以及重组人帕金森蛋白7(PARK7)、神经源性营养因子3(NT-3)、白介素-1β(IL-1β)、血尿酸(UA)、尿素氮(BUN)、同型半胱氨酸(hcy)水平。将117例认知障碍组患者随机分为对照组、银杏叶组、丁苯酞组和联合用药组。银杏叶组、丁苯酞组采用单药治疗,联合用药组患者口服银杏叶提取物+丁苯酞胶囊,治疗8周,评估患者临床疗效。结果经多因素Logistic回归分析,年龄、文化程度、饮酒史、中风史、病程、H-Y分期、血清UA和hcy水平是获得认知功能障碍的独立危险因素,血清NT-3是获得认知功能障碍的独立保护因素(P<0.05)。治疗8周后,联合用药组患者的治疗总有效率明显高于对照组、银杏叶组和丁苯酞组患者(P<0.05)。联合用药组患者UPDRSⅡ和UPDRSⅢ评分以及血清相关因子(PARK7、IL-1β、UA和Hcy)较本组治疗前和其余3组明显降低,而MMSE、MoCA、ADL评分以及血清NT-3水平较本组治疗前和其余3组明显升高(P<0.05)。结论年龄、文化程度、病程、既往有饮酒史、中风史、H-Y分期、血清NT-3、Hcy、UA指标均会影响帕金森患者的认知功能。银杏叶提取物联合丁苯酞的治疗方案可通过降低血清PARK7、IL-1β、UA、Hcy水平,提高血清NT-3水平,显著改善患者的临床症状、认知功能、生活质量,适用于临床推广。

Objective To analyze the risk factors of cognitive dysfunction in Parkinson′s patients,and to observe the effect of butylphthalide combined with Ginkgo biloba extract on cognitive dysfunction in Parkinson′s patients and the influence of related factors.Methods 360 PD patients in hospital from March 2015 to August 2017 were divided into cognitive impairment group(117 cases)and patients with no cognitive impairment group(243 cases)according to Montrealcognitive assessment(MoCA).Unified Parkinson′s Disease Rating Scale(UPDRS),Mini-MentalState Examination(MMSE),MoCA and Activityof Daily Living Scale(ADL),Hoehn-Yahr(H-Y)stage and laboratory parameters,such as Parkinson Disease Protein 7(PARK7),neurotrophin-3(NT-3),interleukin-1β(IL-1β),uric acid(UA),blood urea nitrogen(BUN),homocysteine(hcy)were detected and compared.117 patients in impairment group were randomly divided into control group(27 cases),Ginkgo Biloba extract group(28 cases),Butylphthalide group(30 cases)and combination group(32 cases).Ginkgo biloba extract group was treated with Ginkgo biloba extract,and butylphthalide group was given butylphthalide capsule.The combined group was treated with Ginkgo biloba extract and butylphthalide capsules for 8 weeks.The clinical efficacy was evaluated.Results Multivariate logistic regression analysis showed that age,education,drinking,stroke,course of PD,H-Y stage,serum NT-3,UA and Hcy levels were independent risk factors for cognitive dysfunction and serum NT-3 was an independent protective factor for cognitive dysfunction(P<0.05).After 8 weeks of treatment,the total effective rate of the combined group was significantly higher than that of the control group,the Ginkgo biloba extract group and the butylphthalide group(P<0.05).Compared with before treatment and the other three groups,the UPDRSII and UPDRSIII scores,serum related factors PARK7,IL-1β,UA and Hcy were significantly lower in the combined group,while the MMSE,MoCA,ADL scores and serum NT-3 levels were significantly increased(P<0.05).Conclusion Age,education,drinking,stroke,course of PD,H-Y stage,serum NT-3,UA and Hcy levels would be closely related with cognitive impairment in Parkinson′s patients.And butylphthalide combined with Ginkgo biloba extract can effectively improve the clinical symptoms,cognitive function and life quality in Parkinson′s patients with cognitive impairment.