帕金森病抑郁的中西医治疗研究进展

A review on treating depression in Parkinson’s disease in TCM and Western medicine

帕金森病(Parkinson’s Disease,PD)是一种常见的运动障碍性疾病,常好发于老年人。随着人口老龄化,PD患者逐年递增,严重影响老年人的生活质量。PD的临床表现常分为运动症状和非运动症状,除行动迟缓、静止性震颤、肌强直等典型运动症状外,常见的非运动症状如认知功能障碍、睡眠障碍、便秘和焦虑抑郁等精神症状同样影响患者的生活质量。其中帕金森病抑郁(Depression in Parkinson’s Disease,DPD)是PD最为常见的非运动症状之一,其发病机制复杂,目前尚不完全明确。DPD起病隐匿,可贯穿于PD的整个病程,易误诊漏诊,诊治相对困难,DPD严重时患者还有自杀的倾向。因此,早发现、早治疗能有效提高PD患者的生活质量。目前对于DPD的治疗以采用西药改善症状为主,常为抗PD基础治疗联合抗抑郁药物综合治疗,长期服用此类药物容易出现药效减退、不良反应多等弊端,而临床上运用中医药治疗DPD的效果逐渐显著,不少临床研究表明中西联合治疗DPD比纯西医治疗效果更优,不仅能控制症状,还能减少不良反应的发生,甚至可以减少西药的使用量,起到增效减毒的作用,所以中西医治疗DPD已成为越来越多医者的选择。文章查找了近五年的相关文献,简要概述中西医对DPD的认识和临床上中西医治疗DPD的研究进展,以期为诊治DPD提供参考。

Parkinson’s disease(PD) is a common movement disorder, which often occurs in the elderly. With the aging of the population, the number of PD patients is increasing year by year, which seriously affects the quality of life of the elderly. The clinical manifestations of PD are often divided into motor symptoms and non-motor symptoms. In addition to typical motor symptoms such as retardation, quiescent tremor and myotonia, common non-motor symptoms, such as cognitive dysfunction, sleep disorders, constipation, anxiety and depression, also affect the quality of life of patients. Among them, depression in Parkinson’s disease(DPD) is one of the most common non-motor symptoms of PD, and its pathogenesis is complex and not completely clear at present. The onset of DPD is hidden and can run through the entire course of PD. It is easy to be misdiagnosed and missed, and it is relatively difficult to diagnose and treat. DPD patients have a tendency to commit suicide when they are seriously ill. Therefore, early detection and early treatment can effectively improve the quality of life of PD patients. At present, the treatment of DPD mainly adopts Western medicine to relieve symptoms, which is usually combined with anti-PD basic therapy and antidepressant drugs, and long-term use of this kind of drugs is easy to lead to reduced efficacy, adverse reactions and other drawbacks. Clinical application of traditional Chinese medicine has shown significant effect gradually in the treatment of DPD. Many clinical studies have shown that the combined treatment of TCM and Western medicine for DPD has better effects than pure Western medicine. It can not only control symptoms, but also reduce the occurrence of adverse reactions. It can even reduce the use of Western medicine and play a role in enhancing effectiveness and reducing toxicity, so the treatment of DPD in the integrative medicine has become the choice of more and more doctors. In this paper, relevant literature in the past five years is searched to briefly summarize the understanding of TCM and Western medicine on DPD and the research progress of TCM and Western medicine in clinical treatment of DPD, in order to provide a reference for the diagnosis and treatment of DPD.