刮痧联合药物治疗原发性帕金森病的短期临床疗效研究

Short-term Clinical Effect of Guasha Combined with Drug Therapy on Idiopathic Parkinson’s Disease

背景帕金森病(PD)作为常见的神经退行性疾病之一,因药物治疗不良反应明显,且长期使用疗效降低,使其成为全球医疗难题。刮痧是应用广泛的中医非药物疗法之一,在神经系统疾病治疗中具有独特优势。目前有关刮痧联合药物治疗原发性PD的研究尚少。目的 观察刮痧联合药物治疗原发性PD的短期临床疗效。方法采用目的性抽样法,选取2021年3—9月在南京市中医院和江苏省人民医院PD门诊诊治的16例原发性PD患者为观察组,按照性别、年龄、病程及Hoehn-Yahr分期相匹配的原则,选择16例原发性PD患者作为对照组。观察组采用刮痧联合西药口服治疗,4周为1个疗程,3个疗程后停止刮痧,单纯西药继续治疗1个疗程作为随访。对照组采用单纯西药口服治疗,4周为1个疗程,治疗4个疗程,最后1个疗程作为随访。治疗3个月和随访1个月,观察统一帕金森病评定量表第三部分(MDS-UPDRS Ⅲ)评分、非运动症状量表(NMSS)评分、临床疗效;治疗3个月观察血清白介素1β(IL-1β)、核转录因子κB(NF-κB)水平。结果 治疗3个月,两组患者MDS-UPDRS Ⅲ、NMSS评分及血清IL-1β、NF-κB水平均低于组内治疗前(P<0.05);随访1个月,两组患者MDS-UPDRS Ⅲ、NMSS评分均低于组内治疗前(P<0.001);随访1个月对照组患者MDS-UPDRS Ⅲ评分低于组内治疗3个月(P<0.001);随访1个月观察组患者NMSS评分高于组内治疗3个月(P=0.002)。观察组患者治疗3个月、随访1个月MDS-UPDRS Ⅲ、NMSS评分低于对照组(P<0.05)。观察组治疗后IL-1β、NF-κB水平均低于对照组(P<0.05)。治疗3个月及随访1个月,观察组患者临床疗效均优于对照组(Z值分别为-3.651、-3.468,P<0.05)。结论 刮痧联合药物治疗早、中期原发性PD安全可行,能够改善PD患者的部分运动功能障碍,减轻非运动症状,可明显提高临床疗效,其远期疗效有待开展大样本、多中心的研究进一步探索。

Background Parkinson’s disease(PD),as one of the most common neurodegenerative diseases,has become a global medical problem due to the obvious adverse reaction of drug treatment and the reduced efficacy of long-term use.Guasha is one of the widely used non-drug therapies of traditional Chinese medicine(TCM) with unique advantages in the treatment of nervous system diseases.At present,there are few studies on the treatment of idiopathic PD with Guasha combined with drug therapy.Objective To explore the short-term clinical effect of Guasha combined with drug therapy for idiopathic PD.Methods Sixteen patients with idiopathic PD in the early and middle stages selected by the purposive sampling method from March 2021 to September 2021 in outpatients of Nanjing Hospital of Chinese Medicine and Jiangsu Province Hospital were selected as the observation group,and another 16 patients with idiopathic PD were selected as the control group according to the principle of matching gender,age,course of disease and Hoehn-Yahr stage.The observation group was treated with Guasha combined with western medicine orally for 4 weeks as a course of treatment;after 3 courses of treatment,Guasha was stopped and western medicine orally continued for 1 course of treatment as follow-up.The control group was treated with simple western medicine orally for 4 weeks as a course of treatment,and the last one of 4 courses of treatment was recorded as follow-up.After 3 months of treatment and 1 month of follow-up,the Movement Disorder Society-Unified Parkinson’s Disease Rating Scale Ⅲ (MDSUPDRS Ⅲ) score,Non-motor Symptom Score(NMSS) and clinical efficacy were observed.The levels of serum interleukin-1β(IL-1β) and nuclear transcription factor κB(NF-κB) were observed after 3 months of treatment.Results After 3months of treatment,the scores of MDS-UPDRS Ⅲ and NMSS,and the levels of serum IL-1β and NF-κB in two groups were lower than those before treatment(P<0.05).After 1 month of follow-up,the scores of MDS-UPDRS Ⅲ and NMSS in two groups were lower than those before treatment(P<0.001).The score of MDS-UPDRS Ⅲ of the control group at 1-month follow-up was lower than that at 3 months(P<0.001).The score of NMSS of the observation group at 1-month follow-up was higher than that at 3 months(P=0.002).The scores of MDS-UPDRS Ⅲ and NMSS in the observation group were lower than those in the control group after 3 months of treatment and 1 month of follow-up,and the differences were all statistically significant(P<0.05).The levels of serum IL-1β and NF-κB in the observation group were lower than those in the control group after treatment(P<0.05).After 3 months of treatment and 1 month of follow-up,the clinical efficacy of the observation group was better than that of the control group(Z=-3.651,-3.468,P<0.05).Conclusion It is safe and feasible for Guasha combined with drug therapy in the treatment of idiopathic PD patients at the early and middle stage,which can improve some motor dysfunction and alleviate nonmotor symptoms and significantly improve the clinical efficacy.However,its long-term efficacy needs to be further explored by large sample and multi-center studies.