经脑深部电刺激术治疗前后帕金森病中医证素演变规律及与量表评分相关性研究

Study on the evolution of traditional Chinese medicine syndrome elements in Parkinson’s disease before and after deep brain stimulation and its correlation with scale scores

目的:探索经脑深部电刺激术(DBS)治疗前后帕金森病(PD)中医证素演变规律及证素与UPDRS-Ⅱ、UPDRS-Ⅲ量表评分的相关性。方法:采用前瞻性横断面研究,纳入80例经DBS治疗的PD患者,分别采用PD DBS证候要素量表及UPDRS-Ⅱ、UPDRS-Ⅲ量表采集其术前1周、术后2周信息,采用卡方检验、配对t检验比较DBS治疗前后中医证素分布频数及UPDRS-Ⅱ、UPDRS-Ⅲ量表评分,采用Spearman相关性检验分析DBS治疗前后中医证素与UPDRS-Ⅱ、UPDRS-Ⅲ量表评分的相关性。结果:DBS治疗前后气虚、血虚、阴虚、痰浊、血瘀、肝风6个证素分布频率比较差异具有统计学意义(P<0.05)。DBS术后患者在药物关期、开期时UPDRS-Ⅱ、UPDRS-Ⅲ量表评分均较术前显著降低(P=0.000)。DBS术前药物关期时,UPDRS-Ⅱ评分与内热证呈正相关(r=0.312,P=0.005),UPDRS-Ⅲ评分与内热、肝风证呈正相关(r=0.297,P=0.007;r=0.321,P=0.006);DBS术后药物关期时,UPDRS-Ⅱ评分与阳亢证呈负相关(r=-0.243,P=0.030),与肝风证呈正相关(r=0.230,P=0.040),UPDRS-Ⅲ评分与肾虚、气虚证呈正相关(r=0.262,P=0.019;r=0.290,P=0.009)。结论:DBS治疗前后中医证素演变规律:DBS术后气虚、阴虚、血虚证较术前增加,血瘀、痰浊证显著增加;肝风证明显减轻。DBS治疗可有效改善PD患者运动症状,术后药物关期运动状态可达到术前药物开期运动状态;DBS术治疗前后日常生活活动水平、运动功能与中医证素存在相关性,可为DBS术治疗前后中西医协同治疗提供指导意义。

Objective:To explore the evolution of traditional Chinese medicine(TCM)syndrome elements in Parkinson’s disease before and after deep brain stimulation and its correlation with UPDRS-Ⅱand UPDRS-Ⅲscale scores.Methods:In a prospective cross-sectional study,80 PD patients treated with DBS were included,and their information was collected respectively 1 week before surgery and 2 weeks after surgery using the PD DBS syndrome factor scale and UPDRS-Ⅱand UPDRS-Ⅲscales.Chi-square test and paired t-test were used to compare the distribution frequency of TCM syndrome elements and UPDRS-Ⅱand UPDRS-Ⅲscale scores before and after DBS treatment.Spearman correlation test was used to analyze the correlation between TCM syndrome elements and UPDRS-Ⅱand UPDRS-Ⅲscale scores before and after DBS treatment.Results:There were statistical differences in the distribution frequency of six syndrome elements including qi deficiency,blood deficiency,yin deficiency,phlegm turbidity,blood stasis and liver wind before and after DBS treatment(P<0.05).The UPDRS-Ⅱand UPDRS-Ⅲscales scores of patients after DBS were significantly lower than those before surgery at drug off and on periods,with statistical significance(P=0.000).At DBS preoperative drug off period,UPDRS-Ⅱscore was positively correlated with internal heat syndrome(r=0.312,P=0.005),and UPDRS-Ⅲscore was positively correlated with internal heat and liver wind syndrome(r=0.297,P=0.007;r=0.321,P=0.006);At DBS postoperation drug off period,UPDRS-Ⅱscore was negatively correlated with hyperyang syndrome and positively correlated with liver-wind syndrome(r=-0.243,P=0.030;r=0.230,P=0.040).UPDRS-Ⅲscore was positively correlated with kidney deficiency and qi deficiency syndrome(r=0.262,P=0.019;r=0.290,P=0.009).Conclusion:The evolution rules of TCM syndromes before and after DBS treatment:After DBS,the syndrome of qi deficiency,yin deficiency and blood deficiency increases compared with that before DBS,and the syndrome of blood stasis and phlegm increased significantly,liver-wind syndrome is significantly alleviated.DBS treatment can effectively improve the motor symptoms of PD patients,and the motor state in the drug-off phase after operation can reach the preoperative drug-on phase.The level of daily living activities and motor function before and after DBS are correlated with TCM syndrome elements,which can provide guidance for the coordinated treatment of traditional Chinese and western medicine before and after DBS.