八段锦对帕金森病伴冻结步态患者步态参数和血清神经生长因子的影响

Effects of Baduanjin on gait parameters and serum nerve growth factor in Parkinson disease patients with freezing of gait

目的观察八段锦对帕金森病(Parkinson disease,PD)伴冻结步态(freezing of gait,FOG)患者步态参数及血清神经生长因子的影响。方法2021年12月—2022年12月,采用随机数表法将38例符合纳入排除标准的PD伴FOG患者随机分为研究组(18例)和对照组(20例)。两组患者均进行为期4周的药物治疗联合基本康复治疗,研究组在此基础上额外进行八段锦训练。分别在干预前1 d和干预4周后进行疗效评定,包括统一帕金森病评定量表第Ⅱ部分(unified Parkinson's disease rating scale-Ⅱ,UPDRS-Ⅱ)第14项评分、冻结步态问卷(freezing of gait questionnaire,FOGQ)、起步时间、步行周期、步幅、动态足底峰值压强和平均压强,以及检测患者外周血脑源性神经营养因子(brain-derived neurotrophic factor,BDNF)和胶质细胞源性神经营养因子(glial cell line-derived neurotrophic factor,GDNF)水平。使用SPSS 23.0进行卡方检验、配对样本t检验、独立样本t检验和Mann-Whitney U检验。结果治疗前,两组患者UPDRS-Ⅱ第14项评分、FOGQ评分、起步时间、步行周期、步幅、动态足底峰值压强、平均压强、外周血清BDNF水平和GDNF水平均差异无统计学意义(t=-0.542,0.562,0.490,0.674,0.440,0.606,-0.835,-0.873,-0.250,均P>0.05);治疗后,研究组动态足底峰值压强[对照组(14.26±3.23)N/cm^(2),研究组(11.40±4.13)N/cm^(2),t=-2.389,P=0.022]和平均压强[对照组(3.34±0.72)N/cm^(2),研究组(2.79±0.81)N/cm^(2),t=-2.209,P=0.034]均低于对照组,差异具有统计学意义;治疗后两组患者UPDRS-Ⅱ第14项评分、FOGQ评分、起步时间、步行周期、步幅、外周血清BDNF和GDNF浓度比较均差异无统计学意义(均P>0.05)。治疗前后研究组FOGQ评分差值[对照组1.00(0.00,1.00)分,研究组2.00(0.75,3.00)分,Z=-2.547,P=0.011]、起步时间差值[对照组-1.04(-1.86,-0.47)s,研究组-2.34(-3.41,-1.03)s,Z=-2.280,P=0.023]、步行周期差值[对照组0.29(0.08,0.58)s,研究组0.35(0.16,1.00)s,Z=-2.748,P=0.006]、步幅差值[对照组0.19(0.14,0.24)m,研究组0.26(0.23,0.38)m,Z=-1.360,P=0.005]、动态足底峰值压强差值[对照组-4.11(-5.87,-2.57)N/cm^(2),研究组-8.44(-10.12,-4.81)N/cm^(2),Z=-3.333,P=0.001]和平均压强差值[对照组-0.55(-1.00,-0.03)N/cm^(2),研究组-1.11(-1.51,-0.66)N/cm^(2),Z=-2.062,P=0.009]改善幅度均优于对照组。治疗后研究组外周血清BDNF水平高于治疗前(t=-2.315,P=0.033)。结论八段锦可提高PD伴FOG患者冻结步态评分,改善步态时空参数,这可能与外周血清BDNF的提高有关。

ObjectiveTo explore the effect of Baduanjin on gait parameters and serum nerve growth factor in Parkinson disease(PD)patients with freezing of gait(FOG).MethodsFrom December 2021 to December 2022,thirty-eight PD patients with FOG who met the inclusion and exclusion criteria were randomly divided into observation group(n=18)and control group(n=20)by random number table.The patients in both two groups received 4 weeks of drug therapy combined with basic rehabilitation treatment respectively,and the patients in observation group received additional Baduanjin training.Efficacy was evaluated 1 day before intervention and after 4 weeks of intervention through unified Parkinson's disease rating scale-Ⅱ(UPDRS-Ⅱ)item 14,freezing of gait questionnaire(FOGQ),gait starting time,gait cycle,stride length,dynamic plantar peak pressure and average pressure,while the levels of brain-derived neurotrophic factor(BDNF)and glial cell line-derived neurotrophic factor(GDNF)in peripheral blood of patients were tested.SPSS 23.0 software was used to conduct Chi-square test,paired t-test,independent sample t-test and Mann-Whitney U test.ResultsBefore treatment,there were no significant differences in score of UPDRS-Ⅱitem 14,FOGQ score,gait starting time,gait cycle,stride length,dynamic planar peak pressure,average pressure,peripheral blood BDNF level and GDNF level between the two groups(t=-0.542,0.562,0.490,0.674,0.440,0.606,-0.835,-0.873,-0.250,all P>0.05).After treatment,compared with the control group,dynamic plantar peak pressure(control group(14.26±3.23)N/cm^(2),observation group(11.40±4.13)N/cm^(2),t=-2.389,P=0.022)and plantar average pressure(control group(3.34±0.72)N/cm^(2),observation group(2.79±0.81)N/cm^(2),t=-2.209,P=0.034)of the observation group were significantly decreased(both P<0.05).There were no significant differences in UPDRS-Ⅱitem 14,FOGQ score,gait starting time,gait cycle,stride length,BDNF and GDNF concentrations in peripheral blood between the two groups after treatment(all P>0.05).The difference between pre-treatment and post-treatment of FOGQ score(control group 1.00(0.00,1.00),observation group 2.00(0.75,3.00),Z=-2.547,P=0.011),gait starting time(control group-1.04(-1.86,-0.47)s,observation group-2.34(-3.41,-1.03)s,Z=-2.280,P=0.023),gait cycle(control group 0.29(0.08,0.58)s,observation group 0.35(0.16,1.00)s,Z=-2.748,P=0.006),stride length(control group 0.19(0.14,0.24)m,observation group 0.26(0.23,0.38)m,Z=-1.360,P=0.005),the dynamic plantar peak pressure(control group-4.11(-5.87,-2.57)N/cm^(2),observation group-8.44(-10.12,-4.81)N/cm^(2),Z=-3.333,P=0.001)and average pressure(control group-0.55(-1.00,-0.03)N/cm^(2),observation group-1.11(-1.51,-0.66)N/cm^(2),Z=-2.062,P=0.009)in the observation group were better than those in the control group.After treatment,the BDNF level in peripheral blood in observation group was higher than before treatment(t=-2.315,P=0.033).ConclusionBaduanjin can improve frozen gait score and gait parameters in PD patients with FOG,which may be related to the increase of peripheral blood BDNF.