丁苯酞联合重复经颅磁刺激治疗对帕金森病患者认知功能和脑血流动力学的影响

Effect of butylphthalein combined with repetitive transcranial magnetic stimulation on cognitive function and cerebral hemodynamics in patients with Parkinson's disease

目的 观察丁苯酞联合重复经颅磁刺激(rTMS)治疗对帕金森(PD)患者认知功能、脑血流动力学水平影响。方法 前瞻性选择河北北方学院附属第一医院神经科2020-01—2022-12收治的92例PD患者作为研究对象,采用数字表随机法分为2组,对照组46例给予左旋多巴片及改善肌张力等常规治疗,观察组46例患者在此基础上给予丁苯酞联合r TMS治疗;治疗前、疗程结束后抽取空腹静脉血,检测多巴胺(DA)、5-羟色胺(5-HT)、C反应蛋白(CRP)水平,经颅多普勒超声检查双侧大脑中动脉的峰流速(Vp)、平均流速(Vm)。采用蒙特利尔认知估量表(MoCA)和简易精神评估量表(MMSE)评分评价2组患者治疗前、治疗8周认知功能及症状改善情况。结果 疗程结束后2组患者MMSE、MoCA评分均高于治疗前,观察组疗程结束后Vp、Vm均高于治疗前,5-HT水平高于治疗前,CRP水平低于治疗前,差异有统计学意义(P<0.05)。观察组疗程结束后MMSE、MoCA评分均高于对照组[(26.28±5.28)比(23.21±4.88)分、(21.93±6.25)比(18.84±4.13)分],Vp、Vm均高于对照组[(73.15±5.63)比(69.35±4.36)cm/s、(41.69±5.27)比(35.09±2.43)cm/s],DA、5-HT水平高于对照组[(5.07±0.55)比(4.21±3.17)mmol/L、(20.24±5.70)比(15.69±3.49)μg/L],CRP水平低于对照组[(1.02±0.13)比(6.16±0.95)mg/L],差异均有统计学意义(P<0.05)。观察组总有效率为91.30%,对照组为69.57%,差异有统计学意义(P<0.05)。结论 丁苯酞联合rTMS可改善PD患者脑血流动力学,减轻炎症反应,促进多巴胺、神经元递质分泌,从而改善临床症状和认知功能,提高疗效。

Objective To observe the effect of butylphthalein combined with repetitive transcranial magnetic stimulation(r TMS)on cognitive function and cerebral hemodynamics in patients with Parkinson's disease(PD).Methods A total of 92 patients with Parkinson's disease admitted to the Department of Neurology,the First Affiliated Hospital of Hebei North University from January 2020 to December 2022 were prospectively selected as the research objects.They were divided into two groups by the random number table method.The control group(46 cases)was given conventional treatment,such as levodopa tablets and improving muscle tension,and the observation group(46 cases)was given butylphthalide combined with r TMS on this basis.Before and after treatment,fasting venous blood was extracted to detect the levels of dopamine(DA),5-hydroxytryptamine(5-HT),C-reactive protein(CRP),and the peak velocity(Vp)and average velocity(Vm)of bilateral middle cerebral arteries were examined by transcranial Doppler ultrasound.Montreal cognitive assessment(Mo CA)and mini-mental state examination(MMSE)were used to evaluate the cognitive function and symptom improvement of the two groups before and 8 weeks after treatment.Results After treatment,MMSE and Mo CA scores in both groups were higher than before treatment,Vp and Vm in observation group were higher than before treatment,5-HT level was higher than before treatment,CRP level was lower than before treatment,the differences were statistically significant(P<0.05).After treatment,MMSE and Mo CA scores in observation group were higher than those in control group(26.28±5.28 vs 23.21±4.88,21.93±6.25 vs 18.84±4.13),Vp and Vm were higher than those in control group(73.15±5.63 vs 69.35±4.36,41.69±5.27 vs 35.09±2.43).DA and 5-HT levels were higher than those in control group(5.07±0.55 vs 4.21±3.17,20.24±5.70 vs 15.69±3.49),and CRP levels were lower than those in control group(1.02±0.13 vs 6.16±0.95),with statistically significant differences(P<0.05).The total effective rate was 91.30%in the observation group and 69.57%in the control group,and the difference was statistically significant(P<0.05).Conclusion Butylphthalein combined with r TMS can improve cerebral hemodynamics,reduce inflammatory response,promote dopamine and neuronal transmitter secretion in PD patients,thereby improving clinical symptoms and cognitive function and enhancing therapeutic effect.