艾地苯醌对帕金森病认知障碍患者的疗效

Therapeutic efficacy of idebenone on cognitive impairment in patients with Parkinson's disease

目的观察艾地苯醌对帕金森病认知障碍患者的治疗效果,并探讨其作用机制。方法纳入2017年1月至2024年1月在神经内科住院治疗的帕金森病认知障碍患者216例,随机分为常规治疗组(n=82)和艾地苯醌治疗组(n=134),分别监测两组在药物治疗前及连续药物治疗12个月后的蒙特利尔认知评估量表(Montreal Cognitive Assessment,MoCA)及其单领域认知评分,简易精神状态检查量表(Mini-Mental State Examination,MMSE)评分、统一帕金森评分量表Ⅲ(Unified Parkinson's Disease Rating ScaleⅢ,UPDRS-Ⅲ)评分、胆碱能通路高信号量表(Cholinergic Pathways Hyperintensities Score,CHIPS)评分,白介素-6(interleukin-6,IL-6)、外周血超氧化物歧化酶(superoxide dismutase,SOD)、肝功能和肾功能指标变化情况。结果治疗前两组患者一般资料及Hoehn-Yahr(H-Y)分期差异无统计学意义(P>0.05),各项量表评分、血液学指标差异无统计学意义(P>0.05)。经过12个月药物治疗后,艾地苯醌治疗组MoCA评分及其单领域视空间执行能力、语言的评分增幅高于常规治疗组(P<0.05),UPDRS-Ⅲ评分下降幅度更加明显(P<0.05);艾地苯醌治疗组IL-6水平降低,常规治疗组IL-6水平升高,两组差异有统计学意义(P<0.05);艾地苯醌治疗组SOD水平增高,常规治疗组SOD水平降低,两组差异有统计学意义(P<0.05);两组肝功能、肾功能相关指标差异无统计学意义(P>0.05);调整了治疗前CHIPS评分、病程、年龄协变量后,治疗后艾地苯醌治疗组的CHIPS评分比常规治疗组低2.19分(F=229.16,P<0.01,R^(2)=0.91,调整后R^(2)=0.90)。结论艾地苯醌能够明显减轻帕金森病患者的认知障碍,改善运动症状,延缓白质高信号对胆碱能通路的损害,增加外周血SOD水平及降低IL-6水平。

Objective To investigate the therapeutic effects of idebenone in patients with Parkinsons disease-related cognitive impairment and to explore its mechanisms of action.Methods A total of 216 patients with Parkinsons disease-related cognitive impairment who were hospitalized in the The First Affiliated Hospital of Shandong First Medical University from January 2017 to January 2024 were included.The patients were randomly divided into the conventional treatment group(n=82)and the idebenone treatment group(n=134).The changes of the Montreal Cognitive Assessment(MoCA)and its subdomain cognitive scores,the Mini-Mental State Examination(MMSE),the Unified Parkinsons Disease Rating ScaleⅢ(UPDRS-Ⅲ),the Cholinergic Pathways Hyperintensities Score(CHIPS),interleukin-6(IL-6),peripheral blood superoxide dismutase(SOD),liver function,and kidney function were monitored for both groups before drug treatment and after 12 months of continuous drug treatment.Results There were no statistically significant differences in general data,Hoehn-Yahr(H-Y)staging,various scale scores and hematological indicators before treatment(P>0.05).After 12 months of drug treatment,the increase in MoCA scores and their single-domain visuospatial executive ability and language was higher in the idebenone treatment group than in the conventional treatment group(P<0.05),and the decrease in UPDRS-Ⅲscores was even more pronounced(P<0.05).The IL-6 levels in the idebenone treatment group decreased,while those in the conventional treatment group increased,with a statistically significant difference between the two groups(P<0.05).The SOD levels in the idebenone treatment group increased,while those in the conventional treatment group decreased,with a statistically significant difference between the two groups(P<0.05).There were no statistically significant differences in liver and kidney function-related indicators between the two groups(P>0.05).After adjusting for pre-treatment CHIPS scores,disease duration,and age covariates,the CHIPS score in the idebenone treatment group was 2.19 points lower than that in the conventional treatment group(F=229.16,P<0.01,R^(2)=0.91,adjusted R^(2)=0.90).Conclusion Idebenone can significantly alleviate cognitive impairment,improve motor symptoms,delay the damage of white matter hyperintensities to the cholinergic pathways,increase peripheral blood SOD levels,and reduce IL-6 levels in patients with Parkinsons disease.