摘要
目的观察普拉克索或多巴丝肼初始单独或联合治疗对高原地区帕金森病(PD)非运动症状患者认知功能和血液学指标的影响。方法收集2020年6月至2022年6月青海省人民医院诊治的110例PD患者。根据治疗方案分为多巴丝肼组(35例)、普拉克索组(35例)和联合组(普拉克索联合多巴丝肼,35例)。比较三组疗效,观察治疗前后三组神经元特异性烯醇化酶(NSE)、神经肽Y(NPY)、中枢神经特异性蛋白(S100β)、血液学指标白介素-6(IL-6)、血清胱抑素C(CysC)、同型半胱氨酸(Hcy)水平变化,比较三组自主神经障碍与感觉障碍发生率、疲劳程度、认知功能、睡眠状况和心理状况、预后生活质量及药物不良反应。结果联合组总有效率明显高于多巴丝肼组、普拉克索组(P<0.05)。治疗后联合组NSE、NPY、S100β、IL-6、CysC明显低于多巴丝肼组、普拉克索组(P<0.05),普拉克索组也明显低于多巴丝肼组(P<0.05)。治疗后多巴丝肼组、联合组、普拉克索组Hcy依次明显降低,多巴丝肼组较治疗前明显增高,普拉克索组较治疗前明显降低(P<0.05)。治疗后联合组自主神经障碍、感觉障碍发生率明显低于多巴丝肼组、普拉克索组(P<0.05)。治疗后联合组蒙特利尔认知评估量表(MoCA)明显高于多巴丝肼组、普拉克索组(P<0.05)。与联合组治疗后比较,多巴丝肼组、普拉克索组治疗后MoCA评分明显低,FSS评分、PSQI评分、SAS、SDS评分明显升高(P<0.05)。治疗后1、3、5个月联合组日常生活能力(ADL)评分明显高于多巴丝肼组、普拉克索组(P<0.05),三组ADL评分较治疗前均明显增高(P<0.05)。Pearson参数分析示,患者血液指标与疲劳、认知功能、睡眠状况和心理状况分别存在一定的相关性(P<0.05)。结论普拉克索联合多巴丝肼治疗高原地区PD非运动症状患者,可明显改善患者疲劳、认知功能障碍、睡眠状况及心理状况及预后生活质量等,或与联合用药可更有效降低NSE、NPY、S100β等血液学指标有关,但需控制多巴制剂的口服剂量。
Objective To observe the effect of combination of pramipexole and Levodopa and Benserazide Hydrochloride Tablets in the treatment of patients with non-motor symptoms of Parkinson′s disease in plateau areas.Methods A total of 110 PD patients who were treated in Qinghai Provincial People′s Hospital from June 2020 to June 2022 were enrolled.According to the treatment plan,they were divided into Levodopa and Benserazide Hydrochloride Tablets group(35 cases),pramipexole group(35 cases)and combined group(pramipexole combined with Levodopa and Benserazide Hydrochloride Tablets,35 cases).The therapeutic effects were compared among the three groups.The changes in neuron-specific enolase(NSE),neuropeptide Y(NPY)and central nervous specific protein(S100β),hematological indicators[interleukin-6(IL-6),serum cystatin C(CysC),homocysteine(Hcy)].The incidence of autonomic nervous system dysfunction and sensory disturbance,fatigue level,cognitive function,sleep status,psychological status,prognosis quality of life and adverse drug reactions were compared among the three groups.Results The total effective rate in the combination group was significantly higher than those in the other two groups(P<0.05).After treatment,the levels of NSE,NPY,S100β,IL-6 and CysC of the combined group were sig-nificantly lower than those of the Levodopa and Benserazide Hydrochloride Tablets group and the pramipexole group(P<0.05),and the pramipexole group was also significantly lower than that of the Levodopa and Benserazide Hydrochloride Tablets group(P<0.05).After treatment,Hcy levels in the Levodopa and Benserazide Hydrochloride Tablets group,the combination group,and the pramipexole group decreased in sequence.Hcy level in the Levodopa and Benserazide Hydrochloride Tablets group was significantly higher than that before treatment,and Hcylevel in the pramipexole group was significantly lower than that before treatment(all P<0.05).After treat-ment,the incidence of autonomic dysfunction and sensory disturbance in the combined group was significantly lower than that in the do-base hydrazine group and the pramipexole group(P<0.05).Compared with the combined group,the MoCA scores of the dobase hydra-zine group and the pramipexole group were significantly lower,and the FSS scores,PSQIscores,SAS and SDS scores were significantly increasedafter treatment(P<0.05).The daily living ability(ADL)scores of the combined group were significantly higher than those of the dobase hydrazine group and the pramipexole group 1,3 and 5 months after treatment(P<0.05),and the ADL scores of the three groups were significantly higher than those before treatment(P<0.05).Pearson parameter analysis showed that the blood indexes of patients were correlated with fatigue,cognitive function,sleep status and psychological status(P<0.05).Conclusion Pramipexole combined with Levodopa and BenserazideHydrochloride Tablets in the treatment of patients with non-motor symptoms of PD in plateau areas can significantly improve patients′fatigue,cognitive dysfunction,sleep status,psychological status,and prognosis and quality of life,which may be related to the fact that the combined drug can more effectively reduce hematological indicators such as NSE,NPY,and S100β.However,the oral dose of dopamine preparations needs to be controlled.
作者
高森森
梁玉花
刘建刚
朱爱琴
GAO Sensen;LIANG Yuhua;LIU Jiangang;ZHU Aiqin(Department of Geriatric Medicine,Qinghai Provincial People′s Hospital,Xining 810007,Qinghai,China;Graduate School of Qinghai University,Xining 810016,Qinghai,China)
出处
《医学研究与战创伤救治》
北大核心
2025年第7期719-726,共8页
Journal of Medical Research & Combat Trauma Care
基金
青海省卫生健康委员会重点课题(2021-wjzd-03)。
关键词
帕金森病
普拉克索
多巴丝肼
非运动症状
认知功能
Parkinson′s disease
pramipexole
levodopa/benserazide
non-motor symptom
cognitive function
作者简介
通信作者:朱爱琴,E-mail:xygzrq@126.com。
