益肾逐瘀法对帕金森病病人脑白质超微结构的影响  

Effect of Yishen Zhuyu Therapy on Ultrastructure of Cerebral White Matter in Patients with Parkinson′s Disease

作　　者：陈宇航 刘岑[1] 袁永娥 于艳敏 张华[1] CHEN Yuhang;LIU Cen;YUAN Yong′e;YU Yanmin;ZHANG Hua(Dongzhimen Hospital,Beijing University of Chinese Medicine,Beijing 100700,China)

机构地区：[1]北京中医药大学东直门医院,北京100700 [2]郑州市第十六人民医院

出　　处：《中西医结合心脑血管病杂志》2021年第11期1814-1820,共7页Chinese Journal of Integrative Medicine on Cardio-Cerebrovascular Disease

基　　金：国家中医药管理局国家中医临床研究基地业务建设科研专项课题(No.JDZX2015293)。

摘　　要：目的研究帕金森病(PD)病人脑白质超微结构的改变,探讨益肾逐瘀法对PD病人脑白质超微结构的影响。方法对PD病人(PD组)和健康对照人群(对照组)各9例行结构磁共振成像(SMRI)及弥散张量成像(DTI)扫描,PD组病人基于益肾逐瘀法予培元解痉汤中医辨证施治,服用中药4周后再次进行SMRI及DTI扫描,并在治疗前后行统一帕金森评定量表第3版(UPDRS 3)、帕金森中医证候量化分级表、简易智力状态检查量表(MMSE)测试。SMRI及DTI数据使用dcm2niix、ART、VistaSoft处理后计算出部分各项异性指数(FA),用AFQ、CSD生成具有100个离散位点FA的纤维束走行线图,并用MATLAB对FA值及MMSE评分、中医证候量表、UPDRS 3评分进行比较。结果PD组治疗前左侧扣带束、右侧下纵束、右侧钩束部分节段FA值较对照组低,但双侧皮质脊髓束存在部分节段FA值较对照组高;PD组治疗后左侧扣带束部分位点FA值逆转,较治疗前升高;治疗前后MMSE评分及UPDRS 3评分比较差异无统计学意义(P>0.05);中医证候量表(非运动症状部分)治疗前后比较差异有统计学意义(P<0.05)。结论PD病人在使用益肾逐瘀法治疗后非运动症状改善,并在左侧扣带束部分位点实现FA值逆转,说明益肾逐瘀法对于PD脑白质损伤存在一定治疗效果。Objective To observe the changes on ultrastructure of cerebral white matter in patients with Parkinson′s disease(PD)and to explore the effect of Yishen Zhuyu Therapy on ultrastructure of cerebral white matter in PD patients.Methods Structural magnetic resonance imaging(SMRI)and diffusion tensor imaging(DTI)were performed in 9 patients with PD and healthy controls persons.The patients in PD group were treated with Peiyuan Jiejing Decoction for 4 weeks based on Yishen Zhuyu Therapy,and scanned again after treatment.Before treatment and after treatment,the PD group was assessed by Unified Parkinson′s Disease Rating Scale 3rd version(UPDRS 3),Quantitative Classification Table of Traditional Chinese Medicine Syndromes of Parkinson′s disease(TCM table)and Mini-mental State Examination(MMSE).SRI and DTI data were analyzed by dcm2niix,ART,VistaSoft to calculate partial fractional anisotropy(FA),AFQ and CSD were used to generate the fiber bundles with 100 equidistant nodes FA,and MATLAB was used to compare FA values,UPDRS 3,TCM table and MMSE scores,and UPDRS 3 scores.Results FA values of the left cingulate bundle,the right inferior longitudinal bundle and the right uncinate bundle in the PD group were lower than those in the control group.FA values of the bilateral corticospinal tract in the PD group were higher than those in the control group.After treatment,some FA values sites of the left cingulate band in PD group were reversed and increased wore than that before treatment.MMSE and UPDRS 3 scale showed no significant difference before treatment and after treatment(P>0.05).After treatment,TCM table(the part of non-motor symptoms)showed significant difference(P<0.05).Conclusion After the treatment with Yishen Zhuyu Therapy,the non-motor symptoms of PD patients of Yishen Zhuyu therapy improved and the FA value reversed in the left cingulum,indicating there were certain therapeutic effect on cerebral white matter injury of PD.

关 键 词：帕金森病 弥散张量成像 脑白质超微结构 扣带束 益肾逐瘀法 培元解痉汤 

分 类 号：R74[医药卫生—神经病学与精神病学]