加减地黄饮子联合重复经颅磁刺激治疗帕金森病步态障碍患者的临床观察  

Clinical Observation of Modified Dihuang Yinzi Decoction Combined with Repeated Transcranial Magnetic Stimulation on Gait Disorder in Parkinson′s Disease

作　　者：张臻年[1] 惠振[1] 王苏雷[1] 梁艳[1] 唐莉莉[1] 徐成成[1] 陈畅[1] 肖婧[2] 陈清 王敬卿[1] 赵杨[1] ZHANG Zhen-nian;HUI Zhen;WANG Su-lei;LIANG Yan;TANG Li-li;XU Cheng-cheng;CHEN Chang;XIAO Jing;CHEN Qing;WANG Jing-qing;ZHAO Yang(Nanjing University of Traditional Chinese Medicine Affiliated Nanjing Hospital of Traditional Chinese Medicine,Nanjing Jiangsu 210022;The Second Affiliated Hospital of Nanjing University of Traditional Chinese Medicine,Nanjing Jiangsu 210017;Nanjing Pukou District Hospital of Traditional Chinese Medicine,Nanjing Jiangsu 211800)

机构地区：[1]南京中医药大学附属南京中医院,江苏南京210022 [2]南京中医药大学第二附属医院,江苏南京210017 [3]南京市浦口区中医院,江苏南京211800

出　　处：《世界中西医结合杂志》2021年第6期981-985,989,共6页World Journal of Integrated Traditional and Western Medicine

基　　金：江苏中医药局“中医脑病学”重点学科培育项目(NBPY201704);南京市卫生科技发展专项资金项目计划(YKK18134);南京中医药大学“江苏高校护理学优势学科建设工程资助项目”(2019YSHL098);南京市“十三五”名中医(刘孔江)工作室建设项目(LKJ-2017-NJ);南京市“十三五”名中医(王敬卿)工作室建设项目(WJQ-2019-NJ)。

摘　　要：目的观察加减地黄饮子联合重复经颅磁刺激治疗帕金森病步态障碍的临床疗效。方法选取2019年1月—2021年1月期间于南京中医药大学附属南京中医院收治的68例帕金森病步态障碍患者,按随机数字表法分为研究组和对照组,每组34例。所有患者入院后均给予基础治疗:常规抗帕金森病药物治疗,包括多巴胺受体激动剂、左旋多巴等。对照组在基础治疗上给予重复经颅磁刺激治疗,研究组在对照组治疗基础上给予加减地黄饮子治疗。连续治疗1个月后,观察比较两组患者治疗前后中医证候积分、步态指标、血清胱抑素C(CysC)和同型半胱氨酸(Hcy)水平、脑神经递质变化[P物质、多巴胺(DA)],并评价其临床疗效及安全性。结果治疗后研究组总有效率为97.06%(33/34),对照组总有效率为76.47%(26/34),两组比较,差异有统计学意义(P<0.05)。治疗后两组患者中医证候总积分均较治疗前降低,差异有统计学意义(P<0.05),且研究组治疗后中医证候总积分较对照组低,两组比较,差异有统计学意义(P<0.05)。治疗后两组患者平衡量表评分(Berg评分)、转身角速度、步速及步长均较治疗前上升,差异有统计学意义(P<0.05),且研究组治疗后Berg评分、转身角速度、步速及步长指标均优于对照组,两组比较,差异有统计学意义(P<0.05)。治疗后两组患者Hcy、CysC、P物质水平均较治疗前下降,DA水平较治疗前上升,差异有统计学意义(P<0.05),且研究组治疗后Hcy、CysC、P物质水平均低于对照组,DA水平高于对照组,两组比较,差异有统计学意义(P<0.05)。治疗期间,研究组出现1例轻度胃肠道不适,对照组出现3例轻度胃肠道不适,均可耐受,均无因不良反应而终止用药。两组患者不良反应发生率比较,差异无统计学意义(P>0.05)。结论加减地黄饮子联合重复经颅磁刺激能够有效改善帕金森病步态障碍患者临床症状,有利于步态恢复正�Objective To observe the clinical effect of modified Dihuang Yinzi Decoction combined with repeated transcranial magnetic stimulation on gait disorder in Parkinson′s disease.Methods From January 2019 to January 2021,68 patients with Parkinson′s disease gait disorder admitted to Nanjing University of Traditional Chinese Medicine Affiliated to Nanjing Hospital of Traditional Chinese Medicine were divided into a study group and a control group according to a random number table,with 34 cases in each group.After admission,all patients were given basic treatment:conventional anti-Parkinson′s disease drug treatment,including dopamine receptor agonists,levodopa,etc.The control group was given repeated transcranial magnetic stimulation on the basis of the basic treatment,and the study group was given modified DihuangYinzi decoction treatment based on the treatment of the control group.After continuously treated for 1 month,observe and compare the TCM syndrome scores,gait indicators,serum CysC and Hcy levels,brain neurotransmitter changes[substance P,dopamine(DA)],clinical efficacy and safety.Results After treatment,the total effective rate of the study group was 97.06%(33/34),and the total effective rate of the control group was 76.47%(26/34).The difference between the two groups was statistically significant(P<0.05).After treatment,the total scores of TCM syndromes of the two groups of patients were lower than before treatment,the difference was statistically significant(P<0.05),and the total scores of TCM syndromes of the study group after treatment were lower than those of the control group,and the difference between the two groups was statistically significant.Significance(P<0.05).After treatment,the Berg score,turning angle speed,pace and step length of the two groups of patients increased compared with before treatment,the difference was statistically significant(P<0.05),and the Berg score,turning angle speed,step speed and step length indicators of the study group after treatment Both were better than the co

关 键 词：加减地黄饮子 重复经颅磁刺激 帕金森病 步态障碍 

分 类 号：R742.5[医药卫生—神经病学与精神病学]