合并2型糖尿病的帕金森病患者的临床症状特点及GLP-1类似物联合美多巴的干预效果  

Clinical symptoms characteristics of concomitant type 2 diabetes mellitus and intervention effect of GLP-1 analogues combined with Madopar in patients with Parkinson′s disease

作　　者：范磊[1] 邓文娟[1] 岳秉宏[1] 潘妍婷[1] FAN Lei;DENG Wen-juan;YUE Bing-hong;PAN Yan-ting(Department of Neurology,the First Affiliated Hospital of Hebei North University,Zhangjiakou 075000,China)

机构地区：[1]河北北方学院附属第一医院神经内科,张家口市075000

出　　处：《广西医学》2021年第17期2067-2073,共7页Guangxi Medical Journal

基　　金：河北省医学科学研究课题(20190899)。

摘　　要：目的总结合并2型糖尿病的帕金森病患者的临床症状特点,并探讨胰高血糖素样肽1类似物利拉鲁肽联合美多巴治疗此类患者的临床效果。方法(1)将190例帕金森病患者根据是否合并2型糖尿病分为合并组(124例)和单纯帕金森病组(66例),采用Hoehn-Yahr(H-Y)分期、非运动症状量表(NMSS)、统一帕金森病评分量表(UPDRS)分别评估患者的运动症状严重程度、非运动症状发生情况和综合临床症状。(2)将合并组患者进一步随机分为对照组和观察组,每组62例。两组均给予口服美多巴治疗和常规降糖治疗,观察组患者同时接受利拉鲁肽注射治疗。治疗12周后,评估两组的临床疗效。于治疗前后,比较两组的空腹血糖、餐后2 h血糖(2hPBG)和糖化血红蛋白(HbA1c)水平,UPDRS和NMSS评分,血清C反应蛋白(CRP)、肿瘤坏死因子α(TNF-α)、白细胞介素6(IL-6)水平。记录治疗期间两组不良反应的发生情况。结果(1)与单纯帕金森病组相比,合并组的H-Y分期和UPDRS评分更高,且部分非运动症状(知觉/幻觉、胃肠道症状、泌尿系统症状、性功能)的发生率升高(均P<0.05)。(2)观察组的临床疗效优于对照组(P<0.05)。治疗后,观察组的空腹血糖、2hPBG、HbA1c水平,NMSS和UPDRS评分,以及血清IL-6、TNF-α水平均有所下降,且以上指标均低于对照组(P<0.05)。两组不良反应发生率差异无统计学意义(P>0.05)。结论合并2型糖尿病的帕金森病患者的运动症状更严重,且非运动症状发生率更高。在常规降糖的基础上,利拉鲁肽联合美多巴能更有效改善合并糖尿病的帕金森病患者的运动症状和非运动症状,获得更好的血糖控制效果,并能减轻机体炎症。Objective To summarize the clinical symptoms characteristics of concomitant type 2 diabetes mellitus in patients with Parkinson′s disease,and to explore the clinical effect of glucagon-like peptide 1(GLP-1)analogues Liraglutide combined with Madopar on these patients.Methods(1)Totally 190 case of Parkinson′s disease were divided into concomitant group(n=124)and simple Parkinson′s disease group(n=66)according to the occurrence of concomitant type 2 diabetes mellitus.The severity of motor symptoms,incidence of non-motor symptoms,general clinical symptoms of the patients were assessed using Hoehn-Yahr(H-Y)stage,the Non-Motor Symptom Scale(NMSS),and the Unified Parkinson′s Disease Rating Scale(UPDRS),respectively.(2)Patients in the concomitant group were randomly divided into control group(n=62)and observation group(n=62)further.Both groups were given oral administration of Madopar and conventional glucose-lowering therapy,and patients in the observation group were treated with Liraglutide injection additionally.Twelve weeks after treatment,assessment on clinical efficacy was conducted in the two groups.Before and after treatment,the levels of FBG,2-hour postprandial blood glucose(2hPBG)and hemoglobin A1c(HbA1c),UPDRS and NMSS scores,and serum C-reactive protein(CRP),tumor necrosis factorα(TNF-α)and interleukin 6(IL-6)levels were compared between the two groups.The incidence of adverse reactions during treatment was recorded in both groups.Results(1)Compared with the simple Parkinson′s disease group,the concomitant group yielded higher H-Y stage and UPDRS score,and elevated incidence rate of some non-motor symptoms such as perception/hallucination,gastrointestinal symptoms,urinary system symptoms and sexual function(all P<0.05).(2)The observation group was superior to the control group in clinical efficacy(P<0.05).After treatment,FBG,2hPBG and HbA1c levels,NMSS and UPDRS scores,as well as serum IL-6 and TNF-α levels,were declined in the observation group,moreover,the aforementioned indices were lower in

关 键 词：2型糖尿病 帕金森病 非运动症状 运动症状 胰高血糖素样肽1 利拉鲁肽 美多巴 血糖控制 炎症反应 

分 类 号：R587.1[医药卫生—内分泌]