A型肉毒毒素与文拉法辛治疗帕金森病合并抑郁的疗效对比  

Comparative of botulinum toxin type A and venlafaxine in the treatment of patients with Parkinson’s disease complicated with depression

作　　者：彭小妍 李丹 李洪涛 李阳 罗蔚锋[2] 刘春风 PENG Xiaoyan;LI Dan;LI Hongtao;LI Yang;LUO Weifeng;LIU Chunfeng(Suqian First People’s Hospital,Suqian 223800,China;The Second Hospital Affiliated to Soochow University,Suzhou 215004,China)

机构地区：[1]宿迁市第一人民医院,江苏宿迁223800 [2]苏州大学附属第二医院,江苏苏州215004

出　　处：《中国实用神经疾病杂志》2022年第4期471-476,共6页Chinese Journal of Practical Nervous Diseases

基　　金：宿迁市科技计划资助项目(编号:S201903);苏州市科技计划项目(编号:SS2019060)。

摘　　要：目的探究应用A型肉毒毒素(BoNT/A)治疗帕金森病(PD)合并抑郁的疗效及安全性。方法BoNT/A组共纳入38例患者,分别在颞部、双侧外眦、额前、眉间20个点注射BoNT/A,文拉法辛组纳入20例患者,给予文拉法辛75~150 mg口服治疗,采用汉密尔顿抑郁量表(HAMD-17)、抑郁自评量表(SDS)、汉密尔顿焦虑量表(HAMA-14)和焦虑自评量表(SAS)评估患者治疗前及治疗后2周、4周、8周和12周的评分。结果2组在治疗后2周、4周、8周和12周的HAMD、SDS、HAMA以及SAS评分均较治疗前下降,BoNT/A组治疗前HAMD、SDS评分分别为(18.89±4.7)分、(53.34±7.9)分,治疗分别为(12.16±3.25)分、(40.08±9.82)分,治疗后较治疗前明显改善(P<0.05)。文拉法辛组治疗前HAMD、SDS评分分别为(17.8±2.76)分、(52.35±9.29)分,治疗后分别为(11.5±2.86)分、(36.5±6.48)分,HAMD、SDS评分也明显改善。但2组间HAMD、SDS评分差异无统计学意义(均P>0.05)。BoNT/A组出现2例注射点肌肉僵硬感;文拉法辛组出现不良反应9例,肉毒毒素的不良反应率明显低于文拉法辛组,差异有统计学意义(P<0.05)。结论发现BoNT/A组通过局部注射能够显著缓解帕金森病合并抑郁患者的临床症状,BoNT/A可作为PD合并抑郁患者的一种新治疗抑郁的方式。Objective To explore the efficacy and safety of botulinum toxin type A(BoNT/A)in the treatment of Parkinson’s disease(PD)with depression.Methods A total of 38 patients in the BoNT/A group were injected at 20 points of temporal region,bilateral lateral canthus,anterior frontal region and intereyebrow,and 20 patients in the venlafaxine group were given oral treatment with venlafaxine.Hamilton depression scale(HAMD-17),self-rating depression scale(SDS),Hamilton anxiety scale(HAMA-14)and Self-rating anxiety scale(SAS)were used to evaluate the scores of patients before treatment and at 2,4,8 and 12 weeks after treatment.Results HAMD,SDS,HAMA and SAS scores of 2,4,8 and 12 weeks after treatment in both groups were lower than those before treatment,and depression scores of BoNT/A group were as follows:HAMD and SDS scores before treatment were(18.89±4.7,53.34±7.9),and after treatment were(12.16±3.25,40.08±9.82).HAMD and SDS scores were significantly improved after treatment,depression score of venlafaxine group:HAMD and SDS scores before treatment were(17.8±2.76,52.35±9.29),HAMD and SDS scores after treatment were(11.5±2.86,36.5±6.48).HAMD and SDS scores were significantly improved,however,there were no significant difference in HAMD and SDS scores between the two groups(all P>0.05)BoNT/A group showed muscle stiffness at injection site in 2 cases.There were 9 cases of adverse reactions in the venlafaxine group,and the adverse reaction rate of botulinum toxin was significantly lower than that in the venlafaxine group,with statistical difference.Conclusion BoNT/A group can significantly relieve the clinical symptoms of PD patients with depression by local injection,which can be used as a new treatment for depression in PD patients with depression.

关 键 词：帕金森病 抑郁症 A型肉毒毒素 文拉法辛 安全性 

分 类 号：R742.5[医药卫生—神经病学与精神病学]