己酮可可碱序贯疗法联合雷沙吉兰及多巴丝肼治疗老年中晚期帕金森病伴症状波动的疗效  

To investigate the efficacy of pentoxifylline sequential therapy combined with rasagiline and levodopa and benserazide in the treatment of Parkinson disease with fluctuations in elderly patients

作　　者：王少颖 高洁 刘明 李宁 王莉迪 刘俐杰 王青青 李净兵 刘翠青 Wang Shaoying;Gao Jie;Liu Ming;Li Ning;Wang Lidi;Liu Lijie;Wang Qingqing;Li Jingbing;Liu Cuiqing(Department of Neurology,the Eighth People's Hospital of Hebei Province,Shijiazhuang 050000,China;Medical Department,the Eighth People's Hospital of Hebei Province,Shijiazhuang 050000,China)

机构地区：[1]河北省第八人民医院神经内科,石家庄050000 [2]河北省第八人民医院医务科,石家庄050000

出　　处：《中国医师进修杂志》2024年第5期409-416,共8页Chinese Journal of Postgraduates of Medicine

基　　金：2022年河北省医学科研究课题(20220799)。

摘　　要：目的探讨己酮可可碱序贯疗法联合雷沙吉兰及多巴丝肼治疗伴有症状波动的老年中晚期帕金森病(PD)的临床疗效以及其对患者血液流变学、血清Toll样受体4(TLR4)信号通路下游相关炎性因子水平的影响。方法采用前瞻性研究的方法,选择河北省第八人民医院2021年6月至2022年10月收治的90例伴有症状波动的老年中晚期PD患者作为研究对象,按随机数字表法分成观察组和对照组各45例。观察组采用己酮可可碱序贯疗法联合雷沙吉兰及多巴丝肼治疗,对照组采用雷沙吉兰联合多巴丝肼治疗。比较两组临床疗效。治疗前后对两组患者进行统一帕金森病评定量表(UPDRS)、蒙特利尔认知评估量表(MoCA)、Berg平衡量表(BBS)、39项帕金森病生活质量问卷(PDQ-39)评分。治疗前后检测两组患者的血液流变学指标[全血高、低切黏度(HBV和LBV)、血浆黏度(PV)、纤维蛋白原(FIB)],以及血清TLR4信号通路下游相关炎性因子[TLR4、白细胞介素(IL)-1β、IL-6、肿瘤坏死因子(TNF)-α]水平。比较两组不良反应情况。结果观察组总有效率与对照组相比显著升高[93.33%(42/45)比77.78%(35/45)],差异有统计学意义(P<0.05)。治疗后两组UPDRS精神活动和情感障碍、日常生活能力、运动功能、运动并发症评分和PDQ-39评分均较治疗前显著降低(P<0.05),MoCA、BBS评分均较治疗前显著升高(P<0.05),均以观察组改善更显著,差异有统计学意义(P<0.05)。治疗后,观察组HBV、LBV、PV、FIB均较治疗前显著降低[(6.52±0.92)mPa·s比(7.25±1.24)mPa·s、(11.45±1.24)mPa·s比(14.13±1.64)mPa·s、(1.55±0.17)mPa·s比(1.88±0.22)mPa·s、(3.25±0.47)g/L比(3.82±0.52)g/L],差异有统计学意义(P<0.05)。对照组治疗前后血液流变学指标比较差异无统计学意义(P>0.05)。治疗后,两组血清TLR4、IL-1β、IL-6、TNF-α水平均较治疗前显著降低,而且观察组各指标明显低于对照组[(2.07±0.18)ng/L比(2.58±0.2Objective To investigate the clinical efficacy of pentoxifylline sequential therapy combined with rasagiline and levodopa in the treatment of elderly patients with symptoms of Parkinson disease(PD),and the influence on hemorheology and serum Toll-like receptor 4(TLR4)signaling pathway downstream related inflammatory factors.Methods A prospective study method was used to select 90 elderly patients with PD with fluctuating symptoms who were admitted to the Eighth People′s Hospital of Hebei Province from June 2021 to October 2022 as research objects.The patients were divided into observation group and control group with 45 cases in each group according to random number table method.The observation group was treated with pentoxifylline sequential therapy combined with rasagiline and levodopa.The control group was treated with rasagiline combined with levodopa.The clinical efficacy of the two groups was compared.The unified Parkinson disease rating scale(UPDRS),Montreal cognitive assessment scale(MoCA),Berg balance scale(BBS)and 39-item Parkinson disease quality of life questionnaire(PDQ-39)were scored before and after treatment.Hemorheology indexes and serum levels of related inflammatory factors downstream of TLR4 signaling pathway,including whole blood high viscosity(HBV),whole blood low shear viscosity(LBV),plasma viscosity(PV),fibrinogen(FIB);TLR4,interleukin(IL)-1β,IL-6,tumor necrosis factor(TNF)-α,were detected before and after treatment in both groups.The adverse reactions of the two groups were compared.ResultsThe total effective rate in observation group was significantly higher than that in control group:93.33%(42/45)vs.77.78%(35/45),and there was statistical difference(P<0.05).After treatment,the UPDRS mental activity and emotional disorders,daily living ability,motor function,motor complications scores and PDQ-39 score of the two groups were significantly lower than before treatment,the MoCA and BBS scores were significantly higher than before treatment,and the improvement was more significant in the

关 键 词：己酮可可碱 帕金森病 雷沙吉兰 多巴丝肼 血液流变学 

分 类 号：R742.5[医药卫生—神经病学与精神病学]