初治帕金森病非运动症状患者不同治疗方案疗效及脑活动改变的静息态fMRI分析  

Therapeutic effects of different treatment plans on patients with non-motor symptoms of Parkinson's disease and resting-state fMRI analysis of changes in brain activities

作　　者：白管兵 潘波 潘娜 BAI Guanbing;PAN Bo;PAN Na(Department of Neurology,Air Force 986 Hospital of Air Force Medical University,Xi'an 710054,China)

机构地区：[1]空军军医大学空军第九八六医院神经内科,陕西西安710054

出　　处：《中国中西医结合影像学杂志》2024年第6期676-681,共6页Chinese Imaging Journal of Integrated Traditional and Western Medicine

基　　金：解放军空军后勤科研基金项目(CKJ17J019)。

摘　　要：目的:观察初治帕金森病非运动症状(NMS)患者不同治疗方案疗效及治疗前后静息态fMRI所测脑活动改变情况。方法:选取198例初治帕金森病NMS患者,以数字表法随机分为A组98例,B组100例。A组予以多巴丝肼片治疗,B组在其基础上采用经颅直流电刺激方法治疗,以帕金森综合量表(UPDRS)评估2组疗效,分别以非运动症状量表(NMSS)、帕金森病睡眠量表(PDSS)、汉密尔顿焦虑量表(HAMA)与抑郁量表(HAMD)对NMS、睡眠质量、焦虑及抑郁情绪进行评估,并使用静息态fMRI评价患者脑活动改变情况。结果:治疗后,B组UPDRS、NMSS各项评分、HAMA评分、HAMD评分均低于A组,PDSS评分高于A组,差异均有统计学意义(均P<0.05)。Post-Hoct检验显示,与治疗后相比,B组治疗前双侧小脑、左侧中央前回、丘脑与桥脑低频振幅更强,双侧额叶、左前扣带回、颞叶与左岛叶更弱;A组治疗前后无明显变化。结论:在多巴丝肼片治疗基础上予以经颅直流电刺激,可有效减轻初治帕金森病患者的NMS,减少焦虑、抑郁情绪,提高睡眠质量,这可能与该方案改善了静息态脑活动情况有关。Objective:To observe the therapeutic effects of different treatments on patients with non-motor symptoms(NMS)of Parkinson's disease(PD),and evaluate the changes in brain activities before and after treatment using resting-state fMRI.Methods:198 patients with newly diagnosed as NMS of PD were selected and randomly divided into 2 groups.Group A was treated with levodopa and benserazide hydrochloride tablets,and group B was treated with transcranial direct current stimulation on the basis of the treatment for group A.UPDRS was used to evaluate curative effect,and NMSS,PDSS,HAMA,HAMD were used to assess NMS,sleep quality,anxiety and depression.Resting-state fMRI was used to assess changes in brain activities.Results:After treatment,the scores of UPDRS,NMSS,HAMA and HAMD of group B were lower than those of group A,while the PDSS score of group B was higher than that of group A,all the differences were statistical(all P<0.05).Post-Hoc t test showed that,compared with post-treatment,group B had the stronger ALFF in bilateral cerebella,left central anterior gyrus,thalamus,pons,and the weaker ALFF in bilateral frontal lobes,left anterior cingulate gyrus,temporal lobes,left insula lobes before treatment.No significant changes were observed in group A before and after treatment.Conclusions:Transcranial direct current stimulation based on the treatment with levodopa and benserazide hydrochloride tablets can effectively relieve NMS in patients with newly diagnosed PD,reduce their anxiety and depression,and improve the sleep quality,which may be related to the improvement of resting-state brain activities.

关 键 词：帕金森病 非运动症状 多巴丝肼片 经颅直流电刺激 磁共振成像 

分 类 号：R742.5[医药卫生—神经病学与精神病学] R445.2[医药卫生—临床医学]