基于神经递质、CT脑血流灌注分析M1高频联合SMA低频rTMS辅助药物治疗老年帕金森病的疗效与机制  

Analysis on therapeutic effects of M1 high-frequency combined with SMA low-frequency rTMS assisting with drug in treatment of elderly Parkinson′s disease based on neurotransmitter and CT cerebral blood flow perfusion and their mechanisms

作　　者：张芮娟 贺蕾 ZHANG Ruijuan;HE Lei(Department of Neurology,Yan′an University Xianyang Hospital,Xianyang 712000,China)

机构地区：[1]延安大学咸阳医院神经内科,咸阳712000

出　　处：《中国临床新医学》2025年第3期292-297,共6页CHINESE JOURNAL OF NEW CLINICAL MEDICINE

基　　金：陕西省重点研发计划项目(编号:2021SF-942)。

摘　　要：目的基于神经递质、CT脑血流灌注分析初级运动皮层区(M1)高频联合辅助运动区(SMA)低频重复经颅磁刺激(rTMS)辅助药物治疗老年帕金森病的疗效与机制。方法招募2021年9月至2023年6月延安大学咸阳医院收治的老年帕金森病患者106例,采用随机数字表法将其分为观察组和对照组,每组53例。两组均予普拉克索片,在此基础上,对照组予假刺激+美金刚,观察组予rTMS+美金刚,疗程均为4周。比较两组统一帕金森病评定量表(UPDRS)评分、简易智力状态检查量表(MMSE)评分、汉密尔顿焦虑量表(HAMA)评分、汉密尔顿抑郁量表(HAMD)评分、P300波幅和潜伏期、神经递质指标[多巴胺、5-羟色胺、谷氨酸、γ-氨基丁酸(GABA)]、脑血流灌注及不良反应发生情况。结果在治疗后,观察组UPDRS-Ⅱ评分、UPDRS-Ⅲ评分及UPDRS总分、HAMA评分、HAMD评分和P300潜伏期低于对照组,MMSE评分、P300波幅、多巴胺、5-羟色胺、谷氨酸、GABA以及颞叶、顶叶、额叶脑血流灌注水平高于对照组,差异有统计学意义(P<0.05)。结论M1高频联合SMA低频rTMS辅助药物治疗老年帕金森病,能有效改善患者的运动和非运动症状,调节神经递质水平,增加脑血流灌注,且安全性好。Objective To analyze the therapeutic effects of primary motor cortex(M1)high-frequency combined with supplementary motor area(SMA)low-frequency repetitive transcranial magnetic stimulation(rTMS)assisting with drug in treatment of elderly Parkinson′s disease based on neurotransmitter and computed tomography(CT)cerebral blood flow perfusion and their mechanisms.Methods One hundred and six patients with elderly Parkinson′s disease who were admitted to Yan′an University Xianyang Hospital from September 2021 to June 2023 were recruited and divided into observation group and control group by random number table method,with 53 cases in each group.Both groups were given pramipexole tablets,and on this basis,the control group was given sham stimulation+memantine,while the observation group was given rTMS+memantine.Both groups were treated for 4 weeks.The Unified Parkinson′s Disease Rating Scale(UPDRS)scores,Mini-Mental State Examination(MMSE)scores,Hamilton Rating Scale for Anxiety(HAMA)scores,Hamilton Rating Scale for Depression(HAMD)scores,P300 amplitude and latency,neurotransmitter indicators[dopamine,5-hydroxytryptamine,glutamic acid and gamma-aminobutyric acid(GABA)],cerebral blood flow perfusion and the occurrence of adverse reactions were compared between the two groups.Results After treatment,the UPDRS-Ⅱscores,UPDRS-Ⅲscores,UPDRS total scores,HAMA scores,HAMD scores and P300 latency in the observation group were lower than those in the control group,and the MMSE scores,P300 amplitude,dopamine,5-hydroxytryptamine,glutamic acid,GABA,and the levels of cerebral blood flow perfusion in the temporal lobe,parietal lobe and frontal lobe in the observation group were higher than those in the control group,with statistically significant differences between the two groups(P<0.05).Conclusion M1 high-frequency combined with SMA low-frequency rTMS assisting with drug can effectively improve the motor and non-motor symptoms in treatment of the patients with elderly Parkinson′s disease,regulate the levels of neurotr

关 键 词：重复经颅磁刺激 美金刚 老年 帕金森病 神经递质 脑血流灌注 

分 类 号：R741.05[医药卫生—神经病学与精神病学]