【作者】 李敏；

【导师】 杨明会；

【作者基本信息】 中国人民解放军军医进修学院 ， 中西医结合临床， 2010， 博士

【摘要】 【目的】本课题为“十一五”国家科技支撑计划重大项目,通过研究补肾活血法对PD患者运动症状、中医证候、生活质量、脑神经递质DA水平、肌张力、运动并发症、美多芭用量等指标的影响,以达到优化PD中西医结合治疗方案,提高临床疗效,减轻西药副作用的目的。【方法】①采用多中心、随机、双盲、安慰剂对照方法,按标准纳入120例PD患者,其中治疗组60例和对照组60例。治疗组以补肾活血颗粒配合美多芭治疗,对照组单用美多芭治疗。前3个月为双盲观察,后6个月为揭盲后观察。在入组后及第1月、2月、3月、6月、9月后进行UPDRS, PDQ-39, PDSS,中医证候量化分级表,记时运动试验、十米折返运动试验和美多芭用量等的测量、评分与记录。对其中60例PD患者,在治疗前及治疗第1月、2月、3月、6月、9月后均采用EFG分析仪和Myotonometer(?)肌肉状态测试系统进行测量。②采用多元线形广义回归统计分析方法,建立重复测量的线性拟合数据模型,分析“UPDRSⅡ”,“UPDRSⅢ”、“十米折返运动”、“记时运动”、“睡眠评分”等结局指标的影响因素。【结果】①治疗组(补肾活血组)的UPDRSⅢ,十米折返和记时运动等指标均较对照组有明显改善,在随访期内UPDRSⅢ和起立时间等具有显著性(P<0.01)。记时运动中治疗组可见双手运动次数增加,但组间比较无差异性(P>0.05)。UPDRSⅡ, PDSS和PDQ-39的认知力、情感、躯体不适等5个维度评分,在治疗过程中均有明显下降(P<0.05)。PDQ-39中社会支持、交往等维度无组间差异性(P>0.05)。治疗组中医证候积分显著改善(P<0.01),有效率达85.50%。②治疗组DA总体水平呈上升趋势(P<0.05),对照组部分患者DA水平略微上升,但与治疗组比较无差异性(P>0.05)；治疗期内治疗组患者左侧肱二头肌和股四头肌静息肌张力改善有统计学意义(P<0.05),随访期内治疗组患者双侧肱二头肌和股四头肌静息肌张力均有改善(P<0.05),其中肱二头肌具有显著差异(P<0.01)。最大自主收缩状态时两组间比较均没有差异性(P>0.05)。③治疗组食欲下降、睡眠障碍、症状位置性障碍等并发症改善显著(P<0.01),随着治疗时间增加,异动症和症状波动的评分也明显降低(P<0.05)。治疗组部分患者美多芭用量减少,主要分布在H-Y分级2～3级,对照组出现药量增加的情况。治疗终点时,治疗组出汗、便秘,排尿障碍的发生率显著低于对照组(P<0.01)。④在本课题研究中,“UPDRSⅡ”、“UPDRSⅢ”、“起立时间”等指标的显著影响因素为“H-Y”(P<0.01)。“十米折返行走时间”的影响因素为“美多芭用量”、“H-Y”(P<0.05)。“睡眠评分”的影响因素为“美多芭用量”(P<0.05)。“左手记时试验”的影响因素为“年龄”(P<0.01)；“右手记时试验”的影响因素为“年龄”、“病程”(P<0.05)。【结论】①治疗组PD患者运动功能的改善率较对照组显著,且疗效稳定。治疗组PD患者的中医证候显著改善,有效率达85.50%。补肾活血法能明显改善PD患者日常生活能力和睡眠状况,并从认知力、情感、躯体不适等多方面提高生存质量。②补肾活血法能显著提高PD患者脑内DA水平,并能在一定程度上缓解静息状态下肱二头肌和股四头肌肌张力增高的症状。③补肾活血法可显著减少PD患者运动并发症(汗多、便秘、排尿障碍症状)的发生,减少美多芭用量,减轻美多芭的副作用。随着治疗时间的延长,补肾活血法“减毒增效”作用逐渐显现。④在本课题研究中,PD患者“H-Y”、“美多芭用量”为“UPDRSⅡ”、“UPDRSⅢ”、“十米折返试验”、“睡眠评分”等疗效指标的共同影响因素。更多还原

【Abstract】 [Objective]To study the optimized scheme for treatment of Parkinson’s disease(PD)with combined Traditional Chinese and Western medicine, which is supported by National Ministry of Science and Technology "Eleventh Five-Year" project. We adopted motor signs, symptoms in TCM, quality of Life, levels of DA in brain, muscular tension, usage of Madopar to observe the effects of Strengthening Kidney and Activating Circulation (SKAC).[Method]①A multi-center, randomized, placebo-controlled, double-blind clinical study was undertaken. Totally 120 PD patients were randomly divided into treatment group and placebo group, both groups based on Madopar treatment. All patients were treated for 9 months, including 6 months’follow-up period. The above-mentioned assessment scale, and symptoms in TCM, security indicators for drug adverse effects were measured at each time point:before treatment, treatment after 1,2,3,6,9 month. Among which,60 patients were enrolled in measurement of EFG and Myotonometer at the meantime.②We established the multiple linear regression mode to analyze the effects of "sex", "age", "duration", "H-Y" and "Madopar" on "UPDRSⅡ", "UPDRS III", "10m x 2 time", "Ji-Shi-Test(JST)" and "Sleep" after analysis of repeated measurement data in the study.【Result】①arameters such as UPDRSIII score,10m×2 test and JST were ameliorated in treatment group at each time point. UPDRSIII score and time of getting up showed significant statistical difference in following-up period(P< 0.01).The times of left and right hands showed no statistical significant difference between groups(P>0.05);The scores of UPDRSⅡ, PDSS, and some aspects of PDQ-39 showed statistical significant in both treatment and following-up periods(P<0.05). Symptoms in TCM were improved markedly (effective power 85.50%).②The treatment group showed a higher efficacy than the placebo group in increasing the levels of DA not only in treatment period (P<0.05), DA level in the placebo group was slightly increased, but no statistical difference was found between groups (P>0.05);The treatment group showed a higher efficacy in relieving motor function obstacle, from the aspects of both biceps brachii and quadriceps femoris (P<0.05), especially in biceps brachii (P<0.01).③The symptoms of poor appetite, sleep disorders were significant statistical difference(P<0.01). With the extension of treatment time, the scores of dyskinesia and motor fluctuation was reduced(P<0.05).The usage of Madopar in treatment group were decreased, especially in patients with H-Y 2-3,but placebo group were increased; Treatment complications scores (Sweating,Constipation, Urination disorder) were reduced after 9 months,compared with placebo group(P <0.01).④"H-Y" showed significant effects on "UPDRSⅡ", "UPDRSⅢ", "getting up time" (P<0.01), "Madopar" and "H-Y" had effects on "10m×2 time" (P <0.05), "Madopar" on "sleep" (P<0.05), "age" on "JST-left" (P<0.01) and "age", "duration" on "JST-right" (P<0.05).【Conclusion】①SKAC treatment can improve motor signs and symptoms in TCM of PD patients significantly(effective power 85.50%).The curative effects were more permanent and stable. From the aspects of Ability of Daily Life, Sleep Initiation &Maintenance Disorders and Psychophysiologic Disorders, quality of life of PD patients improved markedly in treatment group. ②Levels of DA in brain and static muscular tension were significantly improved with the effects of the SKAC treatment.③Usage of Madopar and score of treatment complications in treatment group were decreased. SKAC treatment can decrease the side-effects of Madopar and put off the development of PD. The longer treatment time, the more significant effects of "Attenuation and Synergia" for SKAC.④There is a correlation between "H-Y", "Madopar" and clinical evaluation indexes for PD treatment:"UPDRSⅡ", "UPDRSIII"," 10m×2 time" and "Sleep".更多还原