世界中医药

目的:探究重复经颅磁刺激对帕金森认知及步态影响性。方法:选取2014年1月至2018年1月解放军联勤保障部队第940医院安宁分院收治符合纳入条件帕金森患者82例作为研究对象,按照就诊顺序编号随机分为对照组和观察组,每组41例。对照组常规治疗,观察组加用重复经颅磁刺激治疗,均治疗4周。观察2组治疗前、完成治疗后脑内神经递质、炎性反应因子、步态、认知功能、帕金森统一评分量表(UPDRS)、计时运动、折返运动变化并比较;完成治疗后进行疗效比较。结果:1)完成治疗后2组C反应蛋白(CRP)、肿瘤坏死因子-α(TNF-α)较治疗前均显著下降(P<0.05),完成治疗后观察组多巴胺(DA)、乙酰胆碱(Ach)、5-羟色胺(5-HT)较治疗前均显著升高(P<0.05),对照组治疗前后差异无统计学意义(P>0.05),完成治疗后观察组DA、Ach、5-HT较对照组显著升高,CRP、TNF-α显著下降(P<0.05)。2)完成治疗后2组步长、步速、转身角速度、Berg评分较治疗前均显著升高(P<0.05),完成治疗后观察组以上指标均显著高于对照组(P<0.05)。3)完成治疗后2组重组人帕金森病蛋白7(PARK7)较治疗前均显著下降,蒙特利尔认知评估量表(MoCA)、简易精神状态量表(MMSE)较治疗前显著升高(P<0.05),完成治疗后观察组MoCA、MMSE显著高于对照组,PARK7显著低于对照组(P<0.05)。4)完成治疗后观察组精神行为情绪、日常生活活动、运动功能、折返运动、总分较治疗前均显著下降;计时运动较治疗前均显著升高(P<0.05);对照组治疗前、完成治疗后比较,差异无统计学意义(P>0.05);完成治疗后观察组计时运动显著高于对照组,余均显著低于对照组(P<0.05)。5)完成治疗后观察组显效率、总有效率均显著高于对照组,比较差异有统计学意义(P<0.05)。结论:重复经颅磁刺激能通过提高PD神经元递质,抑制炎性反应,从而改善认知功能和促进步态平衡。

English Summary:

To explore the effects of repetitive transcranial magnetic stimulation on Parkinson's cognition and gait.Methods:A total of 82 patients with Parkinson's disease who met the inclusion criteria were enrolled in People's Liberation Army Joint Service Support Unit 940 Hospital Anning Branch from January 2014 to January 2018.They were randomly divided into a control group(41 cases)and an observation group(41 cases).The control group received routine treatment，and the observation group received repetitive transcranial magnetic stimulation for 4 weeks.The changes of neurotransmitters，inflammatory factors，gait，cognitive function，Parkinson's Unified Score Scale(UPDRS)，chronomotor and reentry motor before and after treatment were observed and compared between the 2 groups.Results:1）After treatment，the levels of CRP and TNF-a in the 2 groups were significantly decreased than those before treatment(P<0.05).After treatment，the levels of DA，Ach and 5-HT in the observation group were significantly increased than those before treatment(P<0.05)，while those in the control group were not significantly different(P>0.05).After treatment，DA，Ach and 5-HT in the observation group were significantly increased than those before treatment(P<0.05)，while DA，Ach and 5-HT in the control group were not significantly different(P>0.05).HT increased significantly and CRP and TNF-alpha decreased significantly compared with the control group(P<0.05).2)After treatment，the step length，step speed，turning angle speed and Berg score of the 2 groups were significantly higher than those before treatment(P<0.05)，and the above indexes of the observation group were significantly higher than those of the control group(P<0.05).3)Recombinant human Parkinson's disease protein 7(PARK7)in both groups decreased significantly after treatment，and Montreal Cognitive Assessment Scale(MoCA)and Simple Mental State Scale(MMSE)increased significantly after treatment(P<0.05).MoCA and MMSE in the observation group were significantly higher than those in the control group after treatment，and PARK7 was significantly lower than those in the control group(P<0.05).4)After completion of treatment，the observation group's mental and behavioral mood，daily life activities，motor function，return movement，total scores were significantly decreased than before treatment，and the time movement was significantly higher than before treatment(P<0.05).There was no significant difference between the control group and the control group before and after completion of treatment(P>0.05).After completion of treatment，the observation group's time movement was significantly higher than that of the control group，and the rest were significantly lower than that of the control group(P<0.05).After the completion of treatment，the marked efficiency and total efficiency of the observation group were significantly higher than those of the control group，and the difference was statistically significant(P<0.05).Conclusion:Repeated transcranial magnetic stimulation can improve cognitive function and promote gait balance by increasing neurotransmitters of PD and inhibiting inflammation.

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