rTMS联合普拉克索治疗老年帕金森病患者疗效及对步态指标和血清S100β NSE BDNF水平的影响

doi:10.3969/j.issn.1006-6233.2024.08.025

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摘要 目的: 探究重复经颅磁刺激技术(rTMS)联合普拉克索治疗老年帕金森病(PD)患者疗效及对步态指标和血清中枢神经特异蛋白(S100β)、神经元特异性烯醇化酶(NSE)、脑源性神经营养因子(BDNF)的影响。方法: 纳入我院于2020年5月至2023年5月期间收治的102例老年PD住院患者,按照单双号法将所有患者分为药物组(单)与联合组(双),每组各51例,药物组患者给予普拉克索药物治疗,初始剂量为0.125mg,3次/d,每周增加1次剂量,最大日剂量不超过4.5mg/d;联合组患者在此基础上给予rTMS治疗,1次/d,治疗5d休息2d,两组均持续治疗8周。对比两组患者临床疗效,治疗前后情感功能、步态指标、大脑皮质兴奋性指标、血清生化指标及不良反应。结果: 联合组总有效率(86.27%)高于药物组(68.63%)(P<0.05);治疗后,两组患者HAMD、FAQ均下降,治疗前后差值具有统计学意义(P<0.05);治疗后,两组患者STEF、BBS均上升,MAS下降,MAS低于药物组,治疗前后差值具有统计学意义(P<0.05);治疗后,两组患者MEP下降,RMT、CMCT升高,治疗前后差值具有统计学意义(P<0.05);治疗后,两组患者S100β、NSE均下降,BDNF上升,治疗前后差值具有统计学意义(P<0.05);联合组不良反应发生率(9.80%)与药物组(7.84%)差异无统计学意义(P<0.05)。结论: rTMS联合普拉克索可有效治疗老年PD病,改善患者情感、运动及神经功能,安全性高,值得推广。

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关键词 ：经颅磁刺激技术, 普拉克索, 老年帕金森病

Abstract：Objective: To explore the efficacy of repetitive transcranial magnetic stimulation (rTMS) combined with pramipexole in the treatment of elderly patients with Parkinson' s disease (PD) and its impact on gait indicators, serum central nervous specific protein (S100β), neuron-specific enolase (NSE), and brain-derived neurotrophic factor (BDNF).Methods: A total of 102 elderly inpatients diagnosed with PD from May 2020 to May 2023 were included in this study. Patients were divided into medication group (single) and combined treatment group (double) using odd and even numbers, with 51 patients in each group. Patients in the medication group received pramipexole therapy starting at 0.125 mg three times daily, increasing weekly up to a maximum of 4.5 mg/day. Patients in the combined treatment group received rTMS in addition to pramipexole, with one session per day for 5 days followed by 2 days of rest, for a total of 8 weeks of treatment. Clinical efficacy, emotional function, gait parameters, cortical excitability indices, serum biochemical parameters, and adverse reactions were compared between the two groups.Results: The total effective rate in the combined treatment group (86.27%) was higher than that in the medication group (68.63%) (P<0.05). After treatment, both groups showed significant decreases in HAMD and FAQ scores (P<0.05). Post-treatment, STEF and BBS scores increased while MAS scores decreased in both groups, with MAS scores lower in the combined treatment group (P<0.05). MEP decreased, and RMT and CMCT increased significantly post-treatment in both groups (P<0.05). Post-treatment, S100β and NSE levels decreased while BDNF levels increased significantly in both groups (P<0.05). There was no significant difference in the incidence of adverse reactions between the combined treatment group (9.80%) and the medication group (7.84%) (P>0.05).Conclusion: rTMS combined with pramipexole effectively treats elderly patients with PD, improving emotional, motor, and neurological functions with a high safety profile. This combined approach warrants further promotion in clinical practice.

Key words： Repetitive transcranial magnetic stimulation Pramipexole Elderly parkinson's disease

基金资助:2018-2019年度湖北省中医药科研项目,(编号:ZY2019Z014)

引用本文:

时洁, 耿晓康, 李潇, 富士峰, 徐先顺. rTMS联合普拉克索治疗老年帕金森病患者疗效及对步态指标和血清S100β NSE BDNF水平的影响[J]. 河北医学, 2024, 30(8): 1362-1367.
SHI Jie, GENG Xiaokang, LI Xiao, et al. Efficacy of rTMS Combined with Pramipexole in Elderly Patients with Parkinson's Disease and Impact on Gait Parameters and Serum Levels of S100β NSE BDNF. HeBei Med, 2024, 30(8): 1362-1367.

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http://www.hbyxzzs.cn/CN/10.3969/j.issn.1006-6233.2024.08.025 或 http://www.hbyxzzs.cn/CN/Y2024/V30/I8/1362

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