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Article(id=1193877803763466667, tenantId=1146029695717560320, journalId=1190317699101192196, issueId=1193877800143777917, articleNumber=1001-2494(2025)02-0189-05, orderNo=null, doi=10.11669/cpj.2025.02.012, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=research-article, receivedDate=1716480000000, receivedDateStr=2024-05-24, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1762572249594, onlineDateStr=2025-11-08, pubDate=1737475200000, pubDateStr=2025-01-22, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1762572249594, onlineIssueDateStr=2025-11-08, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1762572249594, creator=13701087609, updateTime=1762572249594, updator=13701087609, issue=Issue{id=1193877800143777917, tenantId=1146029695717560320, journalId=1190317699101192196, year='2025', volume='60', issue='2', pageStart='109', pageEnd='206', issueExtLink='null', onlineDate='null', pubDate='null', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=0, articleOrder=1, issueType=-1, specialIssue=null, createTime=1762572248731, creator=13701087609, updateTime=1762584852274, updator=13701087609, preIssue=null, nextIssue=null, ext={EN=IssueExt(id=1193930663289123481, tenantId=1146029695717560320, journalId=1190317699101192196, issueId=1193877800143777917, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1193930663289123482, tenantId=1146029695717560320, journalId=1190317699101192196, issueId=1193877800143777917, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null}, startPage=189, endPage=193, ext={EN=ArticleExt(id=1193877804027707827, articleId=1193877803763466667, tenantId=1146029695717560320, journalId=1190317699101192196, language=EN, title=Effects of DL-3-n-butylphthalide Soft Capsules Combined with Levodopa and Benserazide on Motor Function and Homocysteine and IGF-1 Levels in Elderly Patients with Parkinson's Disease, columnId=null, journalTitle=Chinese Pharmaceutical Journal, columnName=null, runingTitle=null, highlight=null, articleAbstract=

OBJECTIVE To investigate the effects of DL-3-n-butylphthalide (NBP) soft capsules combined with levodopa and benserazide (LB) on the motor function and serum homocysteine (Hcy) and insulin-like growth factor 1 (IGF-1) levels in elderly patients with Parkinson's disease (PD). METHODS One hundred elderly patients with mid to late-stage PD admitted to our hospital from March 2021 to March 2023 were included in this retrospective study and divided into control group (n=50) and observation group (n=50) based on different treatment methods. The control group received treatment with LB, while the observation group received treatment with LB and NBP soft capsules for a duration of 1 year. The clinical efficacy, Unified Parkinson's Disease Rating Scale (UPDRS) scores, Hoehn-Yahr stage, UPDRS-Ⅲ scores, serum Hcy levels, and IGF-1 levels before and after treatment were compared. RESULTS The clinical effect of the observation group was dramatically better than that of the control group (P<0.05). After 1 year of treatment, both groups showed significant reduction in UPDRS scores, Hoehn-Yahr stage, and UPDRS-Ⅲ scores compared to baseline. Furthermore, the observation group had dramatically lower UPDRS scores, Hoehn-Yahr stage, and UPDRS-Ⅲ scores compared to the control group (P<0.05). After 1 year of treatment, serum Hcy levels were dramatically lower in the observation group compared to the control group, while serum IGF-1 levels were dramatically higher (P<0.05). CONCLUSION In elderly patients with mid to late-stage PD, NBP soft capsules combined with LB can significantly reduce serum Hcy levels, increase IGF-1 levels, and improve motor function in patients with PD.

, correspAuthors=Yana HU, authorNote=null, correspAuthorsNote=null, copyrightStatement=null, copyrightOwner=null, extLink=null, articleAbsUrl=null, sourceXml=null, magXml=null, pdfUrl=null, pdf=null, pdfFileSize=null, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=null, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=null, mapNumber=null, authorCompany=null, fund=null, authors=null, authorsList=Yan CHEN, Yana HU), CN=ArticleExt(id=1193877948504703802, articleId=1193877803763466667, tenantId=1146029695717560320, journalId=1190317699101192196, language=CN, title=丁苯酞软胶囊联合左旋多巴和多巴丝肼对老年帕金森病患者运动功能及同型半胱氨酸、IGF-1水平的影响, columnId=1190352405612040510, journalTitle=中国药学杂志, columnName=论著, runingTitle=null, highlight=null, articleAbstract=

目的 探究丁苯酞(DL-3-n-butylphthalide,NBP)软胶囊联合左旋多巴和多巴丝肼(levodopa and benserazide,LB)对老年帕金森病(Parkinson's disease,PD)患者运动功能及血清同型半胱氨酸(homocysteine,Hcy)、胰岛素样生长因子1(insulin-like growth factor-1,IGF-1)的影响。方法 将2021年3月至2023年3月浙江省金华市中医医院收治的100例老年中晚期PD患者纳入本次回顾性研究,根据治疗方法不同分成对照组(n=50)和观察组(n=50),对照组患者接受LB治疗,观察组患者接受LB+NBP软胶囊治疗,治疗持续1年。比较两组的临床疗效、治疗前后的统一帕金森病评定量表(unified Parkinson's disease rating scale,UPDRS)评分、Hoehn-Yahr 分期及UPDRS-Ⅲ评分及血清Hcy、IGF-1。结果 观察组的临床疗效显著优于对照组(P<0.05);两组治疗1年后的UPDRS评分、Hoehn-Yahr 分期、UPDRS-Ⅲ评分均较治疗前显著下降,且观察组治疗1年后的UPDRS评分、Hoehn-Yahr 分期、UPDRS-Ⅲ评分显著低于对照组(P<0.05);两组治疗1年后的血清Hcy较对照组显著降低,而血清IGF-1刚好相反,且观察组治疗1年后的血清Hcy显著低于对照组,而血清IGF-1显著高于对照组(P<0.05)。结论 在老年中晚期PD患者中,NBP软胶囊联合LB可显著降低血清Hcy,显著提高IGF-1,显著改善患者的运动功能。

, correspAuthors=胡娅娜, authorNote=null, correspAuthorsNote=
*胡娅娜,女,硕士,副主任医师 研究方向:中西医结合脑病 Tel:(0579)82136870
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陈衍,男,本科,副主任中医师 研究方向:帕金森,睡眠障碍,脑血管病

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陈衍,男,本科,副主任中医师 研究方向:帕金森,睡眠障碍,脑血管病

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陈衍,男,本科,副主任中医师 研究方向:帕金森,睡眠障碍,脑血管病

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Herald Med(医药导报), 2023, 42(2):203-207., articleTitle=Clinical research progress of butylphthalide in the treatment of Parkinson's disease, refAbstract=null), Reference(id=1193928910313320634, tenantId=1146029695717560320, journalId=1190317699101192196, articleId=1193877803763466667, doi=null, pmid=null, pmcid=null, year=2020, volume=20, issue=2, pageStart=180, pageEnd=188, url=null, language=null, rfNumber=[17], rfOrder=16, authorNames=LI J, GU C, ZHU M, journalName=Psychogeriatric, refType=null, unstructuredReference=LI J, GU C, ZHU M, et al. Correlations between blood lipid, serum cystatin C, and homocysteine levels in patients with Parkinson's disease[J]. Psychogeriatric, 2020, 20(2):180-188., articleTitle=Correlations between blood lipid, serum cystatin C, and homocysteine levels in patients with Parkinson's disease, refAbstract=null), Reference(id=1193928910376235195, tenantId=1146029695717560320, journalId=1190317699101192196, articleId=1193877803763466667, doi=null, pmid=null, pmcid=null, year=2024, volume=16, issue=2, pageStart=496, pageEnd=505, url=null, language=null, rfNumber=[18], rfOrder=17, authorNames=WANG Y, KOU S, YANG S, journalName=Am J Transl Res, refType=null, unstructuredReference=WANG Y, KOU S, YANG S, et al. Effect of Butylphthalide soft capsules on cognitive function and dementia-related factors in elderly patients with Parkinson's disease dementia during the COVID-19 pandemic[J]. Am J Transl Res, 2024, 16(2):496-505., articleTitle=Effect of Butylphthalide soft capsules on cognitive function and dementia-related factors in elderly patients with Parkinson's disease dementia during the COVID-19 pandemic, refAbstract=null), Reference(id=1193928910447538364, tenantId=1146029695717560320, journalId=1190317699101192196, articleId=1193877803763466667, doi=null, pmid=null, pmcid=null, year=2022, volume=null, issue=null, pageStart=783:136735, pageEnd=null, url=null, language=null, rfNumber=[19], rfOrder=18, authorNames=SHI X, ZHENG J, MA J, journalName=Neurosci Lett, refType=null, unstructuredReference=SHI X, ZHENG J, MA J, et al. Insulin-like growth factor in Parkinson's disease is related to nonmotor symptoms and the volume of specific brain areas[J]. Neurosci Lett, 2022,783:136735. DOI:10.1016/j.neulet.2022.136735., articleTitle=Insulin-like growth factor in Parkinson's disease is related to nonmotor symptoms and the volume of specific brain areas, refAbstract=null)], funds=[Fund(id=1193928908186808489, tenantId=1146029695717560320, journalId=1190317699101192196, articleId=1193877803763466667, awardId=2022KY22, language=CN, fundingSource=金华市中医药科学技术项目资助(2022KY22), fundOrder=null, country=null)], companyList=[AuthorCompany(id=1193928906148376712, tenantId=1146029695717560320, journalId=1190317699101192196, articleId=1193877803763466667, xref=null, ext=[AuthorCompanyExt(id=1193928906152571017, tenantId=1146029695717560320, journalId=1190317699101192196, articleId=1193877803763466667, companyId=1193928906148376712, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=Jinhua Traditional Chinese Medicine Hospital, Jinhua 321017, China), AuthorCompanyExt(id=1193928906160959626, tenantId=1146029695717560320, journalId=1190317699101192196, articleId=1193877803763466667, companyId=1193928906148376712, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=浙江省金华市中医医院, 浙江 金华 321017)])], figs=[ArticleFig(id=1193928907515719839, tenantId=1146029695717560320, journalId=1190317699101192196, articleId=1193877803763466667, language=EN, label=null, caption=null, figureFileSmall=null, figureFileBig=null, tableContent=
组别 例数 男性/女性
/例数		 年龄
/岁		 病程
/年		 Hoehn-Yahr分期/例数
3~4期 5期
观察组 50 27/23 69.18±5.83 7.29±1.20 39 11
对照组 50 29/21 68.92±5.71 7.85±1.32 35 15
χ2/t 0.162 0.832
P 0.687 0.362
), ArticleFig(id=1193928907570245792, tenantId=1146029695717560320, journalId=1190317699101192196, articleId=1193877803763466667, language=CN, label=表1, caption=

帕金森患者观察组与对照组的一般资料比较

, figureFileSmall=null, figureFileBig=null, tableContent=
组别 例数 男性/女性
/例数		 年龄
/岁		 病程
/年		 Hoehn-Yahr分期/例数
3~4期 5期
观察组 50 27/23 69.18±5.83 7.29±1.20 39 11
对照组 50 29/21 68.92±5.71 7.85±1.32 35 15
χ2/t 0.162 0.832
P 0.687 0.362
), ArticleFig(id=1193928907624771745, tenantId=1146029695717560320, journalId=1190317699101192196, articleId=1193877803763466667, language=EN, label=null, caption=null, figureFileSmall=null, figureFileBig=null, tableContent=
组别 例数 显效 有效 无效 总有效率
观察组 50 26(52.0%) 21(42.0%) 3(6.0%) 47(94.0%)
对照组 50 19(38.0%) 21(42.0%) 10(20.0%) 40(80.0%)
χ2 4.332
P 0.037
), ArticleFig(id=1193928907683492002, tenantId=1146029695717560320, journalId=1190317699101192196, articleId=1193877803763466667, language=CN, label=表2, caption=

观察组与对照组的临床疗效比较

, figureFileSmall=null, figureFileBig=null, tableContent=
组别 例数 显效 有效 无效 总有效率
观察组 50 26(52.0%) 21(42.0%) 3(6.0%) 47(94.0%)
对照组 50 19(38.0%) 21(42.0%) 10(20.0%) 40(80.0%)
χ2 4.332
P 0.037
), ArticleFig(id=1193928907738017955, tenantId=1146029695717560320, journalId=1190317699101192196, articleId=1193877803763466667, language=EN, label=null, caption=null, figureFileSmall=null, figureFileBig=null, tableContent=
组别 例数 精神、行为和情绪 日常活动 运动功能 治疗后并发症
治疗前 治疗后 治疗前 治疗后 治疗前 治疗后 治疗前 治疗后
观察组 50 6.14±1.09 3.30±0.71 16.75±1.05 10.31±0.53 12.48±0.89 7.87±0.70 3.39±0.59 1.20±0.44
对照组 50 5.96±0.96 4.23±0.82 17.01±0.99 14.08±0.67 12.14±1.02 9.80±0.76 3.50±0.72 2.29±0.66
t 0.917 6.063 1.274 31.025 1.776 13.208 0.836 9.717
P 0.361 0.000 0.206 0.000 0.079 0.000 0.405 0.000
), ArticleFig(id=1193928907805126820, tenantId=1146029695717560320, journalId=1190317699101192196, articleId=1193877803763466667, language=CN, label=表3, caption=

观察组与对照组治疗前及治疗1年后的统一帕金森病评定量表(UPDRS)评分比较

, figureFileSmall=null, figureFileBig=null, tableContent=
组别 例数 精神、行为和情绪 日常活动 运动功能 治疗后并发症
治疗前 治疗后 治疗前 治疗后 治疗前 治疗后 治疗前 治疗后
观察组 50 6.14±1.09 3.30±0.71 16.75±1.05 10.31±0.53 12.48±0.89 7.87±0.70 3.39±0.59 1.20±0.44
对照组 50 5.96±0.96 4.23±0.82 17.01±0.99 14.08±0.67 12.14±1.02 9.80±0.76 3.50±0.72 2.29±0.66
t 0.917 6.063 1.274 31.025 1.776 13.208 0.836 9.717
P 0.361 0.000 0.206 0.000 0.079 0.000 0.405 0.000
), ArticleFig(id=1193928907863847077, tenantId=1146029695717560320, journalId=1190317699101192196, articleId=1193877803763466667, language=EN, label=null, caption=null, figureFileSmall=null, figureFileBig=null, tableContent=
组别 例数 H-Y分期 UPDRS Ⅲ评分
治疗前 治疗后 治疗前 治疗后
观察组 50 4.25±0.59 2.05±0.46 30.47±5.81 19.50±4.65
对照组 50 4.17±0.60 2.35±0.51 30.28±5.59 22.54±3.92
t 0.672 3.089 0.167 3.534
P 0.503 0.003 0.868 0.001
), ArticleFig(id=1193928907922567334, tenantId=1146029695717560320, journalId=1190317699101192196, articleId=1193877803763466667, language=CN, label=表4, caption=

观察组与对照组治疗前及治疗1年后H-Y分期和UPDRSⅢ评分的比较

, figureFileSmall=null, figureFileBig=null, tableContent=
组别 例数 H-Y分期 UPDRS Ⅲ评分
治疗前 治疗后 治疗前 治疗后
观察组 50 4.25±0.59 2.05±0.46 30.47±5.81 19.50±4.65
对照组 50 4.17±0.60 2.35±0.51 30.28±5.59 22.54±3.92
t 0.672 3.089 0.167 3.534
P 0.503 0.003 0.868 0.001
), ArticleFig(id=1193928907977093287, tenantId=1146029695717560320, journalId=1190317699101192196, articleId=1193877803763466667, language=EN, label=null, caption=null, figureFileSmall=null, figureFileBig=null, tableContent=
组别 例数 c(Hcy)/μmol·L-1 c(IGF-1)/nmol·L-1
治疗前 治疗后 治疗前 治疗后
观察组 50 16.56±2.64 10.24±1.70 8.61±2.09 11.45±1.94
对照组 50 16.83±2.71 12.30±1.74 8.65±2.27 9.57±1.86
t 0.505 5.988 0.092 4.946
P 0.615 0.000 0.927 0.000
), ArticleFig(id=1193928908044202152, tenantId=1146029695717560320, journalId=1190317699101192196, articleId=1193877803763466667, language=CN, label=表5, caption=

观察组与对照组治疗前及治疗1年后血清同型半胱氨酸(Hcy)及胰岛素样生长因子1(IGF-1)比较

, figureFileSmall=null, figureFileBig=null, tableContent=
组别 例数 c(Hcy)/μmol·L-1 c(IGF-1)/nmol·L-1
治疗前 治疗后 治疗前 治疗后
观察组 50 16.56±2.64 10.24±1.70 8.61±2.09 11.45±1.94
对照组 50 16.83±2.71 12.30±1.74 8.65±2.27 9.57±1.86
t 0.505 5.988 0.092 4.946
P 0.615 0.000 0.927 0.000
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丁苯酞软胶囊联合左旋多巴和多巴丝肼对老年帕金森病患者运动功能及同型半胱氨酸、IGF-1水平的影响
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陈衍 , 胡娅娜 *
中国药学杂志 | 论著 2025,60(2): 189-193
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中国药学杂志 | 论著 2025, 60(2): 189-193
丁苯酞软胶囊联合左旋多巴和多巴丝肼对老年帕金森病患者运动功能及同型半胱氨酸、IGF-1水平的影响
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陈衍, 胡娅娜*
作者信息
  • 浙江省金华市中医医院, 浙江 金华 321017

    • 陈衍,男,本科,副主任中医师 研究方向:帕金森,睡眠障碍,脑血管病

通讯作者:

*胡娅娜,女,硕士,副主任医师 研究方向:中西医结合脑病 Tel:(0579)82136870
Effects of DL-3-n-butylphthalide Soft Capsules Combined with Levodopa and Benserazide on Motor Function and Homocysteine and IGF-1 Levels in Elderly Patients with Parkinson's Disease
Yan CHEN, Yana HU*
Affiliations
  • Jinhua Traditional Chinese Medicine Hospital, Jinhua 321017, China
出版时间: 2025-01-22 doi: 10.11669/cpj.2025.02.012
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摘要
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目的 探究丁苯酞(DL-3-n-butylphthalide,NBP)软胶囊联合左旋多巴和多巴丝肼(levodopa and benserazide,LB)对老年帕金森病(Parkinson's disease,PD)患者运动功能及血清同型半胱氨酸(homocysteine,Hcy)、胰岛素样生长因子1(insulin-like growth factor-1,IGF-1)的影响。方法 将2021年3月至2023年3月浙江省金华市中医医院收治的100例老年中晚期PD患者纳入本次回顾性研究,根据治疗方法不同分成对照组(n=50)和观察组(n=50),对照组患者接受LB治疗,观察组患者接受LB+NBP软胶囊治疗,治疗持续1年。比较两组的临床疗效、治疗前后的统一帕金森病评定量表(unified Parkinson's disease rating scale,UPDRS)评分、Hoehn-Yahr 分期及UPDRS-Ⅲ评分及血清Hcy、IGF-1。结果 观察组的临床疗效显著优于对照组(P<0.05);两组治疗1年后的UPDRS评分、Hoehn-Yahr 分期、UPDRS-Ⅲ评分均较治疗前显著下降,且观察组治疗1年后的UPDRS评分、Hoehn-Yahr 分期、UPDRS-Ⅲ评分显著低于对照组(P<0.05);两组治疗1年后的血清Hcy较对照组显著降低,而血清IGF-1刚好相反,且观察组治疗1年后的血清Hcy显著低于对照组,而血清IGF-1显著高于对照组(P<0.05)。结论 在老年中晚期PD患者中,NBP软胶囊联合LB可显著降低血清Hcy,显著提高IGF-1,显著改善患者的运动功能。

帕金森  /  丁苯酞软胶囊  /  左旋多巴  /  多巴丝肼  /  同型半胱氨酸  /  胰岛素样生长因子1

OBJECTIVE To investigate the effects of DL-3-n-butylphthalide (NBP) soft capsules combined with levodopa and benserazide (LB) on the motor function and serum homocysteine (Hcy) and insulin-like growth factor 1 (IGF-1) levels in elderly patients with Parkinson's disease (PD). METHODS One hundred elderly patients with mid to late-stage PD admitted to our hospital from March 2021 to March 2023 were included in this retrospective study and divided into control group (n=50) and observation group (n=50) based on different treatment methods. The control group received treatment with LB, while the observation group received treatment with LB and NBP soft capsules for a duration of 1 year. The clinical efficacy, Unified Parkinson's Disease Rating Scale (UPDRS) scores, Hoehn-Yahr stage, UPDRS-Ⅲ scores, serum Hcy levels, and IGF-1 levels before and after treatment were compared. RESULTS The clinical effect of the observation group was dramatically better than that of the control group (P<0.05). After 1 year of treatment, both groups showed significant reduction in UPDRS scores, Hoehn-Yahr stage, and UPDRS-Ⅲ scores compared to baseline. Furthermore, the observation group had dramatically lower UPDRS scores, Hoehn-Yahr stage, and UPDRS-Ⅲ scores compared to the control group (P<0.05). After 1 year of treatment, serum Hcy levels were dramatically lower in the observation group compared to the control group, while serum IGF-1 levels were dramatically higher (P<0.05). CONCLUSION In elderly patients with mid to late-stage PD, NBP soft capsules combined with LB can significantly reduce serum Hcy levels, increase IGF-1 levels, and improve motor function in patients with PD.

Parkinson's disease  /  DL-3-n-butylphthalide soft capsules  /  levodopa  /  benserazide  /  homocysteine  /  insulin-like growth factor 1
陈衍, 胡娅娜. 丁苯酞软胶囊联合左旋多巴和多巴丝肼对老年帕金森病患者运动功能及同型半胱氨酸、IGF-1水平的影响. 中国药学杂志, 2025 , 60 (2) : 189 -193 . DOI: 10.11669/cpj.2025.02.012
Yan CHEN, Yana HU. Effects of DL-3-n-butylphthalide Soft Capsules Combined with Levodopa and Benserazide on Motor Function and Homocysteine and IGF-1 Levels in Elderly Patients with Parkinson's Disease[J]. Chinese Pharmaceutical Journal, 2025 , 60 (2) : 189 -193 . DOI: 10.11669/cpj.2025.02.012
正文
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帕金森氏病(Parkinson's disease,PD)是仅次于阿尔茨海默病的第二大神经退行性疾病,60岁以上人群PD患病率在1%~3%,该病由纹状体多巴胺水平异常下降所致[1]。2016年全球疾病负担研究报告显示,中国的PD人群较多,约占全球该病数量的23%,据估计,到2030年,全球50%的PD患者将是中国人[2]。PD通常同时存在运动和非运动功能障碍[3]。PD的非运动症状通常在运动症状前就已表现出来,患者的日常生活质量可能会受到显著影响[4]。
PD是一种目前还不可治愈的疾病,因此早诊断和早治疗对改善PD患者的预后至关重要。大量临床试验证据表明,通过早期诊断,并采取运动和其他物理措施,适当的多巴胺摄入可延缓或治疗左旋多巴缺乏相关的运动并发症和非运动性PD相关症状,患者的生活质量也可得到极大改善[5]。药物治疗是PD主要的治疗方法,目前主要药物包括:左旋多巴和多巴丝肼(levodopa and benserazide,LB)、单胺氧化酶抑制剂、儿茶酚氧甲基转移酶抑制剂、多巴胺激动剂等。通过直接补充外源性多巴胺可有效控制PD的快速进展,但由于长期持续使用,药物治疗的效果会大大降低,且会明显加重运动功能障碍[5-6]。因此,临床需要寻找安全性更高,且更有效的PD治疗方法。本次研究将探究丁苯酞(DL-3-n-butylphthalide,NBP)软胶囊联合LB对老年中晚期PD患者运动功能及对血清同型半胱氨酸(homocysteine,Hcy)和胰岛素样生长因子1(insulin-like growth factor-1,IGF-1)的影响。
1 资料与方法
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1.1 一般资料
选择2021年3月~2023年3月我院门诊和住院治疗的老年中晚期PD患者纳入本次回顾性研究,共计100例符合纳入标准的患者分为观察组(n=50)和对照组(n=50),两组的一般资料差异无统计学意义(P>0.05)(表1),有可比性。患者均签署了知情同意书,且本研究由我院医院伦理委员会审定(批件号:2024062801)。
纳入标准:①年龄>60岁;②符合中国PD诊断标准(2016版)[7];③入选患者Hoehn-Yahr(H-Y)分期3~5级,为PD中晚期患者。④近半年内接受LB片治疗;⑤依从性好,能接受1年的治疗;⑥患者或其监护人签署知情同意书
排除标准:①有药物过敏史者;②合并损害运动功能或认知功能的其他疾病;③合并恶性肿瘤等严重影响试验结果的疾病;④对研究药物有禁忌证。
1.2 治疗方法
对照组患者采用单纯LB片(规格:125 mg,上海罗氏制药有限公司,国药准字H10930198)治疗,口服,首剂量0.125 g,每天3次,后续每日剂量增加每周125 mg(视病情而定),直至患者的治疗量合适且耐受,1 d内最大剂量不超过1.5 g。观察组患者给予LB片+NBP胶囊(规格:0.1 g,石药集团恩必普药业有限公司,国药准字H20050299)联合治疗,LB片剂量和方案同上,NBP软胶囊:空腹口服,每次0.2 g,每日4次,疗程均为1年。另外,2组患者均接受相同的常规康复训练。
1.3 观察指标
比较2组的如下指标:①临床疗效,疗效评价标准[5]为:显效是指患者临床症状显著改善,肌张力、运动功能显著改善,能进行一般日常生活活动,UPDRS评分下降≥50%;有效:肌张力、运动功能有相应改善,使用辅助工具和设备可完成一般日常生活活动,统一帕金森病评定量表(unified Parkinson's disease rating scale,UPDRS)评分下降20%~50%;无效:临床症状经药物治疗后仍未改善,甚至进一步加重,UPDRS评分降低<20%,见公式1。②治疗前及治疗1年后的血清Hcy和IGF-1:采集空腹静脉血,离心得到血清,用酶联免疫吸附试验检测血清Hcy和IGF-1;③治疗前及治疗1年后的H-Y分期变化:H-Y分期从轻到重度分为0~5级,级别越高表示特定运动功能损害越严重,H-Y分期可有效和适当地衡量运动障碍的严重程度及其对日常生活的影响;④治疗前及治疗1年后的UPDRS评分[8]:用UPDRS评估PD患者的精神、行为和情绪日常活动、运动功能和并发症。同时采用UPDRS中运动检查评定部分(UPDRS-Ⅲ)[9]评估PD患者的运动症状。
总有效率(%)=(显效例数+有效例数)/总例数×100%
1.4 统计分析
用SPSS21.0软件进行统计分析。计数资料描述为n(%),行χ2检验,计量资料描述为( x ¯±s),组内比较行配对t检验,组间比较行独立样本t检验,P<0.05为差异有统计学意义。
2 结果
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2.1 临床疗效比较
治疗1年后,观察组的治疗总有效率较对照组显著提高(94.0% vs 80.0%,P<0.05)(表2)。
2.2 UPDRS评分比较
根据UPDRS评分,可从精神、行为和情绪、日常活动、运动功能、治疗后并发症等方面评估患者病情的变化,两组治疗前的UPDRS评分差异无统计学意义(P>0.05),而两组治疗后的UPDRS评分均较治疗前显著下降(t精神、行为和情绪=15.438,9.689,P<0.001;t日常活动=38.717,17.322,P<0.001;t运动功能=28.789,13.008,P<0.001;t治疗后并发症=21.040,8.760,P<0.001)(表3)。
2.3 H-Y分期及UPDRS-Ⅲ评分比较
两组治疗前的H-Y分期及UPDRS Ⅲ评分差异无统计学意义(P>0.05),经1年治疗后,两组的H-Y分期及UPDRS Ⅲ评分均较治疗前显著下降(tH-Y分期=20.794,16.343,P<0.001;tUPDRS-Ⅲ评分=10.424,8.016,P<0.001)(表4)。
2.4 血清Hcy和IGF-1比较
两组治疗前的血清Hcy和IGF-1差异无统计学意义(P>0.05),治疗1年后,2组患者的血清Hcy均低于治疗前(t=14.232,9.946,P<0.001),血清IGF-1显著高于治疗前(t=7.042,2.217,P=0.000,0.029),且观察组治疗1年后的血清Hcy较对照组显著下降,而IGF-1刚好相反(P<0.05),见表5。
3 讨论
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PD有两种类型,分别为散发性帕金森病(SPD)和家族性帕金森病(FPD),前者影响95%的患者,后者约占5%~10%。SPD的病因尚不清楚,而FPD与基因突变有关[5]。PD患者中Hcy的升高可能通过损害多巴胺能神经元导致神经退行性疾病的发生[10]。对人类多巴胺能神经元进行的体外试验表明,Hcy高表达会显著增加神经毒性[11]。PD患者的高Hcy同样可能导致智力及协调功能障碍和抑郁[12]。相关研究指出,PD患者的血清Hcy同样受到左旋多巴药物治疗的影响[13]。临床上PD治疗以药物治疗为主,用于缓解临床症状,控制病情进展,联合康复治疗的治疗效果更佳。LB是临床常用的抗PD药物,该药为苄丝肼和左旋多巴的复方制剂[14]。左旋多巴是多巴胺的前药,在PD的治疗中发挥着重要作用。左旋多巴可穿过血脑屏障进入中枢神经系统,而多巴胺不能,左旋多巴通过多巴脱羧酶转化为多巴胺,补充大脑中多巴胺水平。苄丝肼属于多巴脱羧酶抑制剂,可抑制左旋多巴在的外周代谢,提高其利用率,延长作用时间,并维持血药浓度的稳定。研究已经证实LB治疗PD患者的疗效,但大剂量或长期服用LB会引起肌肉僵硬、“开-关”现象、剂量末期恶化、运动障碍等不良事件[15]。NBP在神经内科较为常用,有神经保护的作用,在PD的治疗中取得了良好的治疗效果,该药可有效改善PD患者的运动和非运动症状,且安全性较高[16]。
本次研究结果显示,经过1年的治疗后,观察组的总有效率显著高于对照组,提示两种药物联合治疗的临床疗效更佳,可能是NBP通过减弱神经炎症反应,减少氧化应激起到神经保护的作用,并改善PD的运动症状,进而提高了临床疗效[16]。本研究结果还显示,经过1年治疗后,观察组的H-Y分期和UPDRS评分均较对照组显著下降,且UPDRS Ⅲ评分同样低于对照组,提示相对于单用LB治疗,加用NBP软胶囊治疗,能更有效地改善PD患者的运动功能,减少并发症药物终末波动的发生率。Hcy是氨基酸代谢的中间产物,可导致多巴胺能神经元数量减少,增加多巴胺能神经元的损伤,损害黑质,导致一系列运动障碍症状[17]。本次研究结果显示,观察组患者治疗后的血清Hcy下降幅度明显高于对照组,这可能是由于NBP通过可减轻氧化损伤和线粒体功能障碍,减少多巴胺神经元的损伤,进而起到脑神经保护的效果[18]。此外,IGF-1是由70个氨基酸组成的多肽激素,主要由中枢神经系统细胞产生,其作为一种强大的神经营养因子,在神经可塑性、分化、髓鞘形成和生存中发挥重要作用。脑损伤可诱导IGF-1的生成,导致中枢神经系统中IGF-表达增加,这反映了该物质有内源性神经保护或修复的作用。研究表明,α-突触核蛋白聚集引起的神经毒性是由多巴胺介导的,在多巴胺存在的情况下,IGF-1也可保护神经细胞免受这种聚集的影响,从而保护神经元免受损伤。IGF-1可能是诊断PD的潜在生物标志物[19]。本研究结果显示,观察组治疗后的血清IGF-1较治疗前明显升高,且高于对照组,这可能是由于联用NBP软胶囊可抑制单胺氧化酶B的调节功能,从而促进体内多巴胺的释放,阻断多巴胺的摄取,从而起到保护多巴胺能神经元的作用。
综上,NBP软胶囊与LB联用可显著降低老年中晚期PD患者的血清Hcy水平,升高血清IGF-1水平,从而改善患者运动功能,减少不良反应的发生,缓解用药末波动,疗效显著,值得临床推广和应用。然而,考虑到本研究样本量及临床资料的有限性,需要进一步增加样本量及延长随访时间,以便获取更多的临床资料支撑研究结论,并获取联合治疗的长期结果。
基金
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  • 金华市中医药科学技术项目资助(2022KY22)
文献
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2025年第60卷第2期
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doi: 10.11669/cpj.2025.02.012
  • 接收时间：2024-05-24
  • 首发时间：2025-11-08
  • 出版时间：2025-01-22
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  • 收稿日期：2024-05-24
基金
金华市中医药科学技术项目资助(2022KY22)
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    浙江省金华市中医医院, 浙江 金华 321017

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*胡娅娜,女,硕士,副主任医师 研究方向:中西医结合脑病 Tel:(0579)82136870
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2种不同金属材料的力学参数
科
Family		 属数
Number of
genus		 种数
Number of
species		 占总种数比例
Percentage of
total species (%)		 属
Genus		 种数
Number of
species		 占总种数比例
Percentage of total
species (%)
鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
小菇科 Mycenaceae 2 12 5.74 丝盖伞属 Inocybe 5 2.39
多孔菌科 Polyporaceae 8 14 6.70 蜡蘑属 Laccaria 5 2.39
红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
小菇属 Mycena 11 5.26
光柄菇属 Pluteus 5 2.39
红菇属 Russula 17 8.13
栓菌属 Trametes 5 2.39
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