热敏灸辅助治疗帕金森病抑郁的临床疗效及作用机制探讨

目的:观察热敏灸辅助治疗帕金森病抑郁的临床疗效并探讨其作用机制.方法:将80例帕金森病抑郁患者随机分为观察组和对照组,每组40例.对照组口服多巴丝肼和帕罗西汀治疗;观察组在对照组药物治疗基础上加用热敏灸治疗,疗程为2个月.治疗前后进行汉密尔顿抑郁量表-17(HAMD-17)、统一帕金森病评定量表(UPDRS)及帕金森病生存质量问卷-39(PDQ-39)评分;于治疗后进行疗效评价;并于治疗前后测定患者血清多巴胺(DA)、5-羟色胺(5-HT)及肿瘤坏死因子-α(TNF-α)和白介素-6(IL-6)水平.结果:治疗后,观察组的总有效率高于对照组(P<0.05);两组HAMD-17评分均较治疗前明显降低(均P<0.05),且观察组HAMD-17评分明显低于对照组(P<0.05).两组UPDRS各分项评分及总分均明显减少(均P<0.05),且观察组各分项评分及总分均低于对照组(均P<0.05).观察组患者的PDQ-39评分明显降低(P<0.05),且低于对照组(P<0.05).治疗后,观察组患者血清DA和5-HT水平明显提高(均P<0.05),TNF-α和IL-6水平明显降低(均P<0.05),且均与对照组有统计学差异(均P<0.05).结论:热敏灸辅助治疗帕金森病抑郁疗效确切,能显著改善患者临床症状,提高患者生活质量,可能与其上调DA和5-HT水平,降低TNF-α和IL-6水平相关.

Therapeutic efficacy and mechanism of heat-sensitive moxibustion for adjuvant treatment of depression in Parkinson disease

Objective:To observe the clinical efficacy of heat-sensitive moxibustion for adjuvant treatment of depression in Parkinson disease and explore its mechanism.Methods:A total of 80 patients with Parkinson disease coupled with depression were randomized into an observation group and a control group,with 40 cases in each group.The control group was treated with levodopa and benserazide hydrochloride tablets and paroxetine tablets,while the observation group was treated with heat-sensitive moxibustion on the basis of the medications in the control group.The treatment course was 2 months.The Hamilton depression scale-17(HAMD-17),unified Parkinson's disease rating scale(UPDRS)and Parkinson's disease quality of life questionnaire-39(PDQ-39)were scored before and after the treatment,and the efficacy was evaluated after treatment.Levels of patients'serum dopamine(DA),5-hydroxytryptamine(5-HT),tumor necrosis factor-α(TNF-α)and interleukin-6(IL-6)were detected before and after the treatment.Results:After treatment,the total effective rate of the observation group was higher than that of the control group(P<0.05).The HAMD-17 scores in the two groups decreased significantly after treatment(both P<0.05),and the score in the observation group was obviously lower than that in the control group(P<0.05).The component scores and total scores of UPDRS in both groups decreased significantly(all P<0.05),and the scores in the observation group were lower than those in the control group(all P<0.05).The score of PDQ-39 in the observation group decreased significantly(P<0.05),and was lower than that in the control group(P<0.05).After treatment,the serum DA and 5-HT levels in the observation group increased significantly(both P<0.05)and the TNF-αand IL-6 levels decreased significantly(both P<0.05),which were statistically different from those in the control group(all P<0.05).Conclusion:Heat-sensitive moxibustion has certain auxiliary effect in treating depression in Parkinson disease,significantly improving clinical symptoms and the quality of life,which may be related to the up-regulation of DA and 5-HT levels and down-regulation of TNF-αand IL-6 levels.