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目的探讨盐酸美金刚对于帕金森病痴呆(Parkinson’s disease with dementia,PDD)患者认知功能及其体内炎性因子表达水平的影响,从而探讨其相关作用机制。方法将本院收治的72例老年PDD患者采用完全随机均分为实验组(n=36)和对照组(n=36),实验组患者给与盐酸美金刚治疗,对照组患者则给与盐酸多奈哌奇治疗,在患者治疗前,治疗后4周、8周、16周进行随访,随访时抽取患者的静脉血进行白介素1β(interleukin 1 beta,IL-1β)、IL-2、IL-6、肿瘤坏死因子α(tumor necrosis factor alpha,TNF-α)、干扰素(interferon gamma,IFN-γ)等炎性因子水平检测,同时检测36例健康体检人群的静脉血炎性因子水平作为空白对照,并采用蒙特利尔认知量表(Montreal cognitive assessment,MoCA)评估患者的认知功能,治疗随访期间注意观察两组患者不良反应的发生情况。结果两组患者治疗前MoCA评分无统计学意义(P>0.05),治疗后两组患者MoCA评分均显著升高,组内比较差异具有统计学意义(P<0.05),而实验组与对照组间MoCA评分的差异有统计学意义(P<0.05),实验组MoCA评分高于对照组。实验组、对照组各种炎性因子水平均显著高于健康体检人群血清炎性因子水平,组间比较差异具有统计学意义(P<0.05),治疗后对照组各型炎性因子改变无统计学意义(P>0.05),而实验组IL-1β、TNF-α显著降低,比较差异具统计学意义(P<0.05),IL-2、IL-6、IFN-γ改变无统计学意义(P>0.05)。多元线性回归分析表明IL-1β、TNF-α、年龄、用药与患者MoCA评分存在线性回归关系(P<0.05)。结论炎性反应在帕金森发病过程中发挥重要作用,且与患者的认知功能密切相关,而盐酸美金刚可能通过抑制局部和全身的炎症反应达到提高患者认知功能的作用。
Objective To investigate the effect of memantine hydrochloride on the cognitive function and the expression of inflammatory cytokines in Parkinson’s disease with dementia (PDD), and to explore its mechanism of action. Methods A total of 72 elderly patients with PDD admitted to our hospital were randomly divided into experimental group (n = 36) and control group (n = 36). Patients in the experimental group were treated with memantine hydrochloride, while patients in the control group were given hydrochloric acid Donepezil treatment was followed up before treatment, 4 weeks, 8 weeks and 16 weeks after treatment, and venous blood was collected from patients for follow-up for interleukin 1 beta (IL-1β), IL-2 and IL- 6, inflammatory necrosis factor alpha (TNF-α), interferon gamma (IFN-γ) and other inflammatory cytokines in 36 healthy people at the same time detection of venous inflammatory cytokines as a blank The Montreal cognitive assessment (MoCA) was used to evaluate the cognitive function of the patients. During the follow-up period, attention was paid to observe the adverse reactions in both groups. Results There was no significant difference in MoCA score between the two groups before treatment (P> 0.05). After treatment, the scores of MoCA in both groups were significantly increased (P <0.05), while the scores of MoCA in both groups were significantly higher than those in control group There was significant difference between the MoCA scores (P <0.05). The MoCA score of the experimental group was higher than that of the control group. The levels of inflammatory cytokines in experimental group and control group were significantly higher than those in healthy physical examination group, with significant difference between the two groups (P <0.05). There was no statistical difference in the inflammatory factors in the control group after treatment (P <0.05). However, the levels of IL-1β and TNF-α in the experimental group were significantly lower than those in the experimental group (P <0.05), while there was no significant difference in the levels of IL-2, IL- P> 0.05). Multivariate linear regression analysis showed that there was a linear regression relationship between the levels of IL-1β, TNF-α, age, medication and MoCA score (P <0.05). Conclusions Inflammatory reaction plays an important role in the pathogenesis of Parkinson’s disease and is closely related to the cognitive function of patients. Memantine hydrochloride may improve the cognitive function of patients by inhibiting the local and systemic inflammatory response.