摘要
评估A型肉毒毒素治疗帕金森病合并抑郁症患者的疗效和安全性.方法前瞻性收集2016年8月至2018年11月苏州大学附属第二医院神经内科门诊就诊或住院的42例伴有抑郁症的帕金森病患者,根据治疗方法将其分为A型肉毒毒素组(28例)和舍曲林组(14例),A型肉毒毒素组予以100 U A型肉毒毒素于眉间、额前、双侧外眦、颞部20个点注射,舍曲林组予以50~100(55.36± 14.47)mg/d舍曲林口服治疗,分别比较两组治疗前以及治疗后2周、4周、8周和12周的汉密尔顿抑郁量表(HAMD-17)、抑郁自评量表(SDS)、汉密尔顿焦虑量表(HAMA-14)评分和焦虑自评量表(SAS)各情绪量表评分,以及两治疗组各项情绪量表评分之间的差异,同时比较两治疗组各随访时间点抑郁症、焦虑症缓解率(定义为HAMD、HAMA评分<7分),评估A型肉毒毒素治疗帕金森病伴抑郁症患者的疗效和安全性.结果 A型肉毒毒素组和舍曲林组患者在治疗后的2、4、8和12周HAMD、SDS、HAMA以及SAS评分均较基线评分降低,其中A型肉毒毒素组HAMD、SDS评分下降明显(HAMD评分:F=12.930,P<0.01;SDS评分:F=5.022,P=0.001),舍曲林组HAMD、SDS评分也下降明显(HAMD评分:F=2.883,P=0.030;SDS评分:F=3.427,P=0.013).但两组之间HAMD、SDS评分差异无统计学意义(均P>0.05).HAMD评分结果显示,2周、4周时A型肉毒毒素组抑郁症缓解率较舍曲林组高,分别为17.9%(5/28)、35.7%(10/28),而舍曲林组分别为2/14、4/14,8周、12周时舍曲林组抑郁症缓解率较A型肉毒毒素组高,8周、12周时两组分别为7/14、9/14、46.4%(13/28)、53.6%(15/28),两组缓解率在各随访时间点差异均无统计学意义(均P>0.05).在A型肉毒毒素组男性和女性帕金森病患者之间,HAMD评分差异无统计学意义(P>0.05).42例患者中A型肉毒毒素组有2例出现眉间肌肉发僵感,分别持续2周、1个月好转;舍曲林组有2例出现头痛、头晕症状,2例出现恶心口干,持续约2周后好转.两组不良反应发生率差异无统计学意义(P=0.197).结论 A型肉毒毒素通过眼周表情肌注射,可以明显改善帕金森病患者的抑郁症状,且疗效持续时间长、不良反应发生率较低,安全性高,可考虑作为帕金森病伴抑郁症患者的一种安全有效的治疗新方法.
Objective To explore the curative effect and safety of botulintum toxin A (BTX-A) on depressive disorder in patients with Parkinson′s disease (PD). Methods Forty-two cases of PD with depression prospectively recruited in the Second Hospital Affiliated to Soochow University from August 2016 to November 2018 were divided into two groups: 28 patients in BTX-A group (administered with 100 U BTX-A injection on patients′eyebrow, forehead, bilateral lateral canthus and temporal region at 20 loci), 14 patients in sertraline (control) group (administered with 50-100 (55.36±14.47) mg/d sertraline). The scores of Hamilton Depression Rating Scale (HAMD), Self-rating Depression Scale (SDS), Hamilton Rating Scale for Anxiety (HAMA), Self-rating Anxiety Scale (SAS) after treatment for 2 weeks, 4 weeks, 8 weeks and 12 weeks were compared with the scores of each emotional rating scale for baseline respectively. Meanwhile, the differences in the scores of each emotional scale between the two treatment groups were compared. In addition, the remission rates of depression and anxiety (defined as HAMD, HAMA scores<7) at each follow-up time point between the two groups were compared to evaluate the efficacy and safety of BTX-A in the treatment of PD patients with depression. Results The scores of HAMD, HAMA, SDS, SAS in the BTX-A group and the sertraline group reduced compared to baseline after treatment (at the 2nd, 4th, 8th, 12th weeks). The scores of HAMD and SDS in the BTX-A group (HAMD scores: F=12.930, P<0.01;SDS scores: F=5.022, P=0.001) and those in the sertraline group (HAMD scores: F=2.883, P=0.030;SDS scores:F=3.427, P=0.013) were significantly lower compared to baseline, but there was no statistically significant difference in the scores of HAMD and SDS between the two groups (P>0.05). HAMD score showed that the remission rate of depression in the BTX-A group (17.9%(5/28), 35.7%(10/28)) was higher than that of the sertraline group (2/14, 4/14) at the 2nd and 4th weeks. At the 8th and 12th weeks, the remission rate of depression in the sertraline group (7/14, 9/14) was higher than that of the BTX-A group (46.4%(13/28), 53.6%(15/28)). There was no statistically significant difference in remission rate of depression between the two groups at each follow-up time point (P>0.05). There was no statistically significant difference in HAMD scores between males and females in the BTX-A group (P>0.05). Two of the 28 patients in the BTX-A group had frown muscle stiffness, which lasted for two weeks and improved in one month. Two patients in the sertraline group had headache and dizziness, and two patients had dry mouth and nausea, which improved after two weeks. There was no statistically significant difference in the incidence of adverse reactions between the two groups (P=0.197). Conclusion BTX-A intraocular facial muscle injection can significantly improve the depressive symptoms of PD patients, and the effect lasts for a long time, with low incidence of side effects and high safety, which can be considered as a safe and effective new method for PD patients with depressive symptoms.
作者
吕阿兰
范宇欣
汤璐璐
郭雪艳
刘晶
黄译腺
周旭平
胡华
刘春风
罗蔚锋
Lyu Alan;Fan Yuxin;Tang Lulu;Guo Xueyan;Liu Jing;Huang Yixian;Zhou Xuping;Hu Hua;Liu Chunfeng;Luo Weifeng(Department of Neurology, the Second Hospital Affiliated to Soochow University, Suzhou, Jiangsu 215004,China)
出处
《中华神经科杂志》
CAS
CSCD
北大核心
2019年第9期745-751,共7页
Chinese Journal of Neurology
关键词
帕金森病
抑郁症
A型肉毒毒素
治疗结果
Parkinson disease
Depressive disorder
Botulintum toxins,type A
Treatment outcome
