帕金森病的临床治疗概况
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摘要
帕金森病(Parkinson's disease, PD),在医学上称为"原发性震颤麻痹",又称"震颤麻痹",是一种中枢神经系统变性疾病,主要是因位于中脑部位"黑质"中的多巴胺(DA)能神经元病理性改变后,多巴胺的合成减少,对与其功能相互拮抗的乙酰胆碱的抑制功能降低,则乙酰胆碱的兴奋作用相对增强。两者失衡的结果便出现了"震颤麻痹"。本综述先从PD发病机制方向总结归纳目前临床常用的西医药物(包括左旋多巴、DA降解酶抑制剂、DA受体激动剂、抗胆碱能药物)、基因治疗靶点、手术治疗(脑深部电刺激术)及物理疗法,又从中医角度整体介绍了目前中医中药治疗以及针灸治疗等。因PD对患者的日常生活及身心健康造成了严重影响,我们希望通过本综述为PD综合治疗提供更广阔的临床思路及更好的方案。
Parkinson's disease(PD), known medically as "primary paralysis paralysis," also known as "Parkinson's disease," is a central nervous system degenerative disorder mainly caused by the presence of "substantia nigra " In dopamine(DA) neurons pathological changes after the reduction of dopamine synthesis, and its function antagonism of acetylcholine inhibition decreased, the excitement of acetylcholine relatively enhanced. The result of the imbalance between the two appeared "paralysis of paralysis". This review firstly summarizes the current clinical medicine for western medicine in the direction of the pathogenesis of PD(including levodopa, DA degrading enzyme inhibitors, DA receptor agonists, anticholinergic drugs), gene therapy targets, surgery(DBS) and physical therapy, and also introduces the treatment of traditional Chinese medicine and acupuncture and moxibustion treatment from the point of view of traditional Chinese medicine. PD has a serious impact on patients' daily life and physical and mental health, we hope that through this review, we will provide broader clinical ideas and better solutions for PD comprehensive treatment.
Parkinson's disease(PD), known medically as "primary paralysis paralysis," also known as "Parkinson's disease," is a central nervous system degenerative disorder mainly caused by the presence of "substantia nigra " In dopamine(DA) neurons pathological changes after the reduction of dopamine synthesis, and its function antagonism of acetylcholine inhibition decreased, the excitement of acetylcholine relatively enhanced. The result of the imbalance between the two appeared "paralysis of paralysis". This review firstly summarizes the current clinical medicine for western medicine in the direction of the pathogenesis of PD(including levodopa, DA degrading enzyme inhibitors, DA receptor agonists, anticholinergic drugs), gene therapy targets, surgery(DBS) and physical therapy, and also introduces the treatment of traditional Chinese medicine and acupuncture and moxibustion treatment from the point of view of traditional Chinese medicine. PD has a serious impact on patients' daily life and physical and mental health, we hope that through this review, we will provide broader clinical ideas and better solutions for PD comprehensive treatment.
引文
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[22]Umemura A,Oyama G,Shimo Y,et al.Current Topics in Deep Brain Stimulation for Parkinson Disease[J].Neurologia Medico-Chirurgica(Tokyo),2016,56(10):613-625
[23]Krishnan S,Pisharady KK.Surgical Treatment of Levodopa-induced Dyskinesia in Parkinson's Disease[J].Annals of Indian Academy of Neurology,2017,20(3):199-206
[24]Munhoz R,Cerasa A,Okun M.Surgical treatment of dyskinesia in Parkinson's disease[J].Frontiers in Neurology,2014,5:65
[25]Spindola B,Leite M,Orsini M,et al.Ablative surgery for Parkinson's disease:Is there still a role for pallidotomy in the deep brain stimulation era?[J].Clinical Neurology and Neurosurgery,2017,158:33-39
[26]Fishman PS,Frenkel V.Treatment of Movement Disorders With Focused Ultrasound[J].Journal of Centural Nervous System Disease,2017,9:1179573517705670
[27]吴林,徐兴华,陈炜,等.规范化中西医结合帕金森病综合治疗方案的临床疗效研究[J].辽宁中医杂志,2011,38(2):313-316
[28]王肯堂.证治准绳[M].北京:中国中医药出版社,1997:580
[29]郜利霞,刘轲.中医药治疗帕金森病综述[J].时珍国医国药,2010,21(3):724-725
[30]赵长振.中药复方治疗帕金森病的用药规律研究[J].中医中药,2013,2(3):107-150
[31]朱默里.帕金森病现代中医用药规律探讨[D].山东:山东中医药大学,2014,5,20
[32]周海东.头针加电针治疗帕金森病36例[J].四川中医,2004,22(4):88
[33]李立红,张海峰.针灸治疗帕金森病的临床研究进展[J].甘肃中医,2009,22(1):79
[34]任晓明.针灸治疗帕金森病的临床观察[J].浙江中医药大学学报,2008,32(4):510
[35]张京峰,孙国胜.隔药灸神阙穴治疗帕金森病54例疗效观察[J].中国针灸,2006,25(9):610
[36]Lindvall O,Rehncrona S,Brundin P,et al.Human fetal dopamine neurons grafted into the striatum in two patients with severe Parkinson's disease.A detailed account of methodology and a6-month follow-up[J].Archives of Neurology,1989,46:615-631
[37]Lindvall O,Brundin P,Widner H,et al.Grafts of fetal dopamine neurons survive and improve motor function in Parkinson’s disease[J].Science,1990,247:574-577
[38]Freed C,Breeze R,Rosenberg N,et al.Survival of implanted fetal dopamine cells and neurologic improvement 12 to 46 months after transplantation for Parkinson's disease[J].The New England Journal of Medicine,1992,327:1549-1555
[39]Freed C,Greene P,Breeze R,et al.Transplantation of embryonic dopamine neurons for treatment of severe Parkinson's disease[J].The New England Journal of Medicine,2001,344:710-719
[40]Moore S,Guzman N,Mason S,et al.Which patients with Parkinson's disease participate in clinical trials?One centre's experiences with a new cell based therapy trial(TRANSEURO)[J].Journal of Parkinson's Disease,2014,4:671-676
[2]Maiti P,Manna J,Dunbar GL,et al.Current understanding of the molecular mechanisms in Parkinson's disease:Targets for potential treatments[J].Translational Neurodegeneration,2017,6(1):28
[3]Zhang T,Yu S,Guo P,et al.Nonmotor symptoms in patients with Parkinson disease:Across-sectional observational study[J].Medicine,2016,95(50):e5400
[4]Murakami H,Nohara T,Shozawa H,et al.Effects of dopaminergic drug adjustment on executive function in different clinical stages of Parkinson's disease[J].Neuropsychiatric Disease Treatment,2017,13(1):2719-2726
[5]李明,李秀池,肖召安.帕金森病治疗的药物选择综述[J].中国药业,2016,25(1):94-96
[6]张雪,张雯,杜立达.抗帕金森病药物及其作用靶点研究进展[J].国际药学研究杂志,2016,43(1):87-96
[7]Kasai S,Yoshihara T,Lopatina O,et al.Selegiline Ameliorates Depression-Like Behavior in Mice Lacking the CD157/BST1 Gene,a Risk Factor for Parkinson's Disease[J].Frontiers Behavioral Neuroscience,2017,11:75
[8]苏娜,吴斌,徐珽.司来吉兰治疗帕金森病的有效性与安全性的系统评价[J].中国医院药学杂志,2014,34(14):1206-1212
[9]佟玉珊,杨新玲.雷沙吉兰治疗帕金森病的Meta分析[J].中国循证医学杂志,2014,14(2):205-210
[10]汤森路透.疾病综述:帕金森病[J].国际药学研究杂志,2015,42(3):338-345
[11]Wood M,Dubois V,Scheller D,et al.Rotigotine is a potent agonist at dopamine D1 receptors as well as at dopamine D2 and D3 receptors[J].British Journal of Pharmacology,2015,172(4):1124-1135
[12]刘杰,胡红彦,储照虎.帕金森病的药物治疗进展[J].卒中与神经疾病,2011,18(5):320-322
[13]邹小冬,王浩,王百辰,等.多巴胺受体激动剂治疗帕金森病的基础研究进展[J].中华临床医师杂志(电子版),2016,06(3):167
[14]Eberling J,Jagust W,Christine C,et al.Results from a phase I safety trial of hAADC gene therapy for Parkinson disease[J].Neurology,2008,70:1980-1983
[15]Kaplitt M,Feigin A,Tang C,et al.Safety and tolerability of gene therapy with an adeno-associated virus(AAV)borne GAD gene for Parkinsons disease:an open label,phase I trial[J].The Lancet,2007,369(9579):2097-2105
[16]Marks W,Ostrem J,Verhagen L,et al.Safety and toler-ability of intraputaminal delivery of CERE-120(adeno-associated virus serotype 2-neurturin)to patients with diopathic Parkinson's disease:an open-label,phase I trial[J].Lancet Neurology,2008,7:400-408
[17]Mak MK,Wong-Yu IS,Shen X,et al.Long-term effects of exercise and physical therapy in people with Parkinson disease[J].Nature reviews Neurology,2017,13(11):689-703
[18]Gerson S,Jessika S,Schiess M.Earlier Intervention with Deep Brain St imulation for Parkinson's Disease[J].Parkinson's Disease,2017,2017:9358153
[19]Wagle WS,Zeilman P,Fernandez H,et al.DBS Programming:An Evolving Approach for Patients with Parkinson's Disease[J].Parkinson's Disease,2017,8492619
[20]Youngerman BE,Chan AK,Mikell CB,et al.A decade of emerging indications:deep brain stimulation in the United States[J].Journal of Neurosurgery,2016,125(2):461-471
[21]Bronstein JM,Tagliati M,Alterman RL,et al.Deep brain stimulation for Parkinson disease an expert consensus and review of key issues[J].Archives of Neurology,2011,68(2):165-171
[22]Umemura A,Oyama G,Shimo Y,et al.Current Topics in Deep Brain Stimulation for Parkinson Disease[J].Neurologia Medico-Chirurgica(Tokyo),2016,56(10):613-625
[23]Krishnan S,Pisharady KK.Surgical Treatment of Levodopa-induced Dyskinesia in Parkinson's Disease[J].Annals of Indian Academy of Neurology,2017,20(3):199-206
[24]Munhoz R,Cerasa A,Okun M.Surgical treatment of dyskinesia in Parkinson's disease[J].Frontiers in Neurology,2014,5:65
[25]Spindola B,Leite M,Orsini M,et al.Ablative surgery for Parkinson's disease:Is there still a role for pallidotomy in the deep brain stimulation era?[J].Clinical Neurology and Neurosurgery,2017,158:33-39
[26]Fishman PS,Frenkel V.Treatment of Movement Disorders With Focused Ultrasound[J].Journal of Centural Nervous System Disease,2017,9:1179573517705670
[27]吴林,徐兴华,陈炜,等.规范化中西医结合帕金森病综合治疗方案的临床疗效研究[J].辽宁中医杂志,2011,38(2):313-316
[28]王肯堂.证治准绳[M].北京:中国中医药出版社,1997:580
[29]郜利霞,刘轲.中医药治疗帕金森病综述[J].时珍国医国药,2010,21(3):724-725
[30]赵长振.中药复方治疗帕金森病的用药规律研究[J].中医中药,2013,2(3):107-150
[31]朱默里.帕金森病现代中医用药规律探讨[D].山东:山东中医药大学,2014,5,20
[32]周海东.头针加电针治疗帕金森病36例[J].四川中医,2004,22(4):88
[33]李立红,张海峰.针灸治疗帕金森病的临床研究进展[J].甘肃中医,2009,22(1):79
[34]任晓明.针灸治疗帕金森病的临床观察[J].浙江中医药大学学报,2008,32(4):510
[35]张京峰,孙国胜.隔药灸神阙穴治疗帕金森病54例疗效观察[J].中国针灸,2006,25(9):610
[36]Lindvall O,Rehncrona S,Brundin P,et al.Human fetal dopamine neurons grafted into the striatum in two patients with severe Parkinson's disease.A detailed account of methodology and a6-month follow-up[J].Archives of Neurology,1989,46:615-631
[37]Lindvall O,Brundin P,Widner H,et al.Grafts of fetal dopamine neurons survive and improve motor function in Parkinson’s disease[J].Science,1990,247:574-577
[38]Freed C,Breeze R,Rosenberg N,et al.Survival of implanted fetal dopamine cells and neurologic improvement 12 to 46 months after transplantation for Parkinson's disease[J].The New England Journal of Medicine,1992,327:1549-1555
[39]Freed C,Greene P,Breeze R,et al.Transplantation of embryonic dopamine neurons for treatment of severe Parkinson's disease[J].The New England Journal of Medicine,2001,344:710-719
[40]Moore S,Guzman N,Mason S,et al.Which patients with Parkinson's disease participate in clinical trials?One centre's experiences with a new cell based therapy trial(TRANSEURO)[J].Journal of Parkinson's Disease,2014,4:671-676