帕金森病(parkinson's disease,PD)是一种常见的中老年神经系统退行性疾病,以黑质多巴胺能神经元进行性退变和路易小体形成为主要病理特征,临床表现分为以静止性震颤、肌强直、动作迟缓的运动症状和嗅觉减退、便秘、睡眠行为异常、抑郁等非运动症状.

帕金森病( Parkinson’s disease,PD)是伴有多种运动及非运动症状的神经变性疾病.近些年来非运动症状引起越来越多的重视,包括疼痛、情绪、嗅觉、认知、便秘等,其中疼痛一直有着高伴发率,并逐渐引起学界的重视.其实早在1817年詹姆斯帕金森就曾在专论里写到,疼痛可以是帕金森病疾病损害的早期警示征[1] .疼痛定义是指一种与组织损伤或潜在组织损伤相关的感觉、情感、认知和社会维度的痛苦体验,在中老年人群很常见,在PD患者中更常见.疼痛可早于运动症状出现之前多年[2] ,在 PD 早中晚期阶段均存在,影响到了60% ～80%的PD患者,严重妨碍患者的生活质量,2015年柳叶刀神经病学[3]中就指出疼痛作为一个重要的治疗目标,在PD患者中常常被低估、认识不足并管理不善. 2018年英国伦敦发表了迄今为止最大最详细的多中心的PD疼痛研究,共纳入1957例PD患者,发现疼痛发生率高达85% ,其中42%是中到重度疼痛[4] ,显然这是一个非常高的伴发率,显著高于其它人群.临床常用分类方法 Ford分类[5]把PD疼痛分为以下五种类型:骨骼肌肉疼痛、神经根性疼痛、肌张力障碍疼痛、中枢性疼痛和静坐不能.其中最常见的类型是骨骼肌肉性疼痛,约占所有类型当中的一半左右. 2018年英国伦敦PD疼痛研究将之更为细分化为:肌肉骨骼疼痛、PD相关的慢性疼痛、波动性疼痛、夜间疼痛、衣架样疼痛、口腔颌面部疼痛、肢体远端疼痛和腹痛,其中骨骼肌肉疼痛占66% [4] .慢性骨骼肌肉疼痛严重影响到患者的生活质量[6] .可见PD疼痛分类较为复杂,但不同的分类对于骨骼肌肉疼痛的类型认知一致,其所占比例也最高,对患者生活质量影响也最大,有待并值得进一步研究.

目的 研究动脉粥样硬化病变所致单侧大脑中动脉中-重度狭窄急性缺血性卒中,DWI ASPECTS-NIHSS不匹配与侧支循环的关系.方法 回顾性连续收集2015年9月至2018年6月就诊于安徽省中医院脑病中心的急性缺血性卒中患者,经脑血管数字减影血管造影(DSA)证实动脉粥样硬化型单侧大脑中动脉重度狭窄所致急性缺血性卒中所致大脑中动脉(Middle Cerebral Artery,MCA)闭塞,治疗上予以急诊Solitaire FR支架取栓,取栓后证实MCA中-重度狭窄患者共50例,按照DWI ASPECTS与NIHSS评分是否匹配分为匹配组和不匹配组,研究两组侧支循环代偿类型.结果 DWI ASPECTS与NIHSS评分匹配组与不匹配组侧支循环ASITN/SIR分级两组无统计学差异(P=0.132＞0.05),不匹配组患者30人,混合型侧支代偿约占83.3％,匹配组20人,占62.5％,两组有统计学差异(P=0.03＜0.05).结论 二级代偿在匹配或不匹配患者中占重要优势,混合型代偿是动脉粥样硬化型单侧大脑中动脉中-重度狭窄病变的主要方式,也是DWI ASPECTS-NIHSS不匹配患者之中的重要血管代偿类型,临床中应高度重视早期神经功能缺损程度与DWI ASPECTS不匹配患者的血管代偿类型,采取准确的个体化治疗方案.

Objective To discuss the relationship between the early intervention of PSD,recovery of neurological deficits and life quality. Methods The selected cases were randomly divided into treatment group(with sertraline 50mg every night)and control group(pla-cebo 1# every night),both two groups received combined psychotherapy,and after 12 weeks of treatment,based on NIHSS,PHQ - 9, HAMD,ADL rating standards,the level of COR was monitored,the effect of early intervention in depression of patients with acute cerebral infarction was evaluated,the recovery of neural function,the improvement of the quality of life and the incidence of PSD were followed. Re-sults The treatment efficiency of two groups before and after treatment had significant difference (P < 0. 05),especially that of the treatment group was obvious,and the difference had statistical significance (P < 0. 05). After treatment,NIHSS,COR and HAMD in treatment group were all lower,ADL rating was higher,and the incidence of PSD was lower than those in control group,and the difference had statistical sig-nificance (P < 0. 05). Conclusion Conventional antidepressant and early psychological intervention in cerebral infarction patients with de-pression can promote nerve functional recovery in patients,improve the quality of life,and reduce the level of COR and the incidence of PSD. Attention should be paid to depression in acute cerebral infarction.

Objective To investigate the clinical effect and security of early Chinese and Western intervention in the acute period of stroke for depression.Methods The selected patients were randomly divided into four groups,which were given conventional therapy.The group A was administrated with Jieyuyihao,the group B was administrated with paroxetine and Jieyuyihao,the group C was administrated with paroxetine,the group D only to starch films.Based on the TCM integration,the neurological scale National Institutes of Health Stroke Scale(NIHSS) and Hamilton Depression Rating Scale(HAMD),the improvement situation for the above four groups was evaluated pretreatment and 2,4,8 weeks after the treatment;and the side effects during the treatments were observed simultaneously.Results The clinical effect including the TCM integration,NIHSS and HAMD had significantly improved.Group A and group C revealed differences(P0.05);group B revealed significant difference(P0.01);group B was superior than group A and group C,revealed differences(P0.05).In the aspect of the side effects,the proportion of the group C,group D was significantly higher than the group A and group B.Conclusion Early intervention in the Western antidepressant thrapy can significantly improve depression,reduce the incidence of PSD and neurological deficit situation.Jieyuyihao is superior to paroxetine and have fewer side effects.

目的:观察中药复方龟地苁星颗粒治疗左旋多巴诱发的异动症的临床疗效。方法:63例患者随机分为治疗组32例,对照组31例。2组原有多巴丝肼用法、用量不变,治疗组加用龟地苁星颗粒1日1剂;对照组服用吡贝地尔50mg,1日2次。8周为1个疗程。结果:有效率分别为治疗组78.13%、对照组54.84%2,组比较P<0.05;治疗组异动症总积分和异动症持续时间的改善明显优于对照组。结论:中药复方龟地苁星颗粒能改善患者的异动症总积分、缩短异动症持续时间,对左旋多巴诱发的异动症具有较好的临床疗效。

目的:观察中药龟地苁星颗粒对帕金森病多巴丝肼治疗后症状波动的临床疗效。方法:选取31例已经出现疗效减退及"开关"现象的帕金森病患者,加用龟地苁星颗粒治疗8周。结果:治疗后Webster评分、UPDRSⅡ-Ⅲ评分均有改善,"开"期延长、"关"期缩短,同时左旋多巴用量减少。结论:龟地苁星颗粒能显著改善帕金森病的症状波动如疗效减退及"开关"现象。

目的研究解郁一号方对抑郁性神经症的治疗作用,探讨其组方的合理性。方法选择符合抑郁性神经症患者89例,随机分为治疗组,给予口服汤剂解郁一号方;对照组,给予曲唑酮治疗。治疗两周、4周、6周、8周后分别予以汉密尔顿抑郁量表评定,并进行随访。结果抑郁性神经症患者经解郁一号方治疗后临床症状显著改善,其不良反应与复发率明显低于对照组。结论解郁一号具有明显的抗抑郁作用。

抑郁性神经症是以持久的心境低落为特征的神经性障碍疾病.常伴焦虑、身体不适和睡眠障碍.西医多以三环类抗抑郁药(TCA)、单胺氧化酶抑制剂(MAOI)、选择性5-羟色胺回摄取抑制剂(SSRI)和苯二氮卓类等药物治疗,疗效尚可,但因其副作用较重,患者大多不能耐受.安徽省中医院神经科蔡永亮教授根据长期临床实践.采用自拟解郁一号方联合西药治疗抑郁性神经症,收到显著效果,现报道如下.

患者,男,53岁.1997年7月始出现四肢无力伴双下肢异麻.经肌电图、神经活检等检查诊断为多灶性运动神经元病(MMN).至2001年期间多次住院行甲基强的松龙冲击治疗(MPPT)、环磷酰胺治疗,效果不明显,四肢无力无改善并进行性加重,故再次入我院.症见神疲,四肢无力,肌肉萎缩,不能行走.检查见双上肢肌力Ⅲ-级,双下肢肌力Ⅱ级,四肢肌肉萎缩明显.

杨骏,安徽中医学院教授、主任医师.从事中医针灸临床、教学、科研工作二十春秋,尤善于临床诊治各种杂病,广得病家赞誉.笔者就读于杨师研究生期间,有幸随师应诊,亲聆教诲,略有所悟,今摘其经验,以飨同道.