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目的探讨左旋多巴治疗老年帕金森病(PD)对患者认知功能及血浆Hcy、维生素B12及叶酸水平的影响。方法选取老年PD患者70例为观察组,及同期来院体检的老年健康者50例为对照组。观察组患者随机分为低剂量组(n=35)及高剂量组(n=35),观察组予以左旋多巴治疗,连续治疗6个月。采用简易精神状态测量量表(MMSE)和蒙特利尔认知功能评估量表(MoCA)评估患者认知功能,分别于治疗前后对所有患者进行语言及视空间工作记忆测试;检测并比较治疗前对照组及观察组血同型半胱氨酸(Hcy)、维生素B12及叶酸水平变化及治疗前后观察组上述指标的变化。结果治疗前观察组MMSE、MoCA评分及语音性、语义性记忆评分及距离、位置记忆评分低于对照组(P<0.05或P<0.01);治疗后观察组上述各项评分均较治疗前升高,且治疗后除MMSE、MoCA评分及语言性记忆评分低于对照组外(P<0.05或P<0.01),其余指标均与对照组无显著差异(P>0.05);治疗前观察组血浆Hcy高于对照组(P<0.01),而维生素B12、叶酸水平显著低于对照组(P<0.05或P<0.01);与治疗前比较,治疗后低剂量组及高剂量组血浆Hcy显著升高,而维生素B12水平均降低,且高剂量组与低剂量组间差异显著(P<0.01);2组叶酸水平无显著变化(P>0.05)。结论左旋多巴可在一定程度上改善老年PD患者的认知功能,但治疗的同时伴有血浆Hcy水平升高及维生素B12、叶酸水平降低,增加不良反应发生,因此临床应加强维生素B12及叶酸等营养支持辅助治疗。
Objective To investigate the effects of levodopa on senile Parkinson’s disease (PD) on cognitive function, plasma Hcy, vitamin B12 and folic acid levels. Methods Seventy elderly patients with PD were selected as the observation group and 50 elderly healthy people who were examined during the same period as the control group. The observation group was randomly divided into low dose group (n = 35) and high dose group (n = 35). The observation group was treated with levodopa for 6 months. MMSE and MoCA were used to assess the cognitive function of patients. All patients were assessed with verbal and spatial working memory tests before and after treatment. The levels of cognitive impairment in pre-treatment control group (Hcy), vitamin B12 and folic acid levels in the observation group and the change of the above indexes in the observation group before and after treatment. Results The scores of MMSE, MoCA and voice, semantic memory, distance and location memory in the observation group before treatment were lower than those in the control group (P <0.05 or P <0.01). After treatment, the above scores of the observation group were significantly higher than those before treatment (P <0.05 or P <0.01), and no significant difference (P> 0.05) between the other indexes except the MMSE, MoCA score and verbal memory score in the control group Hcy was higher than the control group (P <0.01), and vitamin B12, folic acid levels were significantly lower than the control group (P <0.05 or P <0.01); compared with before treatment, (P <0.01). There was no significant change in folic acid level between the two groups (P> 0.05). Conclusion Levodopa can improve the cognitive function of senile PD patients to a certain extent, but the treatment accompanied with the increase of plasma Hcy level and the decrease of vitamin B12 and folic acid levels and the increase of adverse reactions, so vitamin B12 and folic acid Other nutritional support adjuvant therapy.