摘要
目的 观察八段锦对帕金森病(Parkinson disease,PD)伴冻结步态(freezing of gait,FOG)患者步态参数及血清神经生长因子的影响.方法 2021年12月—2022年12月,采用随机数表法将38例符合纳入排除标准的PD伴FOG患者随机分为研究组(18例)和对照组(20例).两组患者均进行为期4周的药物治疗联合基本康复治疗,研究组在此基础上额外进行八段锦训练.分别在干预前1 d和干预4周后进行疗效评定,包括统一帕金森病评定量表第Ⅱ部分(unified Parkinson's disease rating scale-Ⅱ,UPDRS-Ⅱ)第 14 项评分、冻结步态问卷(freezing of gait questionnaire,FOGQ)、起步时间、步行周期、步幅、动态足底峰值压强和平均压强,以及检测患者外周血脑源性神经营养因子(brain-derived neurotrophic factor,BDNF)和胶质细胞源性神经营养因子(glial cell line-derived neurotro-phic factor,GDNF)水平.使用SPSS 23.0进行卡方检验、配对样本t检验、独立样本t检验和Mann-Whitney U检验.结果 治疗前,两组患者UPDRS-Ⅱ第14项评分、FOGQ评分、起步时间、步行周期、步幅、动态足底峰值压强、平均压强、外周血清BDNF水平和GDNF水平均差异无统计学意义(t=-0.542,0.562,0.490,0.674,0.440,0.606,-0.835,-0.873,-0.250,均 P＞0.05);治疗后,研究组动态足底峰值压强[对照组(14.26±3.23)N/cm2,研究组(11.40±4.13)N/cm2,t=-2.389,P=0.022]和平均压强[对照组(3.34±0.72)N/cm2,研究组(2.79±0.81)N/cm2,t=-2.209,P=0.034]均低于对照组,差异具有统计学意义;治疗后两组患者UPDRS-Ⅱ第14项评分、FOGQ评分、起步时间、步行周期、步幅、外周血清BDNF和GDNF浓度比较均差异无统计学意义(均P＞0.05).治疗前后研究组FOGQ评分差值[对照组 1.00(0.00,1.00)分,研究组 2.00(0.75,3.00)分,Z=-2.547,P=0.011]、起步时间差值[对照组-1.04(-1.86,-0.47)s,研究组-2.34(-3.41,-1.03)s,Z=-2.280,P=0.023]、步行周期差值[对照组 0.29(0.08,0.58)s,研究组 0.35(0.16,1.00)s,Z=-2.748,P=0.006]、步幅差值[对照组 0.19(0.14,0.24)m,研究组 0.26(0.23,0.38)m,Z=-1.360,P=0.005]、动态足底峰值压强差值[对照组-4.11(-5.87,-2.57)N/cm2,研究组-8.44(-10.12,-4.81)N/cm2,Z=-3.333,P=0.001]和平均压强差值[对照组-0.55(-1.00,-0.03)N/cm2,研究组-1.11(-1.51,-0.66)N/cm2,Z=-2.062,P=0.009]改善幅度均优于对照组.治疗后研究组外周血清BDNF水平高于治疗前(t=-2.315,P=0.033).结论 八段锦可提高PD伴FOG患者冻结步态评分,改善步态时空参数,这可能与外周血清BDNF的提高有关.
Abstract
Objective To explore the effect of Baduanjin on gait parameters and serum nerve growth factor in Parkinson disease(PD)patients with freezing of gait(FOG).Methods From December 2021 to December 2022,thirty-eight PD patients with FOG who met the inclusion and exclusion criteria were randomly divided into observation group(n=18)and control group(n=20)by random number table.The patients in both two groups received 4 weeks of drug therapy combined with basic rehabilitation treatment re-spectively,and the patients in observation group received additional Baduanjin training.Efficacy was evalua-ted 1 day before intervention and after 4 weeks of intervention through unified Parkinson's disease rating scale-Ⅱ(UPDRS-Ⅱ)item 14,freezing of gait questionnaire(FOGQ),gait starting time,gait cycle,stride length,dynamic plantar peak pressure and average pressure,while the levels of brain-derived neurotrophic factor(BDNF)and glial cell line-derived neurotrophic factor(GDNF)in peripheral blood of patients were tested.SPSS 23.0 software was used to conduct Chi-square test,paired t-test,independent sample t-test and Mann-Whitney U test.Results Before treatment,there were no significant differences in score of UPDRS-Ⅱ item 14,FOGQ score,gait starting time,gait cycle,stride length,dynamic planar peak pressure,average pressure,peripheral blood BDNF level and GDNF level between the two groups(t=-0.542,0.562,0.490,0.674,0.440,0.606,-0.835,-0.873,-0.250,all P＞0.05).After treatment,compared with the control group,dynamic plantar peak pressure(control group(14.26±3.23)N/cm2,observation group(11.40±4.13)N/cm2,t=-2.389,P=0.022)and plantar average pressure(control group(3.34± 0.72)N/cm2,observation group(2.79±0.81)N/cm2,t=-2.209,P=0.034)of the observation group were significantly decreased(both P＜0.05).There were no significant differences in UPDRS-Ⅱ item 14,FOGQ score,gait starting time,gait cycle,stride length,BDNF and GDNF concentrations in peripheral blood between the two groups after treatment(all P＞0.05).The difference between pre-treatment and post-treat-ment of FOGQ score(control group 1.00(0.00,1.00),observation group 2.00(0.75,3.00),Z=-2.547,P=0.011),gait starting time(control group-1.04(-1.86,-0.47)s,observation group-2.34(-3.41,-1.03)s,Z=-2.280,P=0.023),gait cycle(control group 0.29(0.08,0.58)s,observation group 0.35(0.16,1.00)s,Z=-2.748,P=0.006),stride length(control group 0.19(0.14,0.24)m,ob-servation group 0.26(0.23,0.38)m,Z=-1.360,P=0.005),the dynamic plantar peak pressure(control group-4.11(-5.87,-2.57)N/cm2,observation group-8.44(-10.12,-4.81)N/cm2,Z=-3.333,P=0.001)and average pressure(control group-0.55(-1.00,-0.03)N/cm2,observation group-1.11(-1.51,-0.66)N/cm2,Z=-2.062,P=0.009)in the observation group were better than those in the con-trol group.After treatment,the BDNF level in peripheral blood in observation group was higher than before treatment(t=-2.315,P=0.033).Conclusion Baduanjin can improve frozen gait score and gait parameters in PD patients with FOG,which may be related to the increase of peripheral blood BDNF.
基金项目
江苏省科研实践与创新计划(SJCX18_0713)
NETL
NSTL
万方数据