作者：范杨，梅玉倩，冯文，杨进，王玉凤，侯昌月，蒋国会，余巨明，张小东

单位：

1.637000四川省南充市，川北医学院附属医院神经内科　2.637000四川省南充市，川北医学院神经疾病研究所　 3.637000四川省南充市，川北医学院影像医学系　4. 637000四川省南充市，川北医学院附属医院重症医学科　5.628000四川省广元市 中心医院神经内科

Units：

1.Department of Neurology, Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, China 2.Institute of Neurological Diseases, North Sichuan Medical College, Nanchong 637000, China 3.School of Medical Imaging, North Sichuan Medical College, Nanchong 637000, China 4.Department of Intensive Care Unit, Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, China 5.Department of Neurology, Guangyuan Central Hospital, Guangyuan 628000, China

关键词：

　帕金森病；胰岛素；运动功能；生活质量；低频振幅

Keywords：

Parkinson disease; Insulin; Moto function; Quality of life; Amplitude of low-frequency fluctuations

CLC：

R 742.5

DOI：

10.12114/j.issn.1008-5971.2023.00.245

Funds：

2020年川北医学院附属医院院级科研课题项目（2020ZD003）

摘要：

　目的　探讨胰岛素鼻内给药对帕金森病（PD）患者运动功能、生活质量及不同脑区低频振幅 （ALFF）的影响。方法　选取2019年 1 月至 2020年1月于川北医学院附属医院神经内科门诊就诊的 PD患者32例。采 用随机数字表法将其分为胰岛素组（ n= 16 ）和对照组（ n=16）。胰岛素组予以门冬胰岛素注射液，对照组予以氯化 钠注射液，两组均于早餐前通过鼻腔给药，连续治疗4周。比较两组一般资料、H&Y分期、帕金森病统一评分量表 （UPDRS）评分、39项帕金森病调查表（PDQ-39）评分及不同脑区ALFF。结果　胰岛素组共剔除7例，对照组共剔 除8例。两组治疗前后H&Y分期比较，差异无统计学意义（P＞0.05）。胰岛素组治疗前后UPDRS Ⅲ评分差值、UPDRS 总分差值大于对照组（P＜0.05）。两组治疗前后身体活动、日常生活行为、精神健康、屈辱感、社会支持、认知、交 流、身体不适维度评分和PDQ-39总分及治疗前后其差值比较，差异无统计学意义（P＞0.05）。对照组剔除1例扫描发 现血管瘤患者。组别与时间在左侧梭状回、左侧舌回、右侧丘脑、右侧辅助运动区、右侧中央前回ALFF上存在交互作 用（P＜0.05）；事后检验结果显示，与治疗前相比，胰岛素组治疗后左侧梭状回、左侧舌回、右侧丘脑、右侧辅助运 动区、右侧中央前回ALFF增加（P＜0.05）；与治疗前相比，对照组治疗后左侧梭状回、左侧舌回、右侧辅助运动区 ALFF降低（P＜0.05）。结论　胰岛素鼻内给药可能通过增加PD患者右侧丘脑、右侧辅助运动区、右侧中央前回ALFF 而提高其神经元自发活动，从而提高PD患者的运动功能，但其对PD患者的生活质量可能无改善作用。

Abstract：

Objective To investigate the effects of intranasal insulin on motor function, quality of life and amplitude of low-frequency fluctuations (ALFF) in different brain regions in patients with Parkinson disease (PD) . Methods A total of 32 PD patients were selected from the Neurology Outpatient Department of Affiliated Hospital of North Sichuan Medical College from January 2019 to January 2020. They were divided into insulin group (n=16) and control group (n=16) by random number table method. The insulin group was given insulin aspart injection and the control group was given sodium chloride injection. Both groups were given treatment through nasal cavity before breakfast for 4 weeks. General data, H&Y staging, Unified Parkinson Disease Rating Scale (UPDRS) score, 39-item Parkinson's Disease Questionnaire (PDQ-39) score and the ALFF in different brain regions were compared between the two groups. Results A total of 7 cases were excluded from the insulin group, and a total of 8 cases were excluded. There was no significant difference in H&Y staging between the two groups before and after treatment (P > 0.05) . The difference of UPDRS Ⅲ and total UPDRS scores before and after treatment in insulin group were larger than those in control group (P < 0.05) . There was no significant difference in physical activity, behavior of daily living, mental health, humiliation, social support, cognition, communication, physical discomfort item score, PDQ-39 total score before and after treatment and their difference before and after treatment between the two groups (P > 0.05) . In the control group, 1 patient with hemangioma was excluded by scanning. The group and time had interaction on ALFF in left fusiform gyrus, left lingual gyrus, right thalamus, right auxiliary motor area and right anterior central gyrus (P < 0.05) . Results of postmortem showed that compared with before treatment, ALFF after treatment in left fusiform gyrus, left lingual gyrus, right thalamus, right auxiliary motor area and right anterior central gyrus increased in the insulin group (P < 0.05) ; compared with before treatment, ALFF after treatment in left fusiform gyrus, left lingual gyrus and right auxiliary motor area decreased in the control group (P < 0.05) . Conclusion Intranasal insulin may improve the spontaneous neuronal activity by increasing the ALFF of right thalamus, right auxiliary motor area and right anterior central gyrus in PD patients, thus improving the motor function of PD patients, but it may not improve the quality of life of PD patients.

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