帕金森病（PD）是一种常见的与年龄相关的神经退行性疾病,其特点是黑质致密部内多巴胺能神经元的进行性丢失以及路易小体的积累。多巴胺能神经元的退化导致纹状体的多巴胺水平降低,最终出现静息性震颤、运动迟缓、肌肉僵硬和姿势不稳等运动症状,以及认知能力下降、嗅觉功能受损、精神异常和睡眠障碍等非运动症状。由于人口结构转变和全球老龄化,PD的不断增加对患者、家庭和社会构成重大负担。尽管广泛的研究已阐明了PD的病因学和潜在机制,但现有治疗主要集中在症状管理,无法阻止疾病的进展。小胶质细胞作为脑内重要的免疫细胞,对维持中枢神经系统的稳态具有关键作用。本文综述了PD研究,包括其病因学因素、分子机制和现有治疗策略。此外,审视了在PD样模型中涉及小胶质细胞的研究,深入探讨了小胶质细胞在疾病进展中的动态,并探究了小胶质细胞在促进或减轻疾病进展方面所扮演的错综角色。通过这样的探讨,本综述旨在为PD复杂的发病机制提供新的洞见和观点,激发出针对性治疗干预的创新思路。

Parkinson's disease（PD）,a prevalent age-related neurodegenerative disorder,is characterized by the progressive loss of dopaminergic neurons within the substantia nigra compacta（SNc）and the accumulation of Lewy bodies．The degeneration of dopaminergic neurons leads to diminished striatal dopamine levels,culminating in motor symptoms such as resting tremors,bradykinesia,muscle rigidity and postural instability,alongside non-motor manifestations encompassing cognitive decline,impaired olfactory function,psychological abnormalities and sleep disturbances．The escalating incidence of PD due to shifting demographics and global aging poses substantial burdens on patients,families and society．Although extensive research has elucidated the etiology and underlying mechanisms of PD,available treatments largely focus on symptom management and lack the capacity to halt disease progression．Microglia,as integral immune cells within the brain,wield pivotal influence over central nervous system homeostasis．This review presents a comprehensive synthesis of PD,encompassing its etiological factors,molecular mechanisms,and existing therapeutic strategies．Furthermore,we scrutinized research involving microglia in PD-like models,delving into the dynamics of microglia in disease progression and probing into the intricate roles that microglia assume in either fostering or mitigating disease advancement．By doing so,this review aims to furnish novel insights and perspectives that shed light on the intricate pathogenesis of PD,potentially sparking innovative concepts for targeted therapeutic interventions．

目的 探讨美多巴联合盐酸司来吉兰治疗帕金森患者的临床效果及对不良反应情况的影响。方法 选取我院2018年1月—2020年12月收治的96例帕金森患者,通过单双号抽签法将96例患者分为2组,分别为对照组、观察组(每组48例)。对照组给予美多巴治疗,观察组在美多巴联合盐酸司来吉兰进行治疗。然后对比2组患者治疗前后的临床疗效,采用帕金森统一评分量表计算精神状态 、运动功能和日常活动评分并记录不良反应的发生率。结果 对比2组患者治疗前后临床疗效,观察组患者临床总有效率高于对照组(87.50% vs 66.66%),差异有统计学意义(χ²=5.897,P=0.015);治疗后2组患者精神状态 、运动功能和日常活动评分低于治疗前(P<0.05),且观察组患者各项评分低于对照组,差异有统计学意义(t=8.250,P<0.001;t=4.388,P=<0.001;t=3.207,P=0.002);对比2组患者不良反应发生率,对照组与观察组不良反应发生率比较无差异(10.41% vs 12.50%,χ²=0.103,P=0.749),2组患者治疗后的不良反应均为一过性,停药或休息后可自行缓解。结论 美多巴联合盐酸司来吉兰治疗帕金森患者的临床疗效良好,能让患者精神状态、运动功能和日常生活得到显著改善,且不良反应较少。

Objective To explore the clinical effect of medopa combined with selegiline hydrochloride in the treatment of patients with Parkinson's disease and its impact on adverse reactions. Methods A total of 96 Parkinson's disease patients from January 2018 to December 2020 were selected and divided into two groups by the odd and even number drawing method, 48 cases each. The control group was treated with medopa, and the observation group was treated with selegiline hydrochloride on the basis of the control group. Then the clinical efficacy of the two groups were compared, and the Unified Parkinson's Disease Rating Scale was used to access the mental state, motor function and daily activity scores of the patients, and the incidence of adverse reactions was recorded. Results The total effective rate of the observation group was higher than that of the control group (87.50% vs 66.66%), with statistical significance(χ²=5.897,P=0.015). After treatment, the scores of mental state, motor function and daily activities were lower (P<0.05), and the scores of the observation group were significantly lower than those of the control group (t=8.250, P<0.001; t=4.388, P=<0.001; t=3.207, P=0.002);the incidence of adverse reactions had no differences (10.41% vs 12.50%, χ²=0.103, P=0.749). The adverse reactions were transient, which could be alleviated by drug withdrawal or rest. Conclusions Madopa combined with selegiline hydrochloride had a good clinical effect in the treatment of patients with Parkinson's disease. It could significantly improve the mental state, motor function and daily life of patients, with less adverse reaction, which is worthy of promotion.

目的 观察应用济川煎加减结合贴穴治疗帕金森病患者便秘的临床疗效。方法 选取帕金森病合并便秘患者64例,随机分为对照组和观察组,各32例。入选患者均进行帕金森病常规治疗,对照组服用莫沙必利;观察组在对照组治疗基础上加服济川煎加减,并选穴敷贴。疗程结束后对两组患者便秘改善程度、生活活动能力、中医证候积分等项目进行比较。结果 观察组患者便秘改善程度、生活活动能力、中医证候改善均优于对照组,两者比较差异有统计学意义(P<0.05)。结论 应用济川煎加减结合贴穴能有效治疗帕金森病患者便秘,并对帕金森病其他症状有正向调节作用,能提高该类患者生存质量。

Objective To investigate the clinical effect of Jichuanjian decoction and acupoint application on the treatment of constipation in Parkinson's disease. Methods 64 patients with constipation in Parkinson's disease were randomly divided into two groups. 32 patients were treated with Mosapride in control group. 32 patients were treated with Jichuanjian decoction and acupoint application in treatment group.The clinical effects were compared in the two groups. Results The clinical effects of the treatment group were better and the differences were statistical significance (P<0.05). Conclusion The treatment of constipation in Parkinson's disease with Jichuanjian decoction and acupoint application had a significant effect.

目的 探究磁敏感加权成像(SWI)对帕金森病(PD)与血管性帕金森综合征(VPS)的鉴别诊断价值。方法 回顾性分析我院2013年1月—2016年12月收治的30例PD患者(PD组)和30例VPS患者(VPS)组SWI分析结果,比较两组患者的脑椎体外系各核团的相位值差异,同时将两组患者的测量值与来我院行常规体检的正常者作为对照组进行测量比较。结果 PD组患者的黑质致密带(SNc)、苍白球(GP)、壳核(PUT)相位值较VPS组、对照组更低,组间数据对比有差异(P<0.05);而对照组的SNc、GP、PUT的相位值与VPS组相比无差异(P>0.05);三组对象的红核(RN)、尾状核(CN)测量值无差异(P>0.05);采用Hoehn&Yahr对PD患者和VPS进行分级后发现,各级PD患者SNc相位值之间差异均有统计学意义(P＜0.05),VPS组Ⅰ~Ⅱ级、III级与IV级患者相比,SNc、PUT、尾状核(CN)有统计学差异(P<0.05),而RN相位值无差异(P>0.05)。结论 采用磁敏感加权成像对PD患者和VPS患者的椎体外系各核团的相位值进行测量,能对两者的鉴别起到较大的参考价值。

Objective To explore the value of magnetic susceptibility weighted imaging (SWI) in the differential diagnosis of Parkinson's disease (PD) and vascularized Parkinson's syndrome (VPS). Methods The results of SWI analysis of 30 patients with PD (PD) and 30 patients with VPS (VPS) from January 2013 to December 2016 were retrospectively analyzed. The results were compared between the two groups. Of the phase value of the difference between the two groups of patients with the measured values and routine examination of our hospital as a control group for comparison. Results The phase values of the substantia nigra (SNc), globus pallidus (GP) and crustal nucleus (PUT) were significantly lower in the PD group than in the VPS group and the control group (P <0.05).There was no significant difference in the GP and PUT values between the control group and the VPS group (P> 0.05).There was no significant difference in the red nuclei (RN) between the three groups (P> 0.05).There was significant difference in SNc phase values between PD patients at all levels (P <0.05). Compared with patients with grade IV, grade I and II were higher than those of patients with grade IV (P <0.05), and the difference was statistically significant (P <0.05) between PD patients and VPS. (P <0.05), but there was no significant difference (P> 0.05) between the PUT and the caudate nucleus (CN). Conclusion The phase value of the nucleus of the vertebral body in PD patients and VPS patients was measured by magnetic susceptibility weighted imaging, which could be used as a reference for the identification of the two.

目的 应用Synapsys人体姿势平衡系统对早期帕金森病(Parkinson's disease, PD)患者姿势障碍定量测试评价效果分析。方法 收集我院神经内科2015年7月-2016年7月收治的早期PD患者52例,随机分为试验组和对照组,每组26例。两组患者均给予常规治疗措施,试验组在常规治疗基础上给予康复治疗措施,最后两组均使用Synapsys人体姿势平衡系统和Berg平衡量表对患者进行评估和训练,观察测试结果。结果 干预前动态和静态异常比例组间差异无统计学意义(P>0.05);干预后试验组动态和静态异常分别为34.62%、30.77%,低于对照组的69.23%、73.08%,差异有统计学意义(P<0.05);干预前Berg平衡量表评分组间差异无统计学意义(P>0.05),干预后试验组评分高于对照组,差异有统计学意义(P<0.05);干预后两组Berg平衡量表评分均升高,其中试验组干预前后比较差异有统计学意义(P<0.05)。结论 应用Synapsys人体姿势平衡系统对早期PD患者姿势障碍准确定量测试,以评价康复效果,并且对于康复治疗具有重要作用。

Objective To analyze the clinical effects of quantitative test on early Parkinson's patients who suffering in postural disorders by using synapsys posturography system (SPS). Methods 52 cases of early Parkinson's patients who treated in our department of neurology from July 2015 to July 2016 were collected and divided into experimental and control groups randomly, 26 cases in each group. During the treatment, cases in experimental group and control group received the same conventional treatments. Meanwhile, on the base of conventional treatments, the cases in experimental group also received recovery therapy. Finally, the clinical effects of different treatments in two groups were evaluated by using SPS and Berg balance scale (BBS). Results Before intervention, the dynamic and static abnormal proportion between two groups had no significant difference (P>0.05); However, after the intervention, dynamic and static abnormal proportion in experimental group were 34.62%、30.77%, respectively, which was lower than those in control group (Dynamic: 69.23%; Static:73.08%), and the difference was significant (P<0.05); In addition, the result of BBS showed there was no difference between the experimental group and control group before intervention (P>0.05), while the scores of BBS in experimental group was higher than that in control group after intervention, and the difference was significant (P<0.05); At the same time, the scores of BBS in each group were both increased after the intervention, especially in the experimental group, and the difference in experimental group was significant (P<0.05). Conclusion The quantitative test on early Parkinson's patients who suffering in postural disorders can perform accurately by using synapsys posturography system. And the synapsys posturography system can also evaluate the recovery effects, which is important for the recovery treatment.

        目的   探讨帕金森病（PD）患者执行功能障碍与脑小血管病（CSVD）总负荷的关系。方法   回顾性分析2020年1月1日—2024年6月30日在佛山市第一人民医院住院的156例PD患者收集患者的临床资料，包括性别、年龄、教育年限、高血压病史等，采用简易精神状态量表（MMSE）、蒙特利尔认知评估量表（MoCA）评估认知功能以及采用额叶功能评定表（FAB）评估执行功能。根据患者的认知功能和执行功能评定结果，将156例患者分为PD认知功能正常（PD-NC）组、PD执行功能异常组（PD-EF）和PD非执行功能异常组（PD-NEF）。所有研究对象均行头颅磁共振检查，行CSVD总负荷的评分。比较3组患者一般临床资料、CSVD及其标志物的差异。结果  PD-EF组的年龄、病程、H-Y分期、脑室周围白质高信号（PVWMH）、皮层下白质高信号（DWMH）、腔隙性脑梗死（LI）、CSVD 总负荷评分高于PD-NEF组、PD-NC组，差异均有统计学意义（均P＜0.05）。Spearman相关性分析结果显示，PD患者FAB评分与PWMH评分、DWMH评分、LI数目、CSVD总负荷评分均呈负相关（均P＜0.05）。多元线性回归分析显示，PD患者FAB评分越低，DWMH评分、LI数目、CSVD总负荷评分均越高（均P＜0.05）。结论  PD患者执行功能障碍和CSVD总负荷相关。

       Objective  To explore whether total burden of cerebaral small vessel disease（CSVD）detected with MRI was associated with the executive functions in patients with Parkinson's disease（PD）．Methods  In total，156 patients with PD in First People’s Hospital of Foshan from January 2020 to June 2024 were retrospectively enrolled．Detailed clinical data were obtained．The clinical data of all the patients such as age，gender，years of education，hypertension history were collected．The MiniMental State Examination（MMSE）and the Montreal Cognitive Assessment Scale（MoCA）were used to assess cognitive function，the Frontal Assessment Battery（FAB）was used to assess executive function．According to the function levels，all cases were divided into PD with normal cognition（PD-NC）group，PD with executive function（PD-EF）and PD with non-executive function（PD-NEF）．All the patients underwent brain MRI to determine the presence and burden of CSVD，scoring between 0 and 4．Results  The age，course of disease，Hoehn-Yahr staging，the scores of periventricular white matter hyperintensities（PWMH），the scores of deep subcortical white matter hyperintensities（DWMH），the numbers of lacunar infarcts（LI），the CSVD scores were significantly higher in the patients of PD-EF group than PD-NC group and PD-NEF group（P＜0.05）．Spearman’s correlation analysis showed that FAB scores had a significant correlation with scores of PWMH，the scores of DWMH，the numbers of LI，and the CSVD burden scores（P＜0.05）．Multivariable analysis showed that there was a significant negative correlation between FAB scores and the scores of DWMH，the numbers of LI，the CSVD scores．Conclusions  The total MRI CSVD burden was associated with the executive functions in patients with PD in this study．