| Objective : To evaluate the clinical efficacy of Chaihu-jia-Longgu-Muli-Decoction(CLMD)in the treatment of patients with Parkinson's disease and depression(PDD),a simple randomized case-control clinical study was conducted.The relationship between TCM syndromes and metabolomics of PDD was also discussed.To clarify the pathogenesis of PDD and the treatment mechanism of traditional Chinese medicine,supplement and improve the diagnostic and evaluation criteria of PDD.Methods:1.Clinical study: A total of 50 patients were randomly divided into CLMD+PHT group(dobasilic hydrazine tablet+pramipexol tablet+CLMD)and PHT group(dobasilic hydrazine tablet+pramipexol tablet).PDD patients were observed by TCM syndrome score scale,Parkinson's disease comprehensive score scale(UPDRS),Hamilton depression scale(HAMD),Beck depression self-rating scale(BDI)after 6 and 12 weeks of treatment.The influence of TCM clinical efficacy index and its adverse reactions.Metabonomics study: Urine samples from 50 patients before treatment were divided into PDD group.Urine samples after 12 weeks of treatment were divided into CLMD +PHT group and PHT group.Urine samples from 25 healthy people were collected and divided into blank control group.The changes of urinary metabolites in all samples were detected by nuclear magnetic resonance(1H-NMR)metabonomics.The differential metabolites were analyzed by multivariate statistical analysis.The mechanism of the changes of endogenous metabolites was analyzed.The data were analyzed to explore the mechanism of CLMD in the treatment of PDD.Results:1.Clinical research:(1)The age distribution,sex composition and HY(Hoehn &Yahr)grading data of two groups of PDD patients were in accordance with normal distribution.Compared with PHT group,CLMD + PHT group had no statistical difference in age,sex,HY grading and depression grade(P > 0.05),which met the requirements of medical statistics and was comparable,and could be used for follow-up trials.(2)TCM syndrome score: CLMD+PHT group and PHT group had significantdifference in TCM syndrome score after 6W and 12 W treatment compared with before treatment(P < 0.01),suggesting that both groups of patients had certain improvement in TCM syndrome after different treatment methods.There was no significant difference in TCM syndrome score and treatment efficiency between the two groups after 6 weeks of treatment(P > 0.05),and the scores and efficiency of the two groups after 12 weeks of treatment were significantly better than those of the PHT group(P < 0.05).(3)UPDRS scale score: Compared with before treatment,UPDRS score of CLMD+PHT group and PHT group had significant statistical difference after 6W and 12 W treatment(P < 0.05),suggesting that Parkinson's symptoms of the two groups were improved to some extent after receiving different treatment methods.There was no significant difference in UPDRS score between the two groups after 6 and 12 weeks of treatment(P > 0.05);the UPDRS effective rate of CLMD + PHT group was higher than that of PHT group after 12 weeks of treatment(P < 0.05),suggesting that CLMD + PHT group had better long-term therapeutic effect than PHT group.(4)HAMD scale: HAMD scores of CLMD+PHT group and PHT group were significantly different after 6W and 12 W treatment compared with before treatment(P <0.01),suggesting that depressive symptoms of patients in both groups were significantly improved after receiving different treatment methods.There was no significant difference in HAMD score and efficiency between the two groups after 6 weeks of treatment(P >0.05);there was significant difference in HAMD score and efficiency between the two groups after 12 weeks of treatment(P < 0.05),suggesting that the depressive symptoms of CLMD + PHT group improved significantly after 12 weeks of treatment,and the therapeutic effect was better than that of PHT group.(5)BDI scale: The BDI scores of CLMD+PHT group and PHT group after 6 and 12 weeks treatment were significantly different from those before treatment(P < 0.01),suggesting that the symptoms of self-conscious depression in the two groups were significantly improved after treatment.There were significant differences in BDI scores and treatment efficiency between the two groups after 6 and 12 weeks of treatment(P <0.05),suggesting that CLMD + PHT group had a better improvement in patients' self-conscious depressive symptoms than PHT group.2.Metabonomics:(1)Seven biomarkers were found between the blank control group and PDD group,namely creatinine,citric acid,pyruvic acid,taurine,glycine,dimethylamine and trimethylamine oxide.Compared with the blank control group,the contents of taurine and creatinine in urine samples of PDD group decreased,while the contents of citric acid,pyruvic acid,glycine,dimethylamine and trimethylamine oxide increased.(2)The metabolic markers in PHT group and CLMD+PHT group were reversed in varying degrees after 12 weeks of treatment.Citric acid,creatinine,taurine and pyruvic acid in PHT group were significantly reversed,while all metabolic markers in CLMD+PHT group were significantly reversed.(3)Compared with PHT group,CLMD+PHT group had stronger callback effect on metabolites.Except for glycine,the callback effect of other metabolites had significant difference.Conclusion:1.The urine of patients with PDD mainly includes seven biomarkers: creatinine,taurine,citric acid,dimethylamine,glycine,pyruvic acid and trimethylamine oxide.The pathogenesis of PDD should be related to the abnormalities of energy metabolism,neurotransmitter metabolism and lipid metabolism.2.Bupleurum and Longgu Oyster Decoction can enhance the effect of pramipexole tablets combined with dopazide tablets on the recovery of multiple biomarkers of PDD,and effectively alleviate the depressive symptoms of PDD patients.3.The possible therapeutic mechanism of Chaihu Jialonggu Oyster Decoction on PDD lies in the regulation of energy metabolism,neurotransmitter metabolism and lipid metabolism.4.The urine of patients with PDD mainly includes seven biomarkers,such as creatinine,taurine,citric acid,dimethylamine,glycine,pyruvic acid and trimethylamine oxide.The pathogenesis of PDD should be related to the abnormalities of energy metabolism,neurotransmitter metabolism and lipid metabolism.5.Bupleurum and Longgu Oyster Decoction can enhance the effect of pramipexole tablets combined with dopazide tablets on the recovery of multiple biomarkers of PDD,and effectively alleviate the depressive symptoms of PDD patients.6.The possible therapeutic mechanism of Chaihu Jialonggu Oyster Decoction on PDD lies in the regulation of energy metabolism,neurotransmitter metabolism and lipid metabolism. |
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