【摘要】 目的 观察柴胡加龙骨牡蛎汤加减方治疗帕金森病(PD)患者非运动症状的临床疗效及对PD患者肠道菌群的影响。方法 将36例PD患者按照随机区组法分为2组，对照组18例(后脱落1例)予抗PD西药治疗，治疗组18例(后脱落2例)在对照组治疗基础上加服柴胡加龙骨牡蛎汤加减方，2组均治疗4周。比较2组治疗前后非运动症状评价量表(NMSS)、帕金森病睡眠量表(PDSS)、汉密尔顿焦虑量表(HAMA)、便秘患者生活质量评价量表(PAC-QOL),治疗前后采集患者粪便标本，通过16s-rRNA测序法确定微生物种类并进行微生物分类分析。结果 (1)治疗组治疗后PDSS评分较本组治疗前升高(P<0.05),对照组治疗后HAMA评分较本组治疗前升高(P<0.05),治疗组治疗后NMSS、HAMA、PAC-QOL评分均低于对照组(P<0.05),PDSS评分高于对照组(P<0.05)。(2)在菌群组成方面，治疗4周后，治疗组弯曲菌科、巨单胞菌属、肠杆菌属等相对丰度较对照组升高(P<0.05),普雷沃氏菌科、克里斯滕森菌科、脱卤杆菌属、普雷沃氏菌属等相对丰度较对照组下降(P<0.05);组内比较，治疗组李斯特氏菌科、盐单胞菌科、盐单胞菌属、环丝菌属等相对丰度较治疗前升高(P<0.05)。(3)相关性分析表明，在属水平上，巨单胞菌属丰度与NMSS、PAC-QOL评分呈负相关性(r=-0.34,P=0.006;r=-0.26,P=0.04);嗜胆菌属、克里斯滕森菌属丰度与PDSS评分呈正相关性(r=0.32,P=0.01;r=0.48,P=0.00);柠檬酸杆菌属丰度与PAC-QOL评分呈负相关性(r=-0.30,P=0.01);罗尔斯通菌属丰度与HAMA评分呈正相关性(r=0.27,P=0.03)。结论 柴胡加龙骨牡蛎汤加减方联合抗PD西药可显著改善PD患者的整体非运动症状，对焦虑抑郁、睡眠障碍、便秘疗效确切，同时上调人体益生菌丰度，抑制致病菌生长，对肠道菌群具有调节作用。更多还原

【Abstract】 Objective To observe the clinical efficacy of supplemented formule of ChaihuLongguMuli Decoction(CLMD) in the treatment of non-motor symptoms in patients with Parkinson’s disease(PD)and its effect on intestinal flora. Methods A total of 36 PD patients were enrolled in this study and were randomly divided into two groups, including: treatment group(18 patients) and control group(18 patients). Patients in control group(1 patient with posterior detachment) received western medicine treatment for PD. On the basis of treatment in control group, patients in treatment group(2 patients with posterior detachment) received supplemented formule of CLMD.Both groups were treated for 4 weeks. The scores of Non-motor Symptoms Scale(NMSS), Parkinson’s Disease Sleep Scale(PDSS), Hamilton Anxiety Scale(HAMA), Patient Assessment of Constipation Quality of Life Scale(PAC-QOL), before and after treatment in two groups were compared. Fecal samples of patients were collected before and after treatment, respectively, and microbiota compositions were identified and classified by 16s rRNA-sequencing.Results(1)After treatment, PDSS scores in treatment group increased obviously compared to before treatment(P<0.05). HAMA scores in control group increased remarkably after treatment(P<0.05). NMSS, HAMA, PAC-QOL scores in the treatment group were significantly lower than those in the control group, whereas PDSS scores were obviously higher than the control group(P<0.05).(2)In terms of flora composition, after 4 weeks of treatment, the relative abundance of Campylobacter, Megamonas, Enterobacteriaceaein the treatment group increased, while Prevaliaceae, Christenseniaceae, Dehalobacter, Prevaliella decreased.Meanwhile, the relative abundance of Listeria, Halomonas, and Cyclomycetes in the treatment group after treatment were higher than before treatment.(3)Correlation analysis showed that at the genus level, the abundance of Macromonas was negatively correlated with NMSS and PAC-QOL scores(r=-0.34, P=0.006;r=-0.26,P=0.04). There was a positive correlation between the abundance of Cholerophilic and Christensenella and PDSS score(r=0.32, P=0.01; r=0.48,P=0.00). The abundance of Citrobacter was negatively correlated with PAC-QOL scores(r=-0.30,P=0.01). The abundance of Ralstonia was positively correlated with HAMA score(r=0.27,P=0.03). Conclusion The supplemented formula of CMLD combined with PD westernmedicine treatment can significantly improve the overall non-motor symptoms of PD patients, and has a definite effect on anxiety, depression, sleep disorders and constipation. In addition, it can increase the abundance of human probiotics, inhibit the growth of pathogenic bacteria, and regulate intestinal flora.更多还原