多巴胺受体位于突触后膜,具有多种亚型。其中麦角类和非麦角类多巴胺受体激动剂 可以选择性作用多巴胺受体不同亚型,达到左旋多巴类似的生理学作用,但在单独应用时 疗效欠理想、并且费用较高,同样伴随症状波动以及并发症的发生[10]。另一种治疗帕金森的药物是抗胆碱能药物,抗胆碱能药物主要通过调节乙酰胆碱的活性,来改善帕金森病患者的运动功能,但是使用后往往出现认知功能下降等并发症[11]。同样治疗帕金森的儿茶酚-O-甲基转移酶催化多巴胺转变成3-甲氧酪胺,3-甲氧酪胺随后经单胺氧化酶-B氧化转化为高香草酸,导致体内多巴胺的消耗[12]。因此,单胺氧化酶-B型抑制剂以及儿茶酚-O-甲基转移酶抑制剂均能通过阻止多巴胺的降解,间接使体内多巴胺的水平增加,从而有效地改善患者运动障碍等并发症的出现,并且具有潜在的神经保护作用[13]。虽然治疗帕金森病药物的联合应用能够作用于多个靶点,在帕金森早期症状上如运动波动、运动障碍等并发症,确实有显著的治疗效果,但随着用药时间和剂量的增加会出逐渐现耐受作用,药物的治疗效果逐渐下降,并且还可能促进精神障碍、自主神经功能障碍等非运动症状的发生[14]。西药治疗帕金森短期内或许效果明显但其长期的使用引发的副作用丝毫不比帕金森本身对患者的伤害低,而利用中药既能有效减缓帕金森的发病进程,其药理毒副作用也比西药来的要小[15]。
临床治疗中中医结合西药治疗帕金森比单一运用某一药物治疗帕金森具有更好的疗效,其中归芍地黄丸在临床治疗中具有显著的疗效,极大程度上延缓了帕金森病的发病进程。归芍地黄丸的组方中地黄现代药理具有抗氧化、镇静作用,能有效降低代谢率,减少氧耗量,其中地黄寡糖可促进骨髓红系母细胞的增殖,增加红细胞数及血红蛋白含量,利 于携氧[16],携带氧气量提升可以提高脑部的活力对于帕金森的疾病发展可能具有阻碍作 用。茯苓多糖的现代药理作用可促进造血、提高血清中SOD活性,减少MDA含量,增强机体抗氧化损伤和抗衰老能力[17]。而帕金森的致病机理中包含了氧化应激,茯苓多糖 的药理作用上能够应对该机理,并且茯苓多糖还具有催眠作用,可降低代谢率,而帕金森的并发症中也包括失眠,长期的睡眠不足会使人的免疫力下降,茯苓多糖包含的药理作用正是对症下药在一定程度上减轻病痛。
网络药理学是基于数据分析及研究药物有效成分、靶点与疾病间的复杂关系,从这一 复杂生物网络的角度理解病证和药物作用机制的新兴学科,涵盖了中药、生物靶点、证候、疾病等多种因素,具有中医药“整体观”的特性[24]。
图2 归芍地黄丸治疗PD机制图
参考文献
[1] Xu L, Wang Z, Li Q. Global trends and projections of Parkinson’s disease incidence: a 30-year analysis using GBD 2021 data [J]. Journal of Neurology, 2025, 272 (4): 286.
[2] Riboldi GM, Frattini E, Monfrini E, et al. A practical approach to early-onset parkinsonism[J]. journal of parkinson's disease, 2021, 12 (1): 1-26.
[3] Alvarez M M, Herrera C G, Martínez O F M, et al. A Comprehensive Approach to Parkinson’s Disease: Addressing Its Molecular, Clinical, and Therapeutic Aspects [J]. International Journal of Molecular Sciences, 2024, 25 (13): 7183.
[4] Wu Y, Bai Y, Lu Y, et al. Transcriptome sequencing and network pharmacology-based approach to reveal the effect and mechanism of Ji Chuan Jian against Parkinson's disease[J]. BMC Complement Med Ther, 2023, 23 (1): 182.
[5] Höglinger U G, Adler H CBerg D, et al. A biological classification of Parkinson's disease: the SynNeurGe research diagnostic criteria [J]. The Lancet Neurology, 2024, 23 (2): 191-204.
[6]Jiashuo WU, Fangqing Z, Zhuangzhuang LI, et al. Integration strategy of network pharmacology in Traditional Chinese Medicine: a narrative review[J]. J Tradit Chin Med, 2022, 42 (3): 479-486.
[7] Jin X, Dong W, Chang K, et al. Research on the signaling pathways related to the intervention of traditional Chinese medicine in Parkinson's disease:A literature review[J]. Journal of ethnopharmacology, 2024, 326: 117850.
[8] Norma C T M, Musa M. MPTP-induced mouse model of Parkinson's disease: A promising direction of therapeutic strategies[J]. Bosnian journal of basic medical sciences, 2020, 21 (4): 422-433.
[9] LIU T, GUO D, WEI J. The pathogenesis of Parkinson’s disease and crosstalk with other diseases [J]. BIOCELL, 2024, 48 (8): 1155-1179.
[10] Liu G, Chen H, Su D, et al. Risk thresholds of levodopa dose for dyskinesia in Chinese patients with Parkinson's disease: a pilot study[J]. Neurol Sci, 2020, 41 (1): 111-118.
[11] Malkiewicz JJ, Kasprzyk AG, Waksmundzki D, et al. Risk factors for dementia in Parkinson's Disease - the overuse of anticholinergic drugs[J]. Neurol Neurochir Pol, 2023, 57 (5): 405-413.
[12] Peter J, Francisco J R, J J F, et al. Redefining the strategy for the use of COMT inhibitors in Parkinson’s disease: the role of opicapone[J]. Expert Review of Neurotherapeutics, 2021, 21 (9): 1019-1033.
[13] Binde CD, Tvete IF, Gåsemyr JI, et al. Comparative effectiveness of dopamine agonists and
monoamine oxidase type-B inhibitors for Parkinson's disease: a multiple treatment comparison meta-analysis[J]. Eur J Clin Pharmacol, 2020, 76 (12): 1731-1743.
[14] 任华, 李亚梅, 李保存等. 激素联合归芍地黄丸和玉屏风散序贯治疗肝肾阴虚型小儿肾病 综合征疗效观察[J]. 现代中西医结合杂志, 2020, 29 (11): 1204-1207.
[15] Bian Z, Zhang R, Zhang X, et al. Extraction, structure and bioactivities of polysaccharides
from Rehmannia glutinosa: A review[J]. J Ethnopharmacol, 2023, 305: 116132.
[16] Fahim M, Yan L, Yongtao Z, et al. Antioxidative role of Traditional Chinese Medicine in Parkinson's disease[J]. Journal of Ethnopharmacology, 2022, 285: 114821.
[17] Xu H, Wang S, Jiang Y, et al. Poria cocos Polysaccharide Ameliorated Antibiotic-Associated Diarrhea in Mice via Regulating the Homeostasis of the Gut Microbiota and Intestinal Mucosal Barrier[J]. Int J Mol Sci, 2023, 24 (2): 1423.
[18] Rui W, Yanfang L, Fang Z, et al. Protective mechanism of Paeonol on central nervous system[J]. Phytotherapy research: PTR, 2024, 38 (2): 470-488.
[19] Xia B, Ding J, Li Q, et al. Loganin protects against myocardial ischemia-reperfusion injury
by modulating oxidative stress and cellular apoptosis via activation of JAK2/STAT3 signaling[J]. Int J Cardiol, 2024, 395: 131426.
[20] 祁建宏, 董芳旭. 丹皮酚现代药理作用及其机制研究进展[J]. 北京联合大学学报, 2023, 37 (02): 72-78.
[21] Mingyue S, Ruixin C, Zhedong L, et al. The Molecular Mechanism of Yam Polysaccharide Protected H2O2-Induced Oxidative Damage in IEC-6 Cells[J]. Foods, 2023, 12 (2): 262.
[22] Dong X, Huang R. Ferulic acid: An extraordinarily neuroprotective phenolic acid with anti-
depressive properties[J]. Phytomedicine, 2022, 105: 154355.
[23] Hong H, Lu X, Wu C, et al. A review for the pharmacological effects of paeoniflorin in the
nervous system[J]. Front Pharmacol, 2022, 13: 898955.
[24] Zhao L, Zhang H, Li N, et al. Network pharmacology, a promising approach to reveal the pharmacology mechanism of Chinese medicine formula[J]. J Ethnopharmacol, 2023, 309: 116306.
[25] Li S ,Xiao W. General expert consensus on the application of network pharmacology in the research and development of new traditional Chinese medicine drugs. [J]. Chinese journal of natural medicines, 2025, 23 (2): 129-142.