通窍活血汤治疗瘀血内阻型血管性认知障碍的临床观察
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摘要
目的:观察通窍活血汤治疗瘀血内阻型血管性认知障碍的临床疗效,探讨其作用机制。方法:将符合纳入标准的60例中医辨证为瘀血内阻型血管性认知障碍患者随机分为治疗组和对照组,每组各30例。基于内科基础治疗的同时,对照组予以盐酸多奈哌齐口服,起始量5 mg·d~(-1),4周后加至10 mg·d~(-1)。治疗组在服用盐酸多奈哌齐的同时服用通窍活血汤,两组均治疗3个月,采用证候积分评价其症状变化,简易精神量表(MMSE)评价患者认知功能,日常生活能力量表(ADL)评价患者日常生活能力,颅脑磁共振动脉自旋标记灌注技术(MRI-ASL)检查了解局部血流灌注情况(CBF值)的变化,全自动生化分析仪测定血浆同型半胱氨酸水平。结果:(1)与本组治疗前相比,治疗组中医证候评分(SDSVD)改善明显(P <0. 05),组间比较治疗组改善程度明显优于对照组(P <0. 05);(2)患者的认知能力及日常生活能力较本组治疗前明显提高,2组MMSE评分及ADL评分较本组治疗前显著改善(P <0. 01),治疗组改善程度优于对照组(P <0. 05);(3)治疗组治疗后CBF值明显高于本组治疗前(P <0. 05)及对照组(P <0. 01);(4)治疗后治疗组血浆同型半胱氨酸水平较对照组明显下降(P <0. 05)。结论:通窍活血汤加减联合盐酸多奈哌齐能有效改善瘀血阻窍型血管性痴呆患者的认知能力、日常生活能力,改善其脑血流灌注及降低同型半胱氨酸水平,值得临床推广。
Objective: This study aims to observe the clinical efficacy of Tongqiao Huoxuetang in treating blood stasis resistance type vascular cognitive impairment,and explore its mechanism of action. Method: A total of 60 patients who met the inclusion standards and were diagnosed as blood stasis resistance type vascular cognitive impairment were randomly divided into treatment group and control group,30 patients in each group. Donepezil hydrochloride was administered orally in control group based on internal medicine treatment at an initial dose of 5 mg/day,changed to 10 mg/day 4 weeks later. Patients in treatment group additionally received Tongqiao Huoxuetang based on donepezil hydrochloride. Both groups were treated for 3 months. Changes of symptoms were assessed by syndrome scores; cognitive function was assessed by the mini-mental scale( MMSE); daily living ability was assessed by the activity of daily living scale( ADL),and changes of local blood perfusion( CBF value)was assessed by brain magnetic resonance perfusion imaging arterial spin labeling( MRI-ASL). Changes of homocysteine levels in plasma were measured by using an automated biochemical analyzer. Result:(1) The values of traditional Chinese medicine( TCM) syndrome scores( SDSVD) were significantly improved in both groups after treatment,and the improvement was more obvious than that of control group( P < 0. 05).(2) The cognitive ability and daily living ability of the patients were significantly improved; the MMSE scores and ADL scores were improved significantly in both groups after treatment( P < 0. 01),and improvement in treatment group was more obvious than that of control group( P < 0. 05).(3) The CBF value in treatment group was significantly higher after treatment( P < 0. 05),and also higher than that in control group( P < 0. 01).(4) Homocysteine level in plasma of treatment group was significantly lower than that of control group( P < 0. 05). Conclusion: The combination of Tongqiao Huoxuetang combined with donepezil hydrochloride can effectively improve the cognitive ability and daily living ability of the patients with vascular dementia,improve the cerebral blood flow perfusion and decrease the level of homocysteine,so it is worth popularizing in clinical practice.
Objective: This study aims to observe the clinical efficacy of Tongqiao Huoxuetang in treating blood stasis resistance type vascular cognitive impairment,and explore its mechanism of action. Method: A total of 60 patients who met the inclusion standards and were diagnosed as blood stasis resistance type vascular cognitive impairment were randomly divided into treatment group and control group,30 patients in each group. Donepezil hydrochloride was administered orally in control group based on internal medicine treatment at an initial dose of 5 mg/day,changed to 10 mg/day 4 weeks later. Patients in treatment group additionally received Tongqiao Huoxuetang based on donepezil hydrochloride. Both groups were treated for 3 months. Changes of symptoms were assessed by syndrome scores; cognitive function was assessed by the mini-mental scale( MMSE); daily living ability was assessed by the activity of daily living scale( ADL),and changes of local blood perfusion( CBF value)was assessed by brain magnetic resonance perfusion imaging arterial spin labeling( MRI-ASL). Changes of homocysteine levels in plasma were measured by using an automated biochemical analyzer. Result:(1) The values of traditional Chinese medicine( TCM) syndrome scores( SDSVD) were significantly improved in both groups after treatment,and the improvement was more obvious than that of control group( P < 0. 05).(2) The cognitive ability and daily living ability of the patients were significantly improved; the MMSE scores and ADL scores were improved significantly in both groups after treatment( P < 0. 01),and improvement in treatment group was more obvious than that of control group( P < 0. 05).(3) The CBF value in treatment group was significantly higher after treatment( P < 0. 05),and also higher than that in control group( P < 0. 01).(4) Homocysteine level in plasma of treatment group was significantly lower than that of control group( P < 0. 05). Conclusion: The combination of Tongqiao Huoxuetang combined with donepezil hydrochloride can effectively improve the cognitive ability and daily living ability of the patients with vascular dementia,improve the cerebral blood flow perfusion and decrease the level of homocysteine,so it is worth popularizing in clinical practice.
引文
[1]中华医学会神经病学分会痴呆与认知障碍学组写作组.血管性认知障碍诊治指南[J].中华神经科杂志,2011,44(2):142-147.
[2]祁秀峰.尤瑞克林治疗血管性认知障碍的临床疗效观察[J].实用药物与临床,2017,20(7):801-805.
[3]缪峰,李慧琪,袁有才.补肾化痰颗粒配合西药治疗血管性痴呆疗效观察[J].陕西中医,2015,36(4):421-423.
[4]高风超,陈翔,田新英.血管性痴呆危险因素及发病机制的研究进展[J].医学综述,2014,20(6):1068-1071.
[5]张伯礼,吴勉华.中医内科学[M].北京:中国中医药出版社,2017:156-162.
[6]江颖,陆晖,方兴,等.通窍活血汤联合阿司匹林治疗缺血性脑卒中的疗效观察[J].中国实验方剂学杂志,2016,22(8):187-190.
[7]葛朝亮,王鑫铭,李飞龙,等.通窍活血汤对血管性痴呆大鼠学习记忆功能及海马神经元细胞内钙离子浓度的影响[J].中国药学杂志,2015,50(8):671-675.
[8]赵斌.磁共振灌注成像临床应用及进展[J].磁共振成像,2014,5(s1):46-50.
[9]杨淑贞,朱小华.脑血流灌注显像在缺血性脑血管病中的应用[J].中国现代医药杂志,2015,17(5):108-112.
[10]田金洲,韩明向,涂晋文,等.血管性痴呆的诊断、辨证及疗效判定标准[J].北京中医药大学学报,2000,23(5):16-24.
[11]高明月,杨珉,况伟宏,等.简易精神状态量表得分的影响因素和正常值的筛查效度评价[J].北京大学学报:医学版,2015,47(3):443-449.
[12]李孟宇,程肖蕊,周文霞,等.梓醇防治阿尔茨海默病作用研究进展[J].国际药学研究杂志,2016,43(2):199-204.
[13]中华人民共和国卫生部.中药新药临床研究指导原则[M].北京:中国医药科技出版社,2002:29-32.
[14] GAO Y Z,ZHANG J J,LIU H,et al. Regional cerebral blood flow and cerebrovascular reactivity in Alzheimer's disease and vascular dementia assessed by arterial spinlabeling magnetic resonance imaging[J].Curr Neurovasc Res,2013,10(1):49-53.
[15] Banerjee S,Neveu P,Kosik K S. A coordinated local translational control point at the synapse involving relief from silencing and MOV10 degradation[J]. Neuron,2009,64(6):871-884.
[16] Cubinkova V, Valachova B, Uhrinova I, et al.Alternative hypotheses related to Alzheimer's disease[J]. Bratisl Med J,2018,119(4):210-216.
[17] LI C,Engstr9m G,Berglund G,et al. Incidence of ischemic stroke in relation to asymptomatic carotid artery atherosclerosis in subjects with normal blood pressure[J]. Cerebrovasc Di,2008,26(3):297-303.
[18] Douglas G, Channon K M. The pathogenesis of atherosclerosis[J]. Medicine,2010,38(8):397-402.
[19] Sreckovic B, Sreckovic V D, Soldatovic I, et al.Homocysteine is a marker for metabolic syndrome and atherosclerosis[J]. Diabetes Metab Syndr,2017,11(3):179-182.
[20] Sudduth T L,Weekman E M,Price B R,et al. Timecourse of glial changes in the hyperhomocysteinemia model of vascular cognitive impairment and dementia(VCID)[J]. Neuroscience,2017,341:42-51.
[21] Stein C,Hopfeld J,Lau H,et al. Effects of ginkgo biloba extract EGb 761,donepezil and their combination on central cholinergic function in aged rats[J]. J Pharm Pharm Sci,2015,18(4):634-646.
[22] LI M Q,ZHANG W W,CHEN T,et al. Evaluation of medication treatment for Alzheimer's disease on clinical evidence[J]. Chin Contemp Neuro Neurosurg,2014,14(3):192-197.
[23] Shimizu S,Kanetaka H,Hirose D,et al. Differential effects of acetylcholinesterase inhibitors on clinical responses and cerebral blood flow changes in patients with Alzheimer's disease:a 12-month,randomized,and open-label trial[J]. Dement Geriatr Cogn Dis Extra,2015,5(1):135-146.
[24] Noguchi T,Kawashima M,Irie H,et al. Arterial spinlabeling MR imaging in moyamoya disease compared with SPECT imaging[J]. Eur J Radiol,2011,80(3):e557-e562.
[25]张晶,付旷.磁共振动脉自旋标记灌注成像技术在脑部疾病中的应用进展[J].脑与神经疾病杂志,2015,23(2):155-157.
[26] Sprezak K,Urbanik A. The value of arterial spin-labeled perfusion magnetic resonance imaging(ASL)in cerebral ischemia[J]. Przegl Lek,2013,70(5):319-327.
[27]莫恭晓,蔡慧,韦邱梦,等.赤芍总苷对失血性休克大鼠血流动力学影响[J].中国临床药理学杂志,2016,32(23):2156-2160.
[28]罗伟华.川芎嗪的临床应用及其制剂研究进展[J].中国现代药物应用,2017,11(18):191-193.
[29]秦劭晨,梁伟雄,温晓文,等.注射用羟基红花黄色素A治疗急性缺血性中风血瘀证疗效观察[J].中国实验方剂学杂志,2016,22(21):157-161.
[2]祁秀峰.尤瑞克林治疗血管性认知障碍的临床疗效观察[J].实用药物与临床,2017,20(7):801-805.
[3]缪峰,李慧琪,袁有才.补肾化痰颗粒配合西药治疗血管性痴呆疗效观察[J].陕西中医,2015,36(4):421-423.
[4]高风超,陈翔,田新英.血管性痴呆危险因素及发病机制的研究进展[J].医学综述,2014,20(6):1068-1071.
[5]张伯礼,吴勉华.中医内科学[M].北京:中国中医药出版社,2017:156-162.
[6]江颖,陆晖,方兴,等.通窍活血汤联合阿司匹林治疗缺血性脑卒中的疗效观察[J].中国实验方剂学杂志,2016,22(8):187-190.
[7]葛朝亮,王鑫铭,李飞龙,等.通窍活血汤对血管性痴呆大鼠学习记忆功能及海马神经元细胞内钙离子浓度的影响[J].中国药学杂志,2015,50(8):671-675.
[8]赵斌.磁共振灌注成像临床应用及进展[J].磁共振成像,2014,5(s1):46-50.
[9]杨淑贞,朱小华.脑血流灌注显像在缺血性脑血管病中的应用[J].中国现代医药杂志,2015,17(5):108-112.
[10]田金洲,韩明向,涂晋文,等.血管性痴呆的诊断、辨证及疗效判定标准[J].北京中医药大学学报,2000,23(5):16-24.
[11]高明月,杨珉,况伟宏,等.简易精神状态量表得分的影响因素和正常值的筛查效度评价[J].北京大学学报:医学版,2015,47(3):443-449.
[12]李孟宇,程肖蕊,周文霞,等.梓醇防治阿尔茨海默病作用研究进展[J].国际药学研究杂志,2016,43(2):199-204.
[13]中华人民共和国卫生部.中药新药临床研究指导原则[M].北京:中国医药科技出版社,2002:29-32.
[14] GAO Y Z,ZHANG J J,LIU H,et al. Regional cerebral blood flow and cerebrovascular reactivity in Alzheimer's disease and vascular dementia assessed by arterial spinlabeling magnetic resonance imaging[J].Curr Neurovasc Res,2013,10(1):49-53.
[15] Banerjee S,Neveu P,Kosik K S. A coordinated local translational control point at the synapse involving relief from silencing and MOV10 degradation[J]. Neuron,2009,64(6):871-884.
[16] Cubinkova V, Valachova B, Uhrinova I, et al.Alternative hypotheses related to Alzheimer's disease[J]. Bratisl Med J,2018,119(4):210-216.
[17] LI C,Engstr9m G,Berglund G,et al. Incidence of ischemic stroke in relation to asymptomatic carotid artery atherosclerosis in subjects with normal blood pressure[J]. Cerebrovasc Di,2008,26(3):297-303.
[18] Douglas G, Channon K M. The pathogenesis of atherosclerosis[J]. Medicine,2010,38(8):397-402.
[19] Sreckovic B, Sreckovic V D, Soldatovic I, et al.Homocysteine is a marker for metabolic syndrome and atherosclerosis[J]. Diabetes Metab Syndr,2017,11(3):179-182.
[20] Sudduth T L,Weekman E M,Price B R,et al. Timecourse of glial changes in the hyperhomocysteinemia model of vascular cognitive impairment and dementia(VCID)[J]. Neuroscience,2017,341:42-51.
[21] Stein C,Hopfeld J,Lau H,et al. Effects of ginkgo biloba extract EGb 761,donepezil and their combination on central cholinergic function in aged rats[J]. J Pharm Pharm Sci,2015,18(4):634-646.
[22] LI M Q,ZHANG W W,CHEN T,et al. Evaluation of medication treatment for Alzheimer's disease on clinical evidence[J]. Chin Contemp Neuro Neurosurg,2014,14(3):192-197.
[23] Shimizu S,Kanetaka H,Hirose D,et al. Differential effects of acetylcholinesterase inhibitors on clinical responses and cerebral blood flow changes in patients with Alzheimer's disease:a 12-month,randomized,and open-label trial[J]. Dement Geriatr Cogn Dis Extra,2015,5(1):135-146.
[24] Noguchi T,Kawashima M,Irie H,et al. Arterial spinlabeling MR imaging in moyamoya disease compared with SPECT imaging[J]. Eur J Radiol,2011,80(3):e557-e562.
[25]张晶,付旷.磁共振动脉自旋标记灌注成像技术在脑部疾病中的应用进展[J].脑与神经疾病杂志,2015,23(2):155-157.
[26] Sprezak K,Urbanik A. The value of arterial spin-labeled perfusion magnetic resonance imaging(ASL)in cerebral ischemia[J]. Przegl Lek,2013,70(5):319-327.
[27]莫恭晓,蔡慧,韦邱梦,等.赤芍总苷对失血性休克大鼠血流动力学影响[J].中国临床药理学杂志,2016,32(23):2156-2160.
[28]罗伟华.川芎嗪的临床应用及其制剂研究进展[J].中国现代药物应用,2017,11(18):191-193.
[29]秦劭晨,梁伟雄,温晓文,等.注射用羟基红花黄色素A治疗急性缺血性中风血瘀证疗效观察[J].中国实验方剂学杂志,2016,22(21):157-161.