培元通脑胶囊联合“智三针”治疗卒中后痴呆的临床观察
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摘要
目的:观察培元通脑胶囊联合"智三针"治疗卒中后痴呆(PSD)的临床疗效及作用机制。方法:采用SAS软件生成随机数字表法将98例符合要求的患者分为对照组和观察组各49例。两组患者基础治疗口服多奈哌齐片,10 mg/次,1次/d;尼莫地平片,30 mg/次,1次/d,口服。对照组采用"智三针",1次/d,5次/周。观察组针刺同对照组,加服培元通脑胶囊,3粒/次,3次/d。两组疗程均为连续治疗12周。于治疗前、治疗后4,8,12周评价简易精神状态(MMSE)和蒙特利尔认知评估量表(MoCA),评估治疗前后日常生活能力量表(ADL),神经精神症状问卷(NPI)和中医证候,检测治疗前后血清同型半胱氨酸(Hcy),肝细胞生长因子(HGF),氧化低密度脂蛋白(Ox-LDL)和乙酰胆碱酶(Ach E)水平。结果:观察组临床疗效总有效率为93.88%,高于对照组的77.55%(χ~2=5.333,P<0.05);经重复测量的方差分析,治疗后两组患者MoCA评分逐渐升高(F_(对照)=3.947,F_(观察)=5.833,P<0.05);MMSE评分也逐渐升高(F_(对照)=3.876,F_(观察)=6.011,P<0.05),;观察组患者在治疗后8周和12周MMSE评分均高于对照组(P<0.05),12周观察组MoCA评分高于对照组(P<0.05);治疗后观察组MMSE量表的定向力、注意力和计算力、语言3个因子评分均高于对照组(P<0.05);观察组患者的MMSE和MoCA评分治疗前后差值均高于对照组(P<0.05);治疗后观察组患者ADL,NPI-1,NPI-2和中医证候评分均低于对照组(P<0.01);观察组患者Hcy,OxLDL和Ach E水平均低于对照组,HGF水平高于对照组(P<0.01)。结论:培元通脑胶囊内服联合"智三针"治疗PSD能进一步的提高认知能力和行为能力,改善精神行为异常,减轻临床症状,提高临床疗效,并能调节Hcy,Ox-LDL,Ach E和HGF水平。
Objective: To observe the clinical efficacy of Peiyuan Tongnao capsule combined with "Zhisanzhen" for post-stroke dementia( PSD) and investigate its mechanism. Method: Ninety-eight eligible patients were randomly divided into control group( 49 cases) and observation group( 49 cases) by random number table. Both groups received donepezil tablet,10 mg/time,qd,and nimodipine tablet,30 mg/time,qd. Patients in control group additionally took "Zhisanzhen",qd,5 times/week. Based on the treatment in control group,patients in observation group additionally took Peiyuan Tongnao capsule,3 capsules/time,tid. The treatment course was 12 weeks. Before and at the 4~(th),8~(th) and 12~(th) week after treatment,mini-mental state examination( MMSE),montreal cognitive assessment( MoCA),activity of daily living scale( ADL),neuropsychiatric inventory( NPI) and symptoms of traditional Chinese medicine( TCM) were evaluated. Before and after treatment,levels of serum hyperhomocysteinemia( Hcy),hepatocyte growth factor( HGF),oxidized low density lipoprotein( Ox-LDL) and acetylcholinesterase( Ach E) were detected. Result: The total clinical effective rate was 93. 88% in observation group,better than 77. 55% in control group( χ~2= 5. 333,P < 0. 05). Repeat measurement ANOVA after treatment showed that scores of MoCA,MMSE were gradually increased( F_(control)= 3. 947,F_(observation)= 5. 833,P < 0. 05 for MoCA. F_(control)= 3. 876,F_(observation)= 6. 011,P < 0. 05 for MMSE). At the 8~(th) and 12~(th) after treatment,scores of MMSE in the observation group were all higher than those in control group( P < 0. 05). At the 12~(th) week after treatment,score of MoCA in observation group was higher than that in control group( P < 0. 05). Scores of directing force,attention,capacity of calculation in observation group were higher than those in control group after treatment( P < 0. 05). The changes in scores of MMSE and MoCA in observation group were larger than those in control group after treatment( P < 0. 05). Scores of ADL,NPI-1,NPI-2 and symptom of TCM in observation group were lower than those in control group( P < 0. 01). Levels of Hcy,Ox-LDL and Ach E were also lower than those in control group,while level of HGF was higher than that in control group( P < 0. 01). Conclusion: Peiyuan Tongnao capsule combined with "Zhisanzhen" can improve cognitive and behavioral abilities,improve clinical efficacy,ameliorate abnormal mental behavior,relieve clinical symptoms,and regulate levels of Hcy,Ox-LDL,Ach E and HGF in the treatment of post-stroke dementia.
Objective: To observe the clinical efficacy of Peiyuan Tongnao capsule combined with "Zhisanzhen" for post-stroke dementia( PSD) and investigate its mechanism. Method: Ninety-eight eligible patients were randomly divided into control group( 49 cases) and observation group( 49 cases) by random number table. Both groups received donepezil tablet,10 mg/time,qd,and nimodipine tablet,30 mg/time,qd. Patients in control group additionally took "Zhisanzhen",qd,5 times/week. Based on the treatment in control group,patients in observation group additionally took Peiyuan Tongnao capsule,3 capsules/time,tid. The treatment course was 12 weeks. Before and at the 4~(th),8~(th) and 12~(th) week after treatment,mini-mental state examination( MMSE),montreal cognitive assessment( MoCA),activity of daily living scale( ADL),neuropsychiatric inventory( NPI) and symptoms of traditional Chinese medicine( TCM) were evaluated. Before and after treatment,levels of serum hyperhomocysteinemia( Hcy),hepatocyte growth factor( HGF),oxidized low density lipoprotein( Ox-LDL) and acetylcholinesterase( Ach E) were detected. Result: The total clinical effective rate was 93. 88% in observation group,better than 77. 55% in control group( χ~2= 5. 333,P < 0. 05). Repeat measurement ANOVA after treatment showed that scores of MoCA,MMSE were gradually increased( F_(control)= 3. 947,F_(observation)= 5. 833,P < 0. 05 for MoCA. F_(control)= 3. 876,F_(observation)= 6. 011,P < 0. 05 for MMSE). At the 8~(th) and 12~(th) after treatment,scores of MMSE in the observation group were all higher than those in control group( P < 0. 05). At the 12~(th) week after treatment,score of MoCA in observation group was higher than that in control group( P < 0. 05). Scores of directing force,attention,capacity of calculation in observation group were higher than those in control group after treatment( P < 0. 05). The changes in scores of MMSE and MoCA in observation group were larger than those in control group after treatment( P < 0. 05). Scores of ADL,NPI-1,NPI-2 and symptom of TCM in observation group were lower than those in control group( P < 0. 01). Levels of Hcy,Ox-LDL and Ach E were also lower than those in control group,while level of HGF was higher than that in control group( P < 0. 01). Conclusion: Peiyuan Tongnao capsule combined with "Zhisanzhen" can improve cognitive and behavioral abilities,improve clinical efficacy,ameliorate abnormal mental behavior,relieve clinical symptoms,and regulate levels of Hcy,Ox-LDL,Ach E and HGF in the treatment of post-stroke dementia.
引文
[1]曲艳吉,卓琳,詹思延.中国脑卒中后认知障碍流行病学特征的系统评价[J].中华老年心脑血管病杂志,2013,15(12):1294-1301.
[2]程蕊容,辛秀峰,刘章佩,等.卒中后认知障碍的研究进展[J].临床荟萃,2018,33(1):89-92.
[3]Danovska M,Stamenov B,Alexandrova M,et al.Post stroke cognitive impairment phenomenology and prognostic factors[J].J IMAB,2012,18:290-297.
[4]中国卒中学会.卒中后认知障碍管理专家共识[J].中国卒中杂志,2017,12(6):519-531.
[5]耿飞,程红亮,胡培佳.针灸治疗血管性认知障碍研究简况[J].中医药临床杂志,2017,29(9):1555-1558.
[6]黎明全,艾春玲,赵建军,等.中国血管性认知功能障碍中医证候分布频率的Meta分析[J].北京中医药,2016,35(7):628-633.
[7]金洁婷,杨金禄.培元通脑胶囊治疗肾元亏虚瘀血阻络型缺血性脑中风102例[J].上海中医药杂志,2014,48(5):36-37.
[8]袁灿兴,吴克明,韩建新,等.培元通脑胶囊结合西医常规疗法治疗恢复期脑梗死的临床多中心随机对照研究[J].上海中医药大学学报,2016,30(2):19-22.
[9]周飞雄.智三针结合高压氧治疗血管性痴呆的临床研究[J].湖南中医杂志,2015,31(8):82-83.
[10]黄健婷,崔韶阳,唐纯志,等.智三针对AD模型大鼠脑内Ch AT及GLUT3表达的影响[J].中国中医基础医学杂志,2016,22(7):915-917.
[11]中华神经科学会.各类脑血管疾病诊断要点[J].中华神经科杂志,1996,29(6):379-380.
[12]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.
[13]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.
[14]郭起浩,洪震.神经心理评估[M].2版.上海:上海科技术出版社,2016:140-150.
[15]张勇,杨百瑜,张振馨,等.卒中后认知障碍的概念、病理生理和受损认知域[J].中国老年学,2016,36(2):509-511.
[16]宓特,屈传强,王翔,等.不同部位急性脑梗死的认知功能障碍特点分析[J].中华医学杂志,2016,96(15):1205-1207.
[17]滕振杰,冯静.脑小血管病与卒中后认知障碍研究进展[J].国际神经病学神经外科学杂志,2017,44(1):102-105.
[18]靳林静,范云龙,于文涛.血管性痴呆中医证候研究概况[J].中西医结合心脑血管病杂志,2016,14(2):152-154.
[19]唐中生,陆莹,宋华,等.电针智三针对血管性痴呆大鼠学习记忆能力及β-淀粉样蛋白表达的影响[J].中国老年学,2012,32(13):2794-2796.
[20]王飞,王民集.补肾活血汤加减结合五神针治疗肝肾不足型血管性痴呆症临床观察[J].中国实验方剂学杂志,2017,23(12):168-172.
[21]李会琪,刘红,张恒,等.卒中后非痴呆型认知障碍与HCY,白质疏松及P300相关性研究[J].陕西医学杂志,2018,47(2):153-155,189.
[22]聂雪丹,吴云,梁庆成.氧化低密度脂蛋白和血脂水平与血管性痴呆的相关性研究[J].哈尔滨医科大学学报,2014,48(4):325-328.
[23]冯梅,温万鑫,卢静敏,等.养血清脑颗粒治疗血管性痴呆的系统评价[J].中国实验方剂学杂志,2015,21(15):207-212.
[24]胡科,张保朝,贾东佩.健脑补肾丸联合银杏叶片治疗轻度认知功能障碍[J].中国实验方剂学杂志,2015,21(23):160-163.
[2]程蕊容,辛秀峰,刘章佩,等.卒中后认知障碍的研究进展[J].临床荟萃,2018,33(1):89-92.
[3]Danovska M,Stamenov B,Alexandrova M,et al.Post stroke cognitive impairment phenomenology and prognostic factors[J].J IMAB,2012,18:290-297.
[4]中国卒中学会.卒中后认知障碍管理专家共识[J].中国卒中杂志,2017,12(6):519-531.
[5]耿飞,程红亮,胡培佳.针灸治疗血管性认知障碍研究简况[J].中医药临床杂志,2017,29(9):1555-1558.
[6]黎明全,艾春玲,赵建军,等.中国血管性认知功能障碍中医证候分布频率的Meta分析[J].北京中医药,2016,35(7):628-633.
[7]金洁婷,杨金禄.培元通脑胶囊治疗肾元亏虚瘀血阻络型缺血性脑中风102例[J].上海中医药杂志,2014,48(5):36-37.
[8]袁灿兴,吴克明,韩建新,等.培元通脑胶囊结合西医常规疗法治疗恢复期脑梗死的临床多中心随机对照研究[J].上海中医药大学学报,2016,30(2):19-22.
[9]周飞雄.智三针结合高压氧治疗血管性痴呆的临床研究[J].湖南中医杂志,2015,31(8):82-83.
[10]黄健婷,崔韶阳,唐纯志,等.智三针对AD模型大鼠脑内Ch AT及GLUT3表达的影响[J].中国中医基础医学杂志,2016,22(7):915-917.
[11]中华神经科学会.各类脑血管疾病诊断要点[J].中华神经科杂志,1996,29(6):379-380.
[12]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.
[13]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.
[14]郭起浩,洪震.神经心理评估[M].2版.上海:上海科技术出版社,2016:140-150.
[15]张勇,杨百瑜,张振馨,等.卒中后认知障碍的概念、病理生理和受损认知域[J].中国老年学,2016,36(2):509-511.
[16]宓特,屈传强,王翔,等.不同部位急性脑梗死的认知功能障碍特点分析[J].中华医学杂志,2016,96(15):1205-1207.
[17]滕振杰,冯静.脑小血管病与卒中后认知障碍研究进展[J].国际神经病学神经外科学杂志,2017,44(1):102-105.
[18]靳林静,范云龙,于文涛.血管性痴呆中医证候研究概况[J].中西医结合心脑血管病杂志,2016,14(2):152-154.
[19]唐中生,陆莹,宋华,等.电针智三针对血管性痴呆大鼠学习记忆能力及β-淀粉样蛋白表达的影响[J].中国老年学,2012,32(13):2794-2796.
[20]王飞,王民集.补肾活血汤加减结合五神针治疗肝肾不足型血管性痴呆症临床观察[J].中国实验方剂学杂志,2017,23(12):168-172.
[21]李会琪,刘红,张恒,等.卒中后非痴呆型认知障碍与HCY,白质疏松及P300相关性研究[J].陕西医学杂志,2018,47(2):153-155,189.
[22]聂雪丹,吴云,梁庆成.氧化低密度脂蛋白和血脂水平与血管性痴呆的相关性研究[J].哈尔滨医科大学学报,2014,48(4):325-328.
[23]冯梅,温万鑫,卢静敏,等.养血清脑颗粒治疗血管性痴呆的系统评价[J].中国实验方剂学杂志,2015,21(15):207-212.
[24]胡科,张保朝,贾东佩.健脑补肾丸联合银杏叶片治疗轻度认知功能障碍[J].中国实验方剂学杂志,2015,21(23):160-163.