通窍活血汤结合奥拉西坦治疗血管性痴呆疗效观察
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摘要
目的:观察通窍活血汤结合奥拉西坦治疗血管性痴呆的临床疗效,以及对患者脑脊液中tau蛋白、淀粉样β蛋白42(amyloidβprotein 42,Aβ42)表达的影响。方法:将120例血管性痴呆患者按随机数表法分为对照组和观察组,每组60例。两组患者给予常规基础疾病治疗、控制感染以及其他对症处理,严禁服用其他对神经系统有影响的药物。对照组患者在常规基础疾病治疗的基础上加用奥拉西坦治疗,观察组患者在对照组治疗基础上加用通窍活血汤(桃仁15 g,赤芍30 g,川芎15 g,红花15 g,当归10 g,丹参10 g,石菖蒲15 g,远志10 g,甘草8 g,大枣7枚,生姜3片)治疗。两组患者均以4周为1个疗程,连续治疗3个疗程。治疗后观察两组患者临床疗效、中医证候评分、脑脊液中tau蛋白和Aβ42含量,并进行简易智力状态检查量表(mini-mental state examination,MMSE)和日常生活能力量表(activity daily living scale,ADL)进行评分。结果:治疗后,观察组有效率为85.0%高于对照组的60.0%,差异有统计学意义(P<0.05);两组患者中医证候评分均降低,其中观察组中医证候评分低于对照组,差异均有统计学意义(P<0.05);两组患者脑脊液中tau蛋白含量减少,观察组tau蛋白含量低于对照组,差异有统计学意义(P<0.05);两组患者Aβ42含量均升高,观察组Aβ42含量高于对照组,差异均有统计学意义(P<0.05);两组患者MMSE评分均提高,观察组MMSE评分高于对照组,差异有统计学意义(P<0.05);两组患者ADL评分均降低,观察组ADL评分低于对照组,差异有统计学意义(P<0.05)。结论:通窍活血汤结合奥拉西坦治疗血管性痴呆疗效显著,能够明显改善患者症状,提高患者认知功能和生活自理能力,可能的作用机制是通过降低tau蛋白和提高淀粉样β蛋白42表达。
Objective: To observe the clinical efficacy of Tongqiao Huoxue Decoction combined with Oxiracetam in treatment of vascular dementia,and the effect on tau protein and amyloid β protein 42( Aβ42) expression in patients' cerebrospinal fluid. Methods: 120 patients with vascular dementia were divided into control group and observation group according to random number table,with 60 cases in each group. The two groups of patients were treated with conventional basic methods( for hypertension,diabetes and coronary atherosclerotic heart disease),infection control and other symptomatic treatment. It is strictly forbidden to take other drugs that have an effect on the nervous system. The patients in the control group were treated with Oxiracetam on the basis of conventional basic disease treatment. The patients in the observation group were given Tongfu Huoxue Decoction( Peach Kernel 15 g,Chishao 30 g,Chuanxiong 15 g,Safflower 15 g,Angelica 10 g),Salvia miltiorrhiza 10 g,Shichangpu 15 g,Yuanzhi 10 g,licorice8 g,jujube 7 pieces,ginger 3 pieces) treatment in addition to that of the control group. Both groups of patients took 4 weeks as a course of treatment and accepted continued treatment for 3 courses. After treatment,the clinical efficacy,TCM syndrome score,tau protein and Aβ42 content in cerebrospinal fluid were observed,and the mini-mental state examination( MMSE) score and activity daily living scale were used to compare the clinical results. Results: After treatment,the effective rate( 85. 0%) of the observation group was significantly higher than that( 60. 0%) of the control group( P < 0. 05). The TCM syndrome scores of the two groups were decreased,and the TCM syndrome score of the observation group was lower than that of the observation group. The difference was statistically significant( P < 0. 05). The tau protein content in the cerebrospinal fluid of the two groups was decreased. The tau protein content in the observation group was significantly lower than that in the control group( P < 0. 05). The Aβ42 content in the two groups was increased. The Aβ42 content in the observation group was significantly higher than that in the control group. The difference was statistically significant( P < 0. 05). The MMSE scores of the two groups were increased. The MMSE scores of the observation group were significantly higher than those of the control group( P < 0. 05). The ADL scores of the two groups were lower. The ADL scores of the observation group were significantly lower than the control group( P < 0. 05). Conclusion: Tongqiao Huoxue Decoction combined with Oxiracetam is effective in treatment of vascular dementia. It can significantly improve the symptoms of patients and improve their cognitive function and self-care ability. The possible mechanism may be the reduction of the tau protein and the increase of the expression of amyloid β protein 42.
Objective: To observe the clinical efficacy of Tongqiao Huoxue Decoction combined with Oxiracetam in treatment of vascular dementia,and the effect on tau protein and amyloid β protein 42( Aβ42) expression in patients' cerebrospinal fluid. Methods: 120 patients with vascular dementia were divided into control group and observation group according to random number table,with 60 cases in each group. The two groups of patients were treated with conventional basic methods( for hypertension,diabetes and coronary atherosclerotic heart disease),infection control and other symptomatic treatment. It is strictly forbidden to take other drugs that have an effect on the nervous system. The patients in the control group were treated with Oxiracetam on the basis of conventional basic disease treatment. The patients in the observation group were given Tongfu Huoxue Decoction( Peach Kernel 15 g,Chishao 30 g,Chuanxiong 15 g,Safflower 15 g,Angelica 10 g),Salvia miltiorrhiza 10 g,Shichangpu 15 g,Yuanzhi 10 g,licorice8 g,jujube 7 pieces,ginger 3 pieces) treatment in addition to that of the control group. Both groups of patients took 4 weeks as a course of treatment and accepted continued treatment for 3 courses. After treatment,the clinical efficacy,TCM syndrome score,tau protein and Aβ42 content in cerebrospinal fluid were observed,and the mini-mental state examination( MMSE) score and activity daily living scale were used to compare the clinical results. Results: After treatment,the effective rate( 85. 0%) of the observation group was significantly higher than that( 60. 0%) of the control group( P < 0. 05). The TCM syndrome scores of the two groups were decreased,and the TCM syndrome score of the observation group was lower than that of the observation group. The difference was statistically significant( P < 0. 05). The tau protein content in the cerebrospinal fluid of the two groups was decreased. The tau protein content in the observation group was significantly lower than that in the control group( P < 0. 05). The Aβ42 content in the two groups was increased. The Aβ42 content in the observation group was significantly higher than that in the control group. The difference was statistically significant( P < 0. 05). The MMSE scores of the two groups were increased. The MMSE scores of the observation group were significantly higher than those of the control group( P < 0. 05). The ADL scores of the two groups were lower. The ADL scores of the observation group were significantly lower than the control group( P < 0. 05). Conclusion: Tongqiao Huoxue Decoction combined with Oxiracetam is effective in treatment of vascular dementia. It can significantly improve the symptoms of patients and improve their cognitive function and self-care ability. The possible mechanism may be the reduction of the tau protein and the increase of the expression of amyloid β protein 42.
引文
[1]陶艳丽,曹敏,陈禧.益智汤联合奥拉西坦治疗肾虚血瘀型血管性痴呆临床研究[J].河南中医,2017,37(3):446-448.
[2]代云凯,罗艺,陈惠芳,等.通窍活血方药或联合西药治疗血管性痴呆疗效和安全性系统评价与Meta分析[J].中药新药与临床药理,2016,27(5):720-725.
[3]王太山.通窍活血汤化裁联合奥拉西坦治疗瘀血阻窍证血管性痴呆的临床研究[J].现代中西医结合杂志,2016,25(3):316-317,342.
[4]伍大华,蒋军林,龙华君,等.温肾活血方治疗肾阳虚血瘀证血管性痴呆的研究[J].现代中西医结合杂志,2015,24(31):3432-3434.
[5]杜雪平,吴永浩,王和天.全科医学科诊疗常规[M].北京:中国医药科技出版社,2013:146-148.
[6]郑筱萸.中药新药临床研究指导原则[M].北京:中国医药科技出版社,2002:176-179.
[7]陈金.肉苁蓉总苷对血管性痴呆大鼠学习记忆、p-tau蛋白表达及蛋白组学的实验研究[D].济南:山东大学,2015.
[8]胡仁琳,唐智敏,张细六,等.血清β淀粉样蛋白与tau蛋白在血管性痴呆早期诊断中的临床意义分析[J].中国实验诊断学,2014,18(5):817-818.
[9]梁国聪,石胜良,毕桂南,等.β淀粉样蛋白和Tau蛋白在血管性痴呆发病机制中的作用[J].广西医科大学学报,2011,28(5):661-664.
[10]林森,赵颖,王建华,等.依达拉奉对血管性痴呆大鼠脑组织β淀粉样蛋白、Tau蛋白表达的影响[J].现代中西医结合杂志,2011,20(29):3656-3657,3662.
[11]李书剑,胡亚梅,向莉,等.天智颗粒对血管性痴呆大鼠海马Tau蛋白、β淀粉样蛋白及VEGF表达的影响[J].医药论坛杂志,2011,32(15):15-18.
[12]安玉会,宋丹,赵岩,等.酸性肽对血管性痴呆小鼠学习记忆力和脑组织APP、BACE和tau蛋白表达的影响[J].郑州大学学报(医学版),2011,46(2):204-208.
[13]刘扬,孙中武.血清β-淀粉样蛋白与tau蛋白在皮质下缺血性血管性痴呆早期诊断的应用价值[J].蚌埠医学院学报,2011,36(3):227-230.
[14]王频,杨骏,柳刚,等.艾灸头部穴位为主对血管性痴呆患者脑脊液中生长抑素和精氨酸血管加压素水平影响的随机对照试验[J].中西医结合学报,2010,8(7):636-640.
[15]许二赫,武剑,贾建平.血管性痴呆患者血浆中Aβ及Tau蛋白的检测分析[J].中风与神经疾病杂志,2010,27(5):413-415.
[16]邱晓阳.血管性痴呆患者脑脊液中tau蛋白、淀粉样β蛋白42及血清中转化生长因子α和淀粉样β蛋白42的相关性分析[J].中国临床康复,2005,12(16):122-124.
[2]代云凯,罗艺,陈惠芳,等.通窍活血方药或联合西药治疗血管性痴呆疗效和安全性系统评价与Meta分析[J].中药新药与临床药理,2016,27(5):720-725.
[3]王太山.通窍活血汤化裁联合奥拉西坦治疗瘀血阻窍证血管性痴呆的临床研究[J].现代中西医结合杂志,2016,25(3):316-317,342.
[4]伍大华,蒋军林,龙华君,等.温肾活血方治疗肾阳虚血瘀证血管性痴呆的研究[J].现代中西医结合杂志,2015,24(31):3432-3434.
[5]杜雪平,吴永浩,王和天.全科医学科诊疗常规[M].北京:中国医药科技出版社,2013:146-148.
[6]郑筱萸.中药新药临床研究指导原则[M].北京:中国医药科技出版社,2002:176-179.
[7]陈金.肉苁蓉总苷对血管性痴呆大鼠学习记忆、p-tau蛋白表达及蛋白组学的实验研究[D].济南:山东大学,2015.
[8]胡仁琳,唐智敏,张细六,等.血清β淀粉样蛋白与tau蛋白在血管性痴呆早期诊断中的临床意义分析[J].中国实验诊断学,2014,18(5):817-818.
[9]梁国聪,石胜良,毕桂南,等.β淀粉样蛋白和Tau蛋白在血管性痴呆发病机制中的作用[J].广西医科大学学报,2011,28(5):661-664.
[10]林森,赵颖,王建华,等.依达拉奉对血管性痴呆大鼠脑组织β淀粉样蛋白、Tau蛋白表达的影响[J].现代中西医结合杂志,2011,20(29):3656-3657,3662.
[11]李书剑,胡亚梅,向莉,等.天智颗粒对血管性痴呆大鼠海马Tau蛋白、β淀粉样蛋白及VEGF表达的影响[J].医药论坛杂志,2011,32(15):15-18.
[12]安玉会,宋丹,赵岩,等.酸性肽对血管性痴呆小鼠学习记忆力和脑组织APP、BACE和tau蛋白表达的影响[J].郑州大学学报(医学版),2011,46(2):204-208.
[13]刘扬,孙中武.血清β-淀粉样蛋白与tau蛋白在皮质下缺血性血管性痴呆早期诊断的应用价值[J].蚌埠医学院学报,2011,36(3):227-230.
[14]王频,杨骏,柳刚,等.艾灸头部穴位为主对血管性痴呆患者脑脊液中生长抑素和精氨酸血管加压素水平影响的随机对照试验[J].中西医结合学报,2010,8(7):636-640.
[15]许二赫,武剑,贾建平.血管性痴呆患者血浆中Aβ及Tau蛋白的检测分析[J].中风与神经疾病杂志,2010,27(5):413-415.
[16]邱晓阳.血管性痴呆患者脑脊液中tau蛋白、淀粉样β蛋白42及血清中转化生长因子α和淀粉样β蛋白42的相关性分析[J].中国临床康复,2005,12(16):122-124.