美金刚与多奈哌齐治疗老年血管性痴呆的比较研究

目的 探究美金刚与多奈哌齐治疗老年血管性痴呆的疗效对比。方法 选取2015年1月-2017年7月在焦作市第二人民医院门诊就诊的40例老年血管性痴呆患者为研究对象，据随机数表法分为美金刚组和多奈哌齐组，每组各20例。美金刚组患者口服盐酸美金刚片，第1周5 mg/次，1次/d，后每周以5 mg增量，第4周20 mg/d，10 mg/次。维持第4周剂量至疗程结束。多奈哌齐组患者口服盐酸多奈哌齐片，5 mg/次，1次/d；服用4周后，10 mg/次，1次/d，服用至疗程结束。两组疗程均为12周。观察两组患者的临床疗效，同时比较两组患者简易智能状态检查表（MMSE）评分、临床痴呆评定量表（CDR）评分、日常生活能力量表（ADL）评分和血清学指标。结果 两组间临床疗效比较差异无统计学意义。治疗后，两组MMSE评分显著升高，而CDR和ADL评分显著降低（P<0.05）；治疗4周、12周后，多奈哌齐组MMSE和ADL评分显著低于同期美金刚组，CDR评分显著高于同期美金刚组，差异有统计学意义（P<0.05）。治疗后，两组脑源性神经营养因子（BDNF）、胰岛素样生长因子-1（IGF-1）水平显著升高，内皮素（ET）水平显著降低（P<0.05）；治疗4周、12周后，多奈哌齐组BDNF、IGF-1和ET水平显著低于同期美金刚组，差异有统计学意义（P<0.05）。结论 美金刚与多奈哌齐治疗老年血管性痴呆患者均具一定临床效果，且安全性相当，这可能与BDNF、IGF-1水平升高，ET水平降低有关。

A comparative study of memantine and donepezil in treatment of elderly patients with vascular dementia

Objective To explore the effect of memantine and donepezil in treatment of elderly patients with vascular dementia. Methods A total of 40 elderly patients with vascular in the Second People''s Hospital of Jiaozuo from January 2015 to July 2017 were selected as the research objects. According to the random number table method, they were divided into memantine and donepezil group, with 20 patients in each group. Patients in the memantine group were po administered with Memantine Hydrochloride Tablets, 5 mg/time and once daily in the first week, then at 5 mg increments for per week, and 20 mg/d and 10 mg/time in the fourth week. The dose was maintained for 4 weeks until the end of treatment. Patients in the donepezil group were po administered with Donepezil Hydrochloride Tablets, 5 mg/time, once daily, after 4 weeks, 10 mg/time, once daily, until the end of the course of treatment. The course of treatment was 12 weeks in two groups. The clinical efficacy in two groups was observed, and the MMSE score, CDR score, ADL score, and serological indicators were compared between two groups. Results There was no statistically significant difference in clinical efficacy between two groups. After treatment, MMSE scores in two groups were significantly increased, while CDR and ADL scores were significantly decreased (P<0.05). After 4 and 12 weeks of treatment, the MMSE and ADL scores in donepezil group were significantly lower than those in memantine group, and the CDR scores were significantly higher than those of memantine group, with statistically significant differences (P<0.05). After treatment, BDNF and IGF-1 levels were significantly increased in two groups, but ET levels were significantly decreased (P<0.05). After 4 weeks and 12 weeks of treatment, BDNF, IGF-1 and ET levels in donepezil group were significantly lower than those in memantine group, with statistically significant differences (P<0.05). Conclusion Both memantine and donepezil showed certain clinical efficacy and comparable safety in treatment of elderly patients with vascular dementia, which may be related to increased BDNF and IGF-1 levels, and decreased ET levels.