天智颗粒联合盐酸多奈哌齐片对轻中度肝阳上亢证血管性痴呆的临床分析

目的:通过核磁共振波谱技术探讨天智颗粒联合盐酸多奈哌齐片治疗轻中度肝阳上亢型血管性痴呆的有效性和作用机制。方法:80例轻中度血管性痴呆肝阳上亢证患者,随机按数字表法分成治疗组和对照组各40例,对照组口服盐酸多奈哌齐片,5 mg/次,1次/d。治疗组在对照组治疗的基础上口服天智颗粒,5 g/次,3次/d,两组疗程均为90 d。观察简易精神状态量表(MMSE),日常生活活动能力量表(ADL),肝阳上亢证量表(GYSK)的评分变化,采用磁共振成像设备(GE Signa EXCITE 3.0 T)进行检查,多体素氢质子核磁共振波谱分析(1H-MRS)采用PRESS序列。观察左额叶及海马区代谢物N-乙酰天门冬氨酸(NAA)/肌酸(Cr),胆碱(Cho)/肌酸(Cr)比值变化。结果:两组患者痴呆程度,MMSE,ADL和GYSK评分治疗前均无显著性差异;两组患者治疗90 d后与治疗前比较MMSE,ADL量表评分改善均有不同程度提高(P0.05);对照组治疗90 d后GYSK量表评分比治疗前有所降低,但差异无统计学意义;治疗组治疗90 d后GYSK量表评分比治疗前明显降低,并低于治疗90 d后的对照组,差异更为显著(P0.05);左侧额叶及海马区Cho/Cr,NAA/Cr比较,两组治疗90 d后左侧额叶及海马区Cho/Cr明显下降,左侧额叶及海马区NAA/Cr明显升高(P0.05);治疗组治疗90 d后与对照组比较,左侧额叶及海马区NAA/Cr高于对照组,有显著性差异(P0.05);左侧额叶及海马区Cho/Cr降低低于对照组,但无统计学意义。结论:天智颗粒联合盐酸多奈哌齐片治疗VD效果优于单用盐酸多奈哌齐片,其作用机制可能与促进神经元修复、抑制其胶质细胞增生及调控神经细胞膜磷脂代谢有关。

Clinical Analysis of Tianzhi Granules Combined with Donepezil Hydrochloride on Mild-to-Moderate Vascular Dementia with Hyperactivity of Liver Yang Syndrome

Objective: To explore the clinical efficacy and mechanism of Tianzhi granules combined with donepezil for mild-to-moderate vascular dementia patients with liver-yang excessive syndromes by using the nuclear magnetic resonance (NMR) spectrum. Method: A total of 80 mild-to-moderate vascular dementia patients with liver-yang excessive syndrome were randomly divided into 2 groups according to random number table:treatment group and control group, with 40 patients in each group. Patients in control group were given with donepezil orally (5 mg/time, 1 time/d);Patients in treatment group were also given with Tianzhi granules orally (3 times/d, 5 g/time) based on the treatment of control group. Treatment course was 90 days in both groups. Mini-Mental State Examination Scale (MMSE), Activity of Daily Living Scale (ADL) and Gan Yang Shang Kang Scale (GYSK) were evaluated before and after intervention. Multivoxel 1H-MRS examinations were performed with PRESS sequence and GE Signa EXCITE 3.0 T Magnetic Resonance Imaging system was used in the examination. The changes of N-acetyl-aspartic acid/creatine (NAA/Cr), choline/creatine (Cho/Cr) ratios at left frontal lobe and hippocampus were observed as well. Result: Before treatment, no significant difference was observed in dementia degree, MMSE, ADL score and GYSK score between two groups. After 90 days of treatment, both groups had improvement in MMSE and ADL scores (P<0.05).GYSK score was decreased in control group, however the difference was not statistically significant .GYSK score was decreased significantly in treatment group, and it was lower than that of control group, with more significant difference (P<0.05). After 90 days of treatment, Cho/Cr ratio in the left frontal lobe and hippocampus was significantly decreased in both groups, while the NAA/Cr ratio was significantly increased in both groups (P<0.05). After 90 days of treatment, the NAA/Cr ratio of left frontal lobe and hippocampus in treatment group was higher than that of control group with statistical significance (P<0.05), and the Cho/Cr ratio in treatment group was lower than that of control group without statistical significance. Conclusion: The efficacy of Tianzhi granules combined with donepezil therapy was superior than that of donepezil alone, and the mechanism may be associated with promotion of neuron repair, inhibition of gliocyte proliferation and regulatiojn of phospholipid metabolism of nerve cell membrane.