本文選題：法舒地爾　切入點：血管性認知障礙　出處：《河北醫(yī)科大學》2017年碩士論文　論文類型：學位論文

【摘要】：目的:認知障礙是一種常見的老年性疾病,而血管性認知障礙是指與腦血管疾病有關的認知障礙的綜合征,其嚴重程度可由輕度的認知障礙發(fā)展為癡呆。探索新型的藥物或治療方法對于改善血管性認知障礙患者的生活質(zhì)量,并有效控制老年癡呆發(fā)病率具有重大意義。本文旨在探討鹽酸多奈哌齊聯(lián)合法舒地爾對血管性認知障礙患者的治療效果及對血清中TNF-α、hs-CRP及IL-6水平的影響。方法:選取2016年1月~2016年12月在保定市第一中心醫(yī)院老年病科住院的60例血管性認知障礙患者,采用隨機數(shù)字表法隨機將患者分為兩組,即觀察組和對照組,每組各30例;對照組即多奈哌齊組,患者口服鹽酸多奈哌齊5 mg,每日一次;觀察組為聯(lián)合法舒地爾組,患者在口服鹽酸多奈哌齊基礎上加用鹽酸法舒地爾30mg,每日一次,靜脈滴注21天。利用MMSE以及ADAS-cog雙量表的評分方法來比較兩組患者的治療效果;兩組患者分別在治療前、治療后采取靜脈血,檢測血清TNF-α、IL-6及hs-CRP炎性細胞因子的變化,采用放射免疫分析法測定血清中TNF-α及IL-6水平;采用免疫比濁法測定血清中hs-CRP水平。結果:聯(lián)合法舒地爾組和多奈哌齊組均能夠不同程度地改善血管性認知障礙患者的認知功能:將兩組患者治療前后的MMSE、ADAS-cog評分進行比較,發(fā)現(xiàn)治療后MMSE評分均較治療前有所提高,而ADAS-cog評分均較治療前有所降低,差異均具有統(tǒng)計學意義(P0.05);將兩組患者治療后的MMSE、ADAS-cog評分進行比較,聯(lián)合法舒地爾組患者的MMSE評分明顯高于多奈哌齊組患者,而ADAS-cog評分明顯低于多奈哌齊組患者,差異均具有統(tǒng)計學意義(P0.05)。多奈哌齊組患者在時間定向能力和地點定向能力兩個方面取得顯著改善(P0.01),在記憶力和執(zhí)行能力兩個方面也取得一定改善(P0.05),而在語言能力和計算能力兩個方面未取得有效改善;而聯(lián)合法舒地爾組患者在時間定向能力、地點定向能力以及執(zhí)行能力三個方面都取得顯著改善(P0.01),在語言能力、記憶力和計算能力三個方面也取得一定改善(P0.05)。聯(lián)合法舒地爾組患者在時間定向能力、地點定向能力、語言能力、計算能力以及執(zhí)行能力五個方面取得的功能改善都要優(yōu)于多奈哌齊組治療的患者。與本組治療前相比,兩組患者體內(nèi)血清中TNF-α、IL-6及hs-CRP等細胞炎癥因子的水平均明顯降低(P0.05);同時,治療后聯(lián)合法舒地爾組患者體內(nèi)TNF-α、IL-6及hs-CRP的血清濃度較單用多奈哌齊組患者顯著降低(P0.05)。結論:多奈哌齊聯(lián)合法舒地爾與單用多奈哌齊相比較,能更好地改善血管性認知功能障礙患者的認知功能,并可顯著降低血清炎性因子的水平,提示法舒地爾對血管性認知障礙有改善作用。本研究為臨床治療血管性認知功能障礙提供了藥物選擇。
[Abstract]:Objective: cognitive impairment is a common disease in the elderly, and vascular cognitive impairment is a syndrome refers to cognitive impairment associated with cerebral vascular disease, the severity of the development of mild cognitive impairment to dementia. To explore a new drug or treatment for patients with vascular cognitive impairment and quality of life. To effectively control the incidence of dementia is of great significance. This paper aims to explore the donepezil combined method of fasudil on vascular cognitive impairment in the treatment effect and the serum levels of TNF- alpha, effects of hs-CRP and IL-6 level. Methods: January 2016 ~2016 year in December 60 cases of vascular cognitive impairment in patients with geriatric inpatients in Baoding First Central Hospital. According to the random number table method were randomly divided into two groups, treatment group and control group, 30 cases in each group; the control group with oral donepezil hydrochloride group. In 5 mg, once a day; the observation group and fasudil group, in patients treated with donepezil hydrochloride combined with fasudil hydrochloride 30mg, once a day, intravenous drip for 21 days. The scoring method using MMSE and ADAS-cog double scale to compare the therapeutic effect of two groups of patients were in the group; two take the venous blood before treatment, after treatment, serum levels of TNF- alpha, IL-6 and hs-CRP changes of inflammatory cytokines, determination of TNF- alpha and IL-6 in serum by radioimmunoassay; the serum levels of hs-CRP in the immune turbidimetric method. Results: the combination of fasudil group and donepezil group were improved in different degree the cognitive function of patients with vascular cognitive impairment: two groups of patients before and after treatment were compared with MMSE, ADAS-cog scores, MMSE scores were found after treatment than before treatment increased, while the ADAS-cog score was significantly higher than before treatment Decreased, the differences were statistically significant (P0.05); the two groups after treatment were compared with MMSE, ADAS-cog score, and fasudil group of patients with MMSE was significantly higher than that of donepezil group, ADAS-cog score was lower than donepezil group, the differences were statistically significant (P0.05) has made significant improvements in two aspects. Time and place in the directional orientation ability of donepezil group (P0.01), two patients in the aspects of memory and executive ability have been improved (P0.05), and did not improve in two aspects of language and computing ability; and combined with fasudil group patients in time orientation ability, have achieved significant improvement in three aspects place orientation ability and executive ability (P0.01), in the three aspects of language ability, memory and computing ability have been improved (P0.05). Patients in group when combined with fasudil hydrochloride Between the orientation ability and place orientation ability, language ability is superior to the group of patients treated with donepezil has five aspects of computing ability and the ability to execute the function improved. Compared with the group before treatment, two groups of serum alpha TNF-, IL-6 and hs-CRP cell inflammatory factor levels were significantly reduced (P0.05) at the same time, after treatment; combined with fasudil group patients TNF- alpha, serum concentrations of IL-6 and hs-CRP compared with donepezil group were significantly decreased (P0.05). Conclusion: donepezil combined and fasudil with donepezil compared, can improve vascular cognitive dysfunction and cognitive function. Significantly decreased the level of serum inflammatory factor, suggesting that fasudil had effect on vascular cognitive impairment. This study provides a selection of drugs for clinical treatment of vascular cognitive impairment.

【學位授予單位】：河北醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R749.13

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