加減薯蕷丸治療血管性癡呆的磁共振波譜研究
發(fā)布時(shí)間：2018-07-13 14:48
【摘要】：目的:血管性癡呆是臨床實(shí)踐中面臨的一種常見癡呆類型,越來(lái)越受到重視。但目前尚缺乏有效的治療手段,中醫(yī)藥治療本病具有優(yōu)勢(shì)。本研究擬通過(guò)磁共振波譜(MRS)檢查的方法,嘗試探討加減薯蕷丸治療輕中度血管性癡呆的有效性及其作用機(jī)制。方法:本研究納入湖北省中醫(yī)院2015年12月至2016年12月門診及住院符合標(biāo)準(zhǔn)的受試者共80人,其中血管性癡呆患者60人(腎精虧虛證、痰濁阻竅證、瘀血阻絡(luò)證各20人),正常組20人。80名受試者干預(yù)前均予以神經(jīng)精神評(píng)估、中醫(yī)癥候評(píng)估、肝腎功能、心電圖等安全性檢查和顱腦雙側(cè)丘腦、額葉MRS檢查(選擇多體素,點(diǎn)分辨自旋回波序列)。60例血管性癡呆患者在針對(duì)基礎(chǔ)疾病進(jìn)行治療的同時(shí),予以加減薯蕷丸(由湖北省中醫(yī)院制劑科制成合劑),每次15ml,每日兩次,口服,療程12周。觀察:1.血管性癡呆患者治療前顱腦MRS與正常組的差異;2.治療前后血管性癡呆患者簡(jiǎn)易精神狀態(tài)量表(MMSE)、血管性癡呆中醫(yī)辨證量表(SDSVD)、顱腦MRS的變化及不良反應(yīng)情況。結(jié)果:1.在受試者隨訪過(guò)程中,腎精虧虛證患者脫落2例(漏服藥物1例,檢查不配合1例),痰濁阻竅證患者脫落3例(檢查不配合2例,罹患其他疾病1例),瘀血阻絡(luò)證患者脫落3例(漏服藥物1例,檢查不配合2例)。2.與正常組相比較,在右側(cè)額葉,三組Va D患者Cho/Cr值較正常組有不同程度的上升(腎精虧虛P(yáng)=0.000,痰濁阻竅P=0.000,瘀血阻絡(luò)P=0.001),NAA/Cr值較正常組有不同程度的下降(腎精虧虛P(yáng)=0.000,痰濁阻竅P=0.000,瘀血阻絡(luò)P=0.002),且均有統(tǒng)計(jì)學(xué)差異。在左側(cè)額葉,也可觀察到和右側(cè)額葉類似的情況。Va D患者Cho/Cr值較正常組有不同程度的上升(腎精虧虛P(yáng)=0.001,痰濁阻竅P=0.000,瘀血阻絡(luò)P=0.032),NAA/Cr值較正常組有不同程度的下降(腎精虧虛P(yáng)=0.000,痰濁阻竅P=0.001,瘀血阻絡(luò)P=0.009),且均有統(tǒng)計(jì)學(xué)差異。3.三組Va D患者相比較,在右側(cè)額葉可見腎精虧虛證患者NAA/Cr值較瘀血阻絡(luò)證患者(P=0.034)和痰濁阻竅證患者(P=0.006)有明顯下降。4.經(jīng)治療后3組Va D患者M(jìn)MSE評(píng)分和SDSVD評(píng)分均有明顯好轉(zhuǎn)(P0.05)。5.三組Va D患者經(jīng)加減薯蕷丸干預(yù)治療后,在右側(cè)額葉NAA/Cr值較治療前均有不同程度升高(腎精虧虛P(yáng)=0.001,痰濁阻竅P=0.001,瘀血阻絡(luò)P=0.008);在左側(cè)額葉,NAA/Cr值僅有腎精虧虛證患者較前升高(P=0.026)具有統(tǒng)計(jì)學(xué)意義,但與正常組相比較仍有統(tǒng)計(jì)學(xué)差異P0.05。6.三組Va D患者的血常規(guī)、尿常規(guī)、大便常規(guī),肝功能,腎功能檢查及心電圖檢查在受試過(guò)程中都沒(méi)有發(fā)現(xiàn)異常情況。結(jié)論:1.1H-MRS可作為一種無(wú)創(chuàng)、客觀的檢查方式,運(yùn)用于血管性癡呆患者的診斷和療效評(píng)估當(dāng)中,并且提示血管性癡呆可能與額葉神經(jīng)元代謝功能異常有關(guān)。2.加減薯蕷丸在安全有效的改善血管性癡呆患者認(rèn)知功能的同時(shí),還能從整體出發(fā),改善患者的其他癥狀。3.加減薯蕷丸改善血管性癡呆患者認(rèn)知功能的機(jī)制可能與修復(fù)神經(jīng)元功能有關(guān)。
[Abstract]:Objective: vascular dementia is a common type of dementia in clinical practice. However, there is still a lack of effective treatment, traditional Chinese medicine treatment of this disease has an advantage. In this study, magnetic resonance spectroscopy (Mrs) was used to explore the efficacy and mechanism of Dioscorea zingiberensis pills in the treatment of mild and moderate vascular dementia. Methods: from December 2015 to December 2016, 80 subjects were enrolled in this study, including 60 patients with vascular dementia (kidney essence deficiency syndrome, phlegm turbid obstruction of orifices syndrome). 20 cases of blood stasis and obstruction of collaterals), 20 subjects of normal group. 80 subjects of normal group were given neuropsychiatric evaluation, traditional Chinese medicine symptom evaluation, liver and kidney function, electrocardiogram and other safety examination, and brain bilateral thalamus, frontal lobe Mrs examination before intervention. Point-resolved spin echo sequence. 60 patients with vascular dementia were treated with Dioscorea zingiberensis pill (made from preparation department of Hubei Provincial Hospital of traditional Chinese Medicine), 15ml, twice a day, orally for 12 weeks, while the patients were treated with Dioscorea zingiberensis Pill. Observe one. The difference of craniocerebral Mrs between patients with vascular dementia and normal group before treatment is 2. 5%. The changes of MMSE, SDSVD, Mrs and adverse reactions in patients with vascular dementia before and after treatment. The result is 1: 1. During the follow-up, 2 patients with deficiency of kidney essence (1 patient with missing drug, 1 patient without examination) and 3 patients with phlegm turbid obstruction of orifices (2 patients without examination), 2 patients with deficiency of kidney essence (1 patient with missing drug, 1 patient without examination) and 3 patients with phlegm turbid obstruction syndrome (2 patients without examination), Other diseases occurred in 1 case, blood stasis and collaterals obstruction in 3 cases (1 case of drug leakage, 2 cases of uncoordinated examination) .2. In the right frontal lobe, Compared with the normal group, the values of Chor / Cr in the three groups were increased in varying degrees (deficiency of kidney essence, stagnation of phlegm, obstruction of resuscitation, P0. 000, P0. 001). The values of NAA / Cr in the three groups were significantly lower than those in the normal group (P 0. 000 for deficiency of kidney essence, 0. 000 for phlegm, 0. 000 for phlegm and P 0. 002 for blood stasis). In the left frontal lobe, It was also observed that in patients with right frontal lobe, the value of Chor / Cr in patients with Va D was increased in varying degrees than that in the normal group (kidney essence deficiency P0. 001, phlegm turbidity obstruction of orifices P0. 000, blood stasis obstruction of collaterals P0. 032). The value of NAA / Cr in patients with VAD was lower than that in the normal group (kidney essence deficiency P0. 000, phlegm turbidity P0. 000). Obstruction of orifices Pu 0.001, blood stasis blocking collaterals P0. 009), and there is a statistical difference. 3. Compared with the three groups of Vad patients, NAA / Cr value in the right frontal lobe patients with deficiency of kidney essence was significantly lower than that in patients with stagnation of blood and obstruction of collaterals (P0. 034) and patients with phlegm turbid obstruction of orifices (P0. 006). After treatment, MMSE score and SDSVD score of Vad patients in 3 groups improved significantly (P0.05). Three groups of Va D patients were treated with Dioscorea zingiberensis Pill. NAA / Cr in the right frontal lobe was significantly higher than that before treatment (deficiency of kidney essence 0.001, phlegm obstructing resuscitation P 0.001, blood stasis obstructing collaterals P 0.008), and NAA / Cr in left frontal lobe was significantly higher than that in patients with deficiency of kidney essence (P0. 026). But compared with the normal group, there is still a statistical difference (P0.05.6). The blood routine, urine routine, stool routine, liver function, renal function and electrocardiogram were not abnormal in the three groups. Conclusion 1. 1H-MRS can be used as a noninvasive and objective examination method in the diagnosis and evaluation of the curative effect of vascular dementia patients, and suggests that vascular dementia may be related to abnormal metabolic function of frontal neurons. Addition and subtraction Dioscorea Zingiberensis pills can improve the cognitive function of vascular dementia patients, but also improve the other symptoms. 3. The mechanism of Dioscorea zingiberensis Pill in improving the cognitive function of vascular dementia patients may be related to the function of repair neurons.
【學(xué)位授予單位】：湖北中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R277.7
本文編號(hào)：2119757
[Abstract]:Objective: vascular dementia is a common type of dementia in clinical practice. However, there is still a lack of effective treatment, traditional Chinese medicine treatment of this disease has an advantage. In this study, magnetic resonance spectroscopy (Mrs) was used to explore the efficacy and mechanism of Dioscorea zingiberensis pills in the treatment of mild and moderate vascular dementia. Methods: from December 2015 to December 2016, 80 subjects were enrolled in this study, including 60 patients with vascular dementia (kidney essence deficiency syndrome, phlegm turbid obstruction of orifices syndrome). 20 cases of blood stasis and obstruction of collaterals), 20 subjects of normal group. 80 subjects of normal group were given neuropsychiatric evaluation, traditional Chinese medicine symptom evaluation, liver and kidney function, electrocardiogram and other safety examination, and brain bilateral thalamus, frontal lobe Mrs examination before intervention. Point-resolved spin echo sequence. 60 patients with vascular dementia were treated with Dioscorea zingiberensis pill (made from preparation department of Hubei Provincial Hospital of traditional Chinese Medicine), 15ml, twice a day, orally for 12 weeks, while the patients were treated with Dioscorea zingiberensis Pill. Observe one. The difference of craniocerebral Mrs between patients with vascular dementia and normal group before treatment is 2. 5%. The changes of MMSE, SDSVD, Mrs and adverse reactions in patients with vascular dementia before and after treatment. The result is 1: 1. During the follow-up, 2 patients with deficiency of kidney essence (1 patient with missing drug, 1 patient without examination) and 3 patients with phlegm turbid obstruction of orifices (2 patients without examination), 2 patients with deficiency of kidney essence (1 patient with missing drug, 1 patient without examination) and 3 patients with phlegm turbid obstruction syndrome (2 patients without examination), Other diseases occurred in 1 case, blood stasis and collaterals obstruction in 3 cases (1 case of drug leakage, 2 cases of uncoordinated examination) .2. In the right frontal lobe, Compared with the normal group, the values of Chor / Cr in the three groups were increased in varying degrees (deficiency of kidney essence, stagnation of phlegm, obstruction of resuscitation, P0. 000, P0. 001). The values of NAA / Cr in the three groups were significantly lower than those in the normal group (P 0. 000 for deficiency of kidney essence, 0. 000 for phlegm, 0. 000 for phlegm and P 0. 002 for blood stasis). In the left frontal lobe, It was also observed that in patients with right frontal lobe, the value of Chor / Cr in patients with Va D was increased in varying degrees than that in the normal group (kidney essence deficiency P0. 001, phlegm turbidity obstruction of orifices P0. 000, blood stasis obstruction of collaterals P0. 032). The value of NAA / Cr in patients with VAD was lower than that in the normal group (kidney essence deficiency P0. 000, phlegm turbidity P0. 000). Obstruction of orifices Pu 0.001, blood stasis blocking collaterals P0. 009), and there is a statistical difference. 3. Compared with the three groups of Vad patients, NAA / Cr value in the right frontal lobe patients with deficiency of kidney essence was significantly lower than that in patients with stagnation of blood and obstruction of collaterals (P0. 034) and patients with phlegm turbid obstruction of orifices (P0. 006). After treatment, MMSE score and SDSVD score of Vad patients in 3 groups improved significantly (P0.05). Three groups of Va D patients were treated with Dioscorea zingiberensis Pill. NAA / Cr in the right frontal lobe was significantly higher than that before treatment (deficiency of kidney essence 0.001, phlegm obstructing resuscitation P 0.001, blood stasis obstructing collaterals P 0.008), and NAA / Cr in left frontal lobe was significantly higher than that in patients with deficiency of kidney essence (P0. 026). But compared with the normal group, there is still a statistical difference (P0.05.6). The blood routine, urine routine, stool routine, liver function, renal function and electrocardiogram were not abnormal in the three groups. Conclusion 1. 1H-MRS can be used as a noninvasive and objective examination method in the diagnosis and evaluation of the curative effect of vascular dementia patients, and suggests that vascular dementia may be related to abnormal metabolic function of frontal neurons. Addition and subtraction Dioscorea Zingiberensis pills can improve the cognitive function of vascular dementia patients, but also improve the other symptoms. 3. The mechanism of Dioscorea zingiberensis Pill in improving the cognitive function of vascular dementia patients may be related to the function of repair neurons.
【學(xué)位授予單位】：湖北中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R277.7
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