培元開智湯治療腦小血管病性認(rèn)知功能障礙的臨床研究
發(fā)布時(shí)間：2018-08-14 14:12
【摘要】：目的:探討培元開智湯治療腦小血管病性認(rèn)知功能障礙的臨床療效及其可能機(jī)制。方法:采用隨機(jī)數(shù)字表法將70例患者分為觀察組和對(duì)照組,每組35例。對(duì)照組采用常規(guī)治療;觀察組在常規(guī)治療基礎(chǔ)上加服中藥湯劑培元開智湯,每日一劑。療程共60天。兩組均于治療前、治療30天、治療60天進(jìn)行MoCABJ(蒙特利爾認(rèn)知評(píng)估量表北京版)評(píng)定、MMSE(簡(jiǎn)易精神狀態(tài)檢查量表)評(píng)定及ADL(日常生活能力量表)評(píng)定,并于治療前后進(jìn)行中醫(yī)證候積分、CRP(血清C反應(yīng)蛋白)及MMP-3(基質(zhì)金屬蛋白酶3)含量測(cè)定,并進(jìn)行中醫(yī)證候療效評(píng)定及認(rèn)知功能療效評(píng)定。結(jié)果:(1)臨床觀察過程中,兩組各脫落2例,實(shí)際完成觀察病例為66例(觀察組33例,對(duì)照組33例)。兩組治療前性別、年齡、教育年限、既往史評(píng)分、伴發(fā)病評(píng)分、中醫(yī)證候積分、MoCABJ評(píng)分、MMSE評(píng)分、ADL評(píng)分、血清CRP及MMP-3含量等方面比較均無顯著性差異(P(29)05.0),具有可比性;(2)兩組中醫(yī)證候積分比較:治療后兩組中醫(yī)證候積分與治療前相比均有降低且差異顯著(P(27)05.0);兩組治療后中醫(yī)證候積分比較,觀察組降低明顯且差異顯著(P(27)05.0);療程結(jié)束后進(jìn)行中醫(yī)證候療效評(píng)定,觀察組療效分級(jí)明顯優(yōu)于對(duì)照組且差異顯著(P(27)05.0);(3)兩組Mo CABJ、MMSE評(píng)分比較:治療30天兩組Mo CABJ、MMSE評(píng)分與治療前相比均有升高且差異顯著(P(27)05.0),與對(duì)照組比觀察組MoCABJ、MMSE評(píng)分升高高于對(duì)照組且差異顯著(P(27)05.0);治療60天兩組MoCABJ、MMSE評(píng)分與治療前相比均有升高且差異顯著(P(27)05.0),與對(duì)照組比觀察組MoCABJ、MMSE評(píng)分升高高于對(duì)照組且差異顯著(P(27)05.0);療程結(jié)束后對(duì)MoCABJ各子項(xiàng)進(jìn)行配對(duì)樣本t檢驗(yàn),提示視空間與執(zhí)行能力、命名能力、語言、延遲回憶及定向力較治療前差異顯著(P(27)05.0),注意力與抽象較治療前差異無顯著性(P(29)05.0),提示培元開智湯對(duì)各認(rèn)知域的改善可能具有不均一性;療程結(jié)束時(shí),進(jìn)行認(rèn)知功能療效評(píng)定,觀察組療效分級(jí)明顯優(yōu)于對(duì)照組且差異顯著(P(27)05.0);(4)兩組ADL評(píng)分比較:治療30天兩組ADL評(píng)分與治療前相比均有升高且差異顯著(P(29)05.0),與對(duì)照組比觀察組ADL評(píng)分稍有升高但無顯著性差異(P(29)05.0);治療60天兩組ADL評(píng)分與治療前相比均有升高且差異顯著(P(27)05.0),與對(duì)照組比觀察組ADL評(píng)分升高高于對(duì)照組且差異顯著(P(27)05.0);(5)兩組血清CRP及MMP-3含量比較:治療后兩組血清CRP及MMP-3含量與治療前相比降低明顯且差異顯著(P(27)05.0);療程結(jié)束后,觀察組與對(duì)照組比觀察組血清CRP及MMP-3含量降低明顯且差異顯著(P(27)05.0);進(jìn)一步對(duì)腦白質(zhì)病變與血清CRP及MMP-3含量進(jìn)行相關(guān)性分析,提示二者均與腦白質(zhì)病變?cè)u(píng)分成正相關(guān)。結(jié)論:(1)培元開智湯用于治療CSVCI患者臨床療效確切,可顯著改善腎虛痰瘀型CSVCI患者中醫(yī)臨床癥狀,改善患者認(rèn)知功能及日常生活能力(而在改善認(rèn)知功能中尤其對(duì)視空間與執(zhí)行能力、命名能力、語言、延遲回憶及定向力等方面較顯著),其可能機(jī)制為拮抗炎癥反應(yīng)、保護(hù)血腦屏障。(2)培元開智湯臨床應(yīng)用安全,無明顯不良反應(yīng)。
[Abstract]:Objective: To explore the clinical effect and possible mechanism of Peiyuan Kaizhi Decoction in the treatment of cognitive impairment caused by cerebellar angiopathy. Methods: 70 patients were divided into observation group and control group by random number table method, each group had 35 cases. The two groups were treated for 60 days before and 30 days after treatment. MoCABJ (Montreal Cognitive Assessment Scale, Beijing version), MMSE (Simple Mental State Examination Scale) and ADL (Activity of Daily Living Scale) were assessed at 60 days after treatment. The scores of TCM syndromes, CRP (Serum C-reactive protein) and MMP-3 (Matrix Metalloproteinase 3) were also assessed before and after treatment. Results: (1) In the course of clinical observation, there were 2 cases in each group, 66 cases in the observation group (33 cases in the observation group, 33 cases in the control group). Before treatment, the gender, age, years of education, past history score, comorbidity score, TCM syndrome score, MoCABJ score, MM, MM were observed in the two groups. SE score, ADL score, serum CRP and MMP-3 content were not significantly different (P (29) 05.0), with comparability; (2) two groups of TCM syndrome score comparison: after treatment, two groups of TCM syndrome score compared with before treatment were reduced and significant difference (P (27) 05.0); two groups of TCM syndrome score after treatment, the observation group decreased significantly and poor. Significant difference (P (27) 05.0); after the end of treatment, the efficacy of TCM syndrome evaluation, the observation group was significantly better than the control group and the difference was significant (P (27) 05.0); (3) MoCABJ, MMSE scores of the two groups: 30 days after treatment, the two groups of MoCABJ, MMSE scores compared with before treatment were increased and significant difference (P (27) 05.0), compared with the control group MoCABJ, MMSE. The scores of MoCABJ and MMSE in the two groups were significantly higher than those in the control group (P (27) 05.0). The scores of MoCABJ and MMSE in the observation group were significantly higher than those in the control group (P (27) 05.0) after 60 days of treatment, and the scores of MoCABJ and MMSE in the control group were significantly higher than those in the control group (P (27) 05.0). Visual space and executive ability, naming ability, language, delayed recall and orientation were significantly different before treatment (P (27) 05.0), attention and abstraction were not significantly different (P (29) 05.0), suggesting that the improvement of cognitive domains by Peiyuan Kaizhi decoction may be inhomogeneous; at the end of treatment, cognitive function was evaluated, and the curative effect of observation group was not significant (P (29) 05.0). The ADL scores of the two groups were significantly higher than those of the control group (P (27) 05.0); (4) The ADL scores of the two groups were significantly higher than those before treatment at 30 days after treatment (P (29) 05.0). The ADL scores of the two groups were slightly higher than those of the control group, but there was no significant difference (P (29) 05.0); the ADL scores of the two groups at 60 days after treatment were both higher and higher than those before treatment (P (29) 05.0). The difference was significant (P (27) 05.0). Compared with the control group, the ADL score of the observation group was higher and the difference was significant (P (27) 05.0); (5) The serum CRP and MMP-3 levels of the two groups were compared: After treatment, the serum CRP and MMP-3 levels of the two groups were significantly lower than before treatment and the difference was significant (P (27) 05.0); After the treatment, the serum CRP of the observation group and the control group were significantly lower than that of the observation group (P (P 27) 05.0 Conclusion: (1) Peiyuan Kaizhi Decoction is effective in the treatment of CSVCI, and can significantly improve the clinical efficacy of kidney deficiency and phlegm stasis type of CSVCI patients. Bed symptoms, improvement of cognitive function and ability of daily living (especially in visual space and executive ability, naming ability, language, delayed recall and directional ability, etc.) may be related to antagonizing inflammation and protecting blood brain barrier. (2) Peiyuan Kaizhi Decoction is safe in clinical application without obvious adverse reactions.
【學(xué)位授予單位】：河南中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2016
【分類號(hào)】：R277.7
本文編號(hào)：2183111
[Abstract]:Objective: To explore the clinical effect and possible mechanism of Peiyuan Kaizhi Decoction in the treatment of cognitive impairment caused by cerebellar angiopathy. Methods: 70 patients were divided into observation group and control group by random number table method, each group had 35 cases. The two groups were treated for 60 days before and 30 days after treatment. MoCABJ (Montreal Cognitive Assessment Scale, Beijing version), MMSE (Simple Mental State Examination Scale) and ADL (Activity of Daily Living Scale) were assessed at 60 days after treatment. The scores of TCM syndromes, CRP (Serum C-reactive protein) and MMP-3 (Matrix Metalloproteinase 3) were also assessed before and after treatment. Results: (1) In the course of clinical observation, there were 2 cases in each group, 66 cases in the observation group (33 cases in the observation group, 33 cases in the control group). Before treatment, the gender, age, years of education, past history score, comorbidity score, TCM syndrome score, MoCABJ score, MM, MM were observed in the two groups. SE score, ADL score, serum CRP and MMP-3 content were not significantly different (P (29) 05.0), with comparability; (2) two groups of TCM syndrome score comparison: after treatment, two groups of TCM syndrome score compared with before treatment were reduced and significant difference (P (27) 05.0); two groups of TCM syndrome score after treatment, the observation group decreased significantly and poor. Significant difference (P (27) 05.0); after the end of treatment, the efficacy of TCM syndrome evaluation, the observation group was significantly better than the control group and the difference was significant (P (27) 05.0); (3) MoCABJ, MMSE scores of the two groups: 30 days after treatment, the two groups of MoCABJ, MMSE scores compared with before treatment were increased and significant difference (P (27) 05.0), compared with the control group MoCABJ, MMSE. The scores of MoCABJ and MMSE in the two groups were significantly higher than those in the control group (P (27) 05.0). The scores of MoCABJ and MMSE in the observation group were significantly higher than those in the control group (P (27) 05.0) after 60 days of treatment, and the scores of MoCABJ and MMSE in the control group were significantly higher than those in the control group (P (27) 05.0). Visual space and executive ability, naming ability, language, delayed recall and orientation were significantly different before treatment (P (27) 05.0), attention and abstraction were not significantly different (P (29) 05.0), suggesting that the improvement of cognitive domains by Peiyuan Kaizhi decoction may be inhomogeneous; at the end of treatment, cognitive function was evaluated, and the curative effect of observation group was not significant (P (29) 05.0). The ADL scores of the two groups were significantly higher than those of the control group (P (27) 05.0); (4) The ADL scores of the two groups were significantly higher than those before treatment at 30 days after treatment (P (29) 05.0). The ADL scores of the two groups were slightly higher than those of the control group, but there was no significant difference (P (29) 05.0); the ADL scores of the two groups at 60 days after treatment were both higher and higher than those before treatment (P (29) 05.0). The difference was significant (P (27) 05.0). Compared with the control group, the ADL score of the observation group was higher and the difference was significant (P (27) 05.0); (5) The serum CRP and MMP-3 levels of the two groups were compared: After treatment, the serum CRP and MMP-3 levels of the two groups were significantly lower than before treatment and the difference was significant (P (27) 05.0); After the treatment, the serum CRP of the observation group and the control group were significantly lower than that of the observation group (P (P 27) 05.0 Conclusion: (1) Peiyuan Kaizhi Decoction is effective in the treatment of CSVCI, and can significantly improve the clinical efficacy of kidney deficiency and phlegm stasis type of CSVCI patients. Bed symptoms, improvement of cognitive function and ability of daily living (especially in visual space and executive ability, naming ability, language, delayed recall and directional ability, etc.) may be related to antagonizing inflammation and protecting blood brain barrier. (2) Peiyuan Kaizhi Decoction is safe in clinical application without obvious adverse reactions.
【學(xué)位授予單位】：河南中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2016
【分類號(hào)】：R277.7
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