【摘要】：目的:通過(guò)對(duì)五臟溫陽(yáng)化瘀湯治療腎陽(yáng)虛衰兼痰瘀型血管性癡呆(vascular dementia,VaD)臨床療效的觀(guān)察,并探討其部分作用機(jī)制,從而為本方治療VaD的臨床應(yīng)用打下堅(jiān)實(shí)基礎(chǔ)。方法:將符合VaD診斷72例患者采用隨機(jī)對(duì)照試驗(yàn)的設(shè)計(jì)方法,分為中藥治療組(37例)和西藥對(duì)照組(35例)。治療組予五臟溫陽(yáng)化瘀方水煎劑口服,對(duì)照組予尼莫地平片口服,治療周期60天,觀(guān)察兩組患者治療前后的認(rèn)知功能積分,日常生活能力積分、中醫(yī)癥候積分及腦神經(jīng)遞質(zhì)水平的變化情況,并對(duì)藥物的安全性和臨床療效進(jìn)行評(píng)價(jià)。結(jié)果:(1)臨床療效比較:治療組與對(duì)照組的總有效率分別是89.19%和80%。兩組患者總有效率相比有顯著差異(P0.05)。說(shuō)明五臟溫陽(yáng)化瘀湯對(duì)VaD患者的治療總療效優(yōu)于尼莫地平片;(2)MMSE積分和ADL積分比較:治療組和對(duì)照組治療后,MMSE積分和ADL積分均有不同程度提高,兩組治療前后組內(nèi)比較均有顯著差異(P0.05),提示兩組患者認(rèn)知功能、日常生活能力明顯改善。治療后,治療組的MMSE積分和ADL積分與對(duì)照組比較有明顯差異(P0.05),說(shuō)明五臟溫陽(yáng)化瘀方在改善VaD患者的認(rèn)知功能及日常生活能力方面優(yōu)于尼莫地平片;(3)中醫(yī)證候積分比較:臨床試驗(yàn)后兩組中醫(yī)證候在形寒肢冷、肥胖、下利清谷、舌淡、脈沉或遲等癥上,治療組優(yōu)于對(duì)照組,有統(tǒng)計(jì)學(xué)差異(P0.05),從而說(shuō)明在治療后五臟溫陽(yáng)化瘀湯對(duì)腎陽(yáng)虛衰兼痰瘀型VaD患者的中醫(yī)癥候改善上優(yōu)于尼莫地平片;(4)腦內(nèi)神經(jīng)遞質(zhì)變化情況比較:腦神經(jīng)遞質(zhì)在兩組間進(jìn)行比較,在Ach、DA、NE等遞質(zhì)方面,治療組優(yōu)于對(duì)照組,有顯著差異(P0.05),從而說(shuō)明五臟溫陽(yáng)化瘀湯對(duì)腎陽(yáng)虛衰兼痰瘀型VaD患者的腦內(nèi)神經(jīng)遞質(zhì)改善上優(yōu)于尼莫地平片。結(jié)論:通過(guò)分析兩組治療前后MMSE積分、ADL積分、中醫(yī)證候積分的觀(guān)察,說(shuō)明五臟溫陽(yáng)化瘀湯對(duì)腎陽(yáng)虛衰兼痰瘀型VaD患者的療效優(yōu)于尼莫地平膠囊,作用機(jī)制可能與改善Ach、DA、NE等腦內(nèi)遞質(zhì)含量有關(guān)。并且本方無(wú)明顯毒副作用,具有較好的臨床應(yīng)用價(jià)值。
[Abstract]:Objective: to observe the clinical effect of Wuzangwenyang Huayu decoction in treating vascular dementia (vascular dementia,VaD) with deficiency of kidney yang and phlegm stasis, and to explore its mechanism, so as to lay a solid foundation for its clinical application in the treatment of VaD. Methods: 72 patients diagnosed by VaD were divided into Chinese medicine treatment group (37 cases) and western medicine control group (35 cases) by randomized controlled trial. The treatment group was treated with Wuzangwenyang Huayu decoction and the control group was treated with nimodipine tablets for 60 days. The cognitive and daily life scores of the two groups were observed before and after treatment. The changes of TCM symptom score and the level of brain neurotransmitters, and the safety and clinical efficacy of drugs were evaluated. Results: (1) comparison of clinical efficacy: the total effective rates of treatment group and control group were 89.19% and 80% respectively. There was significant difference in the total effective rate between the two groups (P0.05). It shows that the total curative effect of Wuzangwenyang Huayu decoction on VaD patients is better than that of nimodipine tablet. (2) comparison of MMSE integral and ADL integral: after treatment, MMSE score and ADL score increased in different degree in the treatment group and control group, and there were significant differences between the two groups before and after treatment (P0.05), which indicated that the cognitive function of the two groups was higher than that of the control group. The ability of daily life has improved markedly. After treatment, the MMSE scores and ADL scores in the treatment group were significantly different from those in the control group (P0.05), indicating that Wuzangwenyang Huayu recipe was superior to nimodipine tablets in improving the cognitive function and daily living ability of VaD patients. (3) comparison of TCM syndromes integral: after clinical trial, the two groups of TCM syndromes were superior to the control group (P0.05). It shows that after the treatment of Wuzangwenyang Huayu decoction for kidney yang deficiency and phlegm stasis type of VaD patients improve the traditional Chinese medicine symptoms better than nimodipine tablets; (4) comparison of the changes of neurotransmitters in brain: compared between the two groups, the treatment group was superior to the control group in terms of Ach,DA,NE and other neurotransmitters (P0.05). The results showed that Wuzang Wenyang Huayu decoction was superior to Nimodipine tablets in improving neurotransmitters in brain of VaD patients with deficiency of kidney yang and phlegm stasis. Conclusion: by analyzing the observation of MMSE integral, ADL integral and TCM syndrome integral before and after treatment, it is concluded that Wuzangwenyang Huayu decoction is superior to nimodipine capsule in treating VaD patients with deficiency of kidney yang and phlegm stasis, and the mechanism may be related to the improvement of Ach,DA,. The content of NE and other transmitters in brain is related. And this prescription has no obvious side effects, and has good clinical application value.
【學(xué)位授予單位】：廣西中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類(lèi)號(hào)】：R277.7

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