【摘要】：目的:通過對五臟溫陽化瘀湯治療腎陽虛衰兼痰瘀型血管性癡呆(vascular dementia,VaD)臨床療效的觀察,并探討其部分作用機制,從而為本方治療VaD的臨床應用打下堅實基礎。方法:將符合VaD診斷72例患者采用隨機對照試驗的設計方法,分為中藥治療組(37例)和西藥對照組(35例)。治療組予五臟溫陽化瘀方水煎劑口服,對照組予尼莫地平片口服,治療周期60天,觀察兩組患者治療前后的認知功能積分,日常生活能力積分、中醫(yī)癥候積分及腦神經(jīng)遞質水平的變化情況,并對藥物的安全性和臨床療效進行評價。結果:(1)臨床療效比較:治療組與對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)。說明五臟溫陽化瘀湯對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積分與對照組比較有明顯差異(P0.05),說明五臟溫陽化瘀方在改善VaD患者的認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)于對照組,有統(tǒng)計學差異(P0.05),從而說明在治療后五臟溫陽化瘀湯對腎陽虛衰兼痰瘀型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)遞質變化情況比較:腦神經(jīng)遞質在兩組間進行比較,在Ach、DA、NE等遞質方面,治療組優(yōu)于對照組,有顯著差異(P0.05),從而說明五臟溫陽化瘀湯對腎陽虛衰兼痰瘀型VaD患者的腦內(nèi)神經(jīng)遞質改善上優(yōu)于尼莫地平片。結論:通過分析兩組治療前后MMSE積分、ADL積分、中醫(yī)證候積分的觀察,說明五臟溫陽化瘀湯對腎陽虛衰兼痰瘀型VaD患者的療效優(yōu)于尼莫地平膠囊,作用機制可能與改善Ach、DA、NE等腦內(nèi)遞質含量有關。并且本方無明顯毒副作用,具有較好的臨床應用價值。
[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.
【學位授予單位】：廣西中醫(yī)藥大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R277.7

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