补脾益心汤加减联合丁苯酞软胶囊治疗脑梗死后血管性痴呆的疗效观察

doi:10.11958/20253541

摘要/Abstract

摘要：

目的探讨补脾益心汤加减联合丁苯酞（NBP）软胶囊治疗脑梗死后血管性痴呆（VD）的疗效及对认知功能、血清组蛋白去乙酰化酶6（HDAC6）、神经调节蛋白1（NRG1）水平的影响。方法纳入100例脑梗死后VD患者，并按照随机数字表法分为NBP组和联合组，2组各50例。其中NBP组采用NBP软胶囊治疗，联合组在NBP组基础上给予补脾益心汤加减治疗。比较2组疗效，患者治疗前后中医证候总积分，认知功能[简易精神状态检查量表（MMSE）、蒙特利尔认知功能量表（MoCA）评分]，痴呆程度[临床痴呆评定量表（CDR）评分、改良长谷川痴呆量表（HDS-R）评分]，血液流变学[全血高/低切黏度、血浆黏度]及血清相关因子[HDAC6、NRG1、脑源性神经营养因子（BDNF）]水平的差异。结果联合组总有效率高于NBP组（P<0.05）。治疗后，联合组中医证候总积分、CDR评分低于NBP组，MMSE评分、MoCA评分、HDS-R评分均高于NBP组；全血高/低切黏度、血浆黏度及血清HDAC6水平均低于NBP组，血清BDNF、NRG1水平高于NBP组（P<0.05）。结论补脾益心汤加减联合NBP软胶囊治疗脑梗死后VD患者具有显著疗效，能够减轻痴呆严重程度，改善认知功能，降低血液黏度，升高血清HDAC6、NRG1水平。

关键词: 脑梗死, 痴呆, 血管性, 认知, 组蛋白去乙酰化酶6, 神经调节蛋白1, 丁苯酞软胶囊, 补脾益心汤加减方

Abstract:

Objective To explore the efficacy of modified Bu Pi Yi Xin decoction combined with N-butylphthalide (NBP) soft capsules in treating vascular dementia (VD) after cerebral infarction, and its influences on cognitive function, serum histone deacetylase 6 (HDAC6) and neuregulin 1 (NRG1) levels. Methods One hundred patients with VD after cerebral infarction were included and randomly divided into the NBP group and the combined group according to the random number table method, with 50 cases in each group. In the NBP group, NBP soft capsules were used for treatment, while in the combined group, on the basis of the NBP group, modified Bu Pi Yi Xin decoction was given. The differences in the total scores of traditional Chinese medicine (TCM) syndromes, cognitive function [Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) scores], degree of dementia [Clinical Dementia Rating (CDR) score and modified Hasegawa Dementia Scale (HDS-R) score], hemorheology [high/low shear whole blood viscosity and plasma viscosity] and serum-related factors [HDAC6, NRG1 and brain-derived neurotrophic factor (BDNF)] were compared before and after treatment between the two groups. Results After treatment, the total effective rate was higher in the combined group than that of the NBP group (P<0.05). After treatment, the total score of TCM syndromes and CDR score were lower in the combined group than those in the NBP group (P<0.05), and MMSE score, MoCA score and HDS-R score were higher in the combined group than those in the NBP group (P<0.05). After treatment, the high/low shear viscosity of whole blood, plasma viscosity and serum levesl of HDAC6 were lower in the combined group than those in the NBP group (P<0.05), while serum levels of BDNF and NRG1 were higher in the combined group than those in the NBP group (P<0.05). Conclusion The modified Bu Pi Yi Xin decoction combined with NBP soft capsules have a significant therapeutic effect on VD patients after cerebral infarction, and it can alleviate the severity of dementia, improve cognitive function, reduce blood viscosity and increase serum levels of HDAC6 and NRG1.

Key words: brain infarction, dementia, vascular, cognition, histone deacetylase 6, neuregulin-1, N-butylphthalide soft capsules, modified Bupi Yixin decoction

中图分类号:

R743

图/表 7

参考文献 21

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组别	性别		年龄/ 岁	病程/ 月	痴呆程度
组别	男	女	年龄/ 岁	病程/ 月	轻度	中度
NBP组	29（58）	21（42）	67.74±6.98	1.86±0.40	20（40）	30（60）
联合组	32（64）	18（36）	68.18±7.24	1.92±0.44	18（36）	32（64）
χ²或t	0.378		0.309	0.706	0.170

组别	性别		年龄/ 岁	病程/ 月	痴呆程度
组别	男	女	年龄/ 岁	病程/ 月	轻度	中度
NBP组	29（58）	21（42）	67.74±6.98	1.86±0.40	20（40）	30（60）
联合组	32（64）	18（36）	68.18±7.24	1.92±0.44	18（36）	32（64）
χ²或t	0.378		0.309	0.706	0.170

组别	显效	有效	无效	总有效
NBP组	19（38）	20（40）	11（22）	39（78）
联合组	30（60）	17（34）	3（6）	47（94）
χ²				5.316^＊

组别	显效	有效	无效	总有效
NBP组	19（38）	20（40）	11（22）	39（78）
联合组	30（60）	17（34）	3（6）	47（94）
χ²				5.316^＊

组别	治疗前	治疗后	t
NBP组	16.39±2.14	8.92±1.84	47.768^＊＊
联合组	16.72±2.68	6.79±1.52	50.973^＊＊
t	0.680	6.292^＊＊