Observation on the therapeutic effect of modified Bu Pi Yi Xin decoction combined with dibenzoyl phenylalanine soft capsules in the treatment of vascular dementia after cerebral infarction

doi:10.11958/20253541

Abstract

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

CLC Number:

R743

Figures/Tables 7

References 21

[1]	楚新歌, 崔春爱. 成纤维细胞生长因子21在血管性痴呆中的研究进展[J]. 医学研究生学报, 2022, 35(4):424-427.
	CHU X G, CUI C A. Research progress on fibroblast growth factor 21 in vascular dementia[J]. Journal of Medical Postgraduates, 2022, 35(4):424-427. doi:10.16571/j.cnki.1008-8199.2022.04.017.
[2]	蔡鸣凡, 祁风, 许璇, 等. 安脑丸联合石杉碱甲治疗脑梗死后血管性痴呆的临床研究[J]. 现代药物与临床, 2022, 37(10):2253-2257.
	CAI M F, QI F, XU X, et al. Clinical study on Annao Pills combined with Huperzine A in treatment of vascular dementia after cerebral infarction[J]. Drugs & Clinic, 2022, 37(10):2253-2257. doi:10.7501/j.issn.1674-5515.2022.10.013.
[3]	PATHAN N, KHAROD M K, NAWAB S, et al. Genetic determinants of vascular dementia[J]. Can J Cardiol, 2024, 40(8):1412-1423. doi:10.1016/j.cjca.2024.03.025.
[4]	银楠楠, 王少洲, 顿玲露, 等. 扶正化痰通络汤治疗脑梗死后血管性痴呆的临床观察[J]. 中医药导报, 2024, 30(4):105-110.
	YIN N N, WANG S Z, DUN L L, et al. Clinical observation on the treatment of vascular dementia after cerebral infarction by Fuzheng Huatan Tongluo Decoction[J]. Guiding Journal of Traditional Chinese Medicine and Pharmacy, 2024, 30(4):105-110. doi:10.13862/j.cn43-1446/r.2024.04.020.
[5]	梅倩倩, 董会, 吉金荣. 通窍活血汤联合丁苯酞治疗脑梗死后血管性痴呆的疗效及其对患者痴呆程度,认知功能的影响[J]. 海南医学, 2024, 35(9):1228-1233.
	MEI Q Q, DONG H, JI J R. Efficacy of Tongqiao Huoxue Decoction combined with butylphthalide in the treatment of vascular dementia after cerebral infarction and its impact on the severity of dementia and cognitive function in patients[J]. Hainan Medical Journal, 2024, 35(9):1228-1233. doi:10.3969/j.issn.1003-6350.2024.09.003.
[6]	班维固, 齐辉, 滕秀英, 等. 参苓养心汤联合针刺治疗心脾两虚型血管性痴呆45例[J]. 环球中医药, 2022, 15(4):689-692.
	BAN W G, QI H, TENG X Y, et al. Shenling Yangxin Decoction combined with acupuncture treatment for 45 cases of vascular dementia caused by deficiency of both heart and spleen[J]. Global Traditional Chinese Medicine, 2022, 15(4):689-692. doi:10.3969/j.issn.1674-1749.2022.04.032.
[7]	中华医学会神经病学分会, 中华医学会神经病学分会脑血管病学组. 中国各类主要脑血管病诊断要点2019[J]. 中华神经科杂志, 2019, 52(9):710-715.
	Chinese Society of Neurology,Chinese Stroke Society. Diagnostic criteria of cerebrovascular diseases in China(version 2019)[J]. Chinese Journal of Neurology, 2019, 52(9):710-715. doi:10.3760/cma.j.issn.1006-7876.2019.09.003.
[8]	中国卒中学会血管性认知障碍分会. 中国血管性认知障碍诊治指南(2024版)[J]. 中华医学杂志, 2024, 104(31):2881-2894.
	Chinese Stroke Association Vascular Cognitive Impairment Subcommittee. Chinese guidelines for the diagnosis and treatment of vascular cognitive impairment(2024 edition)[J]. National Medical Journal of China, 2024, 104(31):2881-2894. doi:10.3760/cma.j.cn112137-20240501-01024.
[9]	国家中医药管理局. 中药新药临床研究指导原则试行[M]. 北京: 中国医药科技出版社,2002:91-98.
	National Administration of Traditional Chinese Medicine. Guidelines for Clinical Research of New Traditional Chinese Medicines (Trial Version)[M]. Beijing: China Pharmaceutical Science and Technology Press,2002:91-98.
[10]	DONG C, HAYASHI S. Deep learning applications in vascular dementia using neuroimaging[J]. Curr Opin Psychiatry, 2024, 37(2):101-106. doi:10.1097/YCO.0000000000000920.
[11]	罗银香, 张雪竹. 慢性脑低灌注致血管性痴呆发病机制研究进展[J]. 山东医药, 2024, 64(3):100-106.
	LUO Y X, ZHANG X Z. Research progress on the pathogenesis of vascular dementia caused by chronic cerebral hypoperfusion[J]. Shandong Medical Journal, 2024, 64(3):100-106. doi:10.3969/j.issn.1002-266X.2024.03.024.
[12]	MACOIR J. Language impairment in vascular dementia:a clinical review[J]. J Geriatr Psychiatry Neuro, 2024, 37(2):87-95. doi:10.1177/08919887231195225.
[13]	王改芳, 殷婷, 肖颖. 脉络宁口服液联合丁苯酞对血管性痴呆认知功能及内质网应激反应相关指标的影响[J]. 中华中医药学刊, 2023, 41(6):161-164.
	WANG G F, YIN T, XIAO Y. Effects of Mailuoning Oral Liquid and Butylphthalide on cognitive function and endoplasmic reticulum stress related indexes in patients with vascular dementia[J]. Chinese Archives of Traditional Chinese Medicine, 2023, 41(6):161-164. doi:10.13193/j.issn.1673-7717.2023.06.034.
[14]	邢海辉, 李巧云, 陈丹. 补脾益心汤加减治疗脑梗死后血管性痴呆临床疗效及对患者血液流变学及认知功能的影响[J]. 四川中医, 2022, 40(4):130-133.
	XING H H, LI Q Y, CHEN D. Effect of Bupi Yixin Decoction on clinical efficacy,hemorheology and cognitive function for patients with vascular dementia after cerebral infarction[J]. Journal of Sichuan of Traditional Chinese Medicine, 2022, 40(4):130-133. doi:10.3969/j.issn.1000-3649.2022.4.sczy202204042.
[15]	高玉宝, 吴伟伟, 朋源凤, 等. 通督调神针刺法联合胞磷胆碱对脑梗死后血管性痴呆患者认知功能、血液流变学和脑血流动力学的影响[J]. 现代生物医学进展, 2022, 22(17):3347-3350,3392.
	GAO Y B, WU W W, PENG Y F, et al. Effects of Tongdu Tiaoshen acupuncture combined with citicoline on cognitive function,hemorheology and cerebral hemodynamics in patients with vascular dementia after cerebral infarction[J]. Progress in Modern Biomedicine, 2022, 22(17):3347-3350,3392. doi:10.13241/j.cnki.pmb.2022.17.029.
[16]	付慧婕, 雷根平, 董盛, 等. 黄芪的现代药理作用及研究进展[J]. 河北中医, 2025, 47(4):695-704.
	FU H J, LEI G P, DONG S, et al. The modern pharmacological effects and research progress of Astragalus membranaceus[J]. Hebei Journal of Traditional Chinese Medicine, 2025, 47(4):695-704. doi:10.3969/j.issn.1002-2619.2025.04.036.
[17]	吴娇, 张驾龙, 仝芳超, 等. 当归的化学成分、药理作用及临床应用[J]. 中医学报, 2025, 40(9):1917-1923.
	WU J, ZHANG J L, TONG F C, et al. Chemical composition,pharmacological effects and clinical applications of Danggui(Angelica)[J]. Acta Chinese Medicine, 2025, 40(9):1917-1923. doi:10.16368/j.issn.1674-8999.2025.09.307.
[18]	王雪, 张振勇, 许彬, 等. 老年血管性痴呆病人血清VEGF,BDNF水平与病情严重程度的关系及对预后的预测价值[J]. 实用老年医学, 2025, 39(1):32-36.
	WANG X, ZHANG Z Y, XU B, et al. Study on association of serum levels of VEGF and BDNF with severity of vascular dementia and predictive value for prognosis[J]. Practical Geriatrics, 2025, 39(1):32-36. doi:10.3969/j.issn.1003-9198.2025.01.008.
[19]	张玉兰, 许竞, 闫建军. 高强度间歇运动对脑梗死后大鼠的脑保护作用及HDAC6表达的影响[J]. 基因组学与应用生物学, 2020, 39(1):407-413.
	ZHANG Y L, XU J, YAN J J. Effects of high-intensity intermittent exercise on brain protection and HDAC6 expression in rats after cerebral infarction[J]. Genomics and Applied Biology, 2020, 39(1):407-413. doi:10.13417/j.gab.039.000407.
[20]	段新飞, 贾俊栋, 胡科, 等. 血管性痴呆患者血清HDAC6和BDNF表达与患者认知功能及预后的相关性分析[J]. 四川医学, 2024, 45(8):848-852.
	DUAN X F, JIA J D, HU K, et al. Correlation analysis of serum HDAC6 and BDNF expression with cognitive function and prognosis in patients with vascular dementia[J]. Sichuan Medical Journal, 2024, 45(8):848-852. doi:10.16252/j.cnki.issn1004-0501-2024.08.007.
[21]	钟文清, 陈晓瑜, 刘丹丹. 血管性痴呆患者血清神经调节蛋白1、神经元正五聚蛋白2的表达及临床意义[J]. 临床神经病学杂志, 2023, 36(1):28-33.
	ZHONG W Q, CHEN X Y, LIU D D. Expression and clinical significance of serum neuregulin 1 and neuronal pentraxin 2 in patients with vascular dementia[J]. Journal of Clinical Neurology, 2023, 36(1):28-33. doi:10.3969/j.issn.1004-1648.2023.01.007.

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^＊＊