卡巴拉汀联合高压氧对老年认知功能障碍患者的临床疗效及对脑脊液t-tau、p-tau181蛋白和Aβ42的影响

Effect of hyperbaric oxygen on rivastigmine in cognitive dysfunction in elderly patients cerebrospinal fluid t-tau protein,p-tau181 protein and Aβ42

目的观察卡巴拉汀(商品名:艾斯能)联合高压氧对老年认知功能障碍患者脑脊液中的t-tau蛋白、p-tau181蛋白和Aβ42的影响。方法收集2014年1月—2015年12月湖北省黄冈市中心医院神经内科诊治疗老年认知功能障碍患者90例作为研究对象,应用随机数表法分为2组,每组45例。观察组患者给予艾斯能联合高压氧治疗,对照组给予单独高压氧治疗,比较2组患者的MMSE评分、Barthel指数以及脑脊液中的t-tau蛋白、p-tau181蛋白和Aβ42含量。结果观察组治疗总有效率为93.33%,显著高于对照组的73.33%(x^2=6.480,P=0.011);与治疗前相比,治疗后2组患者的MMSE评分和Barthel指数均明显上升,且观察组[(25.38±4.75)分、(69.73±15.82)分]上升幅度大于对照组[(21.03±2.78)分、(58.34±13.69)分],差异均有统计学意义(t=5.302、3.652,P<0.05);与治疗前相比,治疗后2组患者的t-tau蛋白、p-tau181蛋白含量明显减少,且观察组下降幅度大于对照组,差异有统计学意义(t=2.274、5.524,P<0.05);与治疗前相比,治疗后2组患者的Aβ42含量均明显增加,且观察组增加幅度大于对照组,差异有统计学意义(t=2.223,P=0.031)。结论艾斯能联合高压氧能够明显改善老年认知功能障碍患者的MMSE评分、Barthel指数,降低脑脊液中的t-tau蛋白、p-tau181蛋白含量,提高Aβ42含量,治疗效果优于单独高压氧,建议在临床推广应用。

Objective To observe the effect of rivastigmine（Exelon） combined with hyperbaric oxygen on cognitive dysfunction in elderly patients with cerebrospinal fluid t-tau protein,p-taul81 protein and Aβ42.Methods Ninety cases of elderly patients with cognitive dysfunction in the Department of Neurology,Huanggang Central Hospital,Hubei Province from January 2014 to December 2015 were studied,they were randomly divided into 2 groups,45 cases in each group.The observation group was treated with Exelon combined with hyperbaric oxygen therapy,the control group was given hyperbaric oxygen therapy alone,compared 2 groups of patients with MMSE score,Barthel index and t-tau in cerebrospinal fluid protein,ptaul81 protein and Ap42 content.Results The total effective rate of the observation group was 93.33%,which was higher than that of the control group＇ s 73.33%（x^2 = 6.480,P = 0.011）;compared with before treatment,after treatment 2 groups of patients＇ MMSE score and Barthel index were significantly increased,and the observation group（25.38 ±4.75,69.73 ±15.82） increased more significantly than that of control group（21.03 ±2.78,58.34 ±13.69）,the differences were statistically significant（t =5.302,t =3.652,P 0.05）;compared with before treatment,after treatment 2 groups of patients＇ ttau protein,p-taul81 protein content decreased significantly,and the observation group[（517.14 ± 146.72）pg/ml,（59.14 ±11.63）pg/ml]decreased more than that of control group[（592.37 ± 166.48）pg/ml,（73.59 ± 13.14） pg/ml],the difference was statistically significant（t = 2.274,t = 5.524,P 0.05）;compared with before treatment,after treatment in 2groups＇ the content of A beta 42 was significantly increased,and the observation group（608.29 ± 124.55） pg/ml increased significantly than the control group（551.35 ±118.42） pg/ml,the difference was statistically significant（t =2.223,P 0.05）.Conclusion Exelon combined with hyperbaric oxygen can significantly improve the cognitive impairment in the elderly patients with MMSE score,Barthel index,reduce t-tau protein and p-taul81 protein content in the cerebrospinal fluid,increased the content of A beta 42,the treatment effect is better than that of hyperbaric oxygen,recommended in clinical application.