银杏叶提取液对不同类型脑小血管病患者认知功能改善的观察

The improvement of cognitive function of Ginkgo biloba extract in patients with different types of cerebral small vessel disease

目的对比分析银杏叶提取液对不同类型脑小血管病(CSVD)患者认知功能的改善情况。方法收集2016年3月至2018年4月西安交通大学第二附属医院老年神经内科收治的123例CSVD患者,根据类型分成三组:脑白质病变组(WML,n=43),腔隙性脑梗死组(LI,n=36)及WML+LI组(n=44);同时选取同时间段门诊就诊的44例无影像学病变的头痛患者作为对照组。收集患者的临床资料,检测血清转化生长因子β(TGF-β)、肿瘤坏死因子α(TNF-α)及Aβ肽1-40(Aβ1-40)短肽水平;分别采用蒙特利尔认知量表(MoCA)、简易智力状态评估量表(MMSE)及痴呆评定量表(CDR)评估患者的认知能力、智力状态及痴呆程度。结果四组患者在年龄、性别、吸烟史、高血压、糖尿病、高血脂及家族史中差异无统计学意义(P>0.05)。TGF-β、TNF-α及Aβ1-40短肽表达结果显示,与治疗前比较,差异具有统计学意义(F=17.064、30.336、28.808,均P<0.01)。给予银杏叶提取液治疗后,WML组和LI组TNF-α和Aβ1-40短肽水平比较有统计学意义(t=2.459、2.713、-4.777、-5.942,P<0.05),但TGF-β水平差异无统计学意义(P>0.05)。WML+LI组TGF-β、TNF-α及Aβ1-40短肽水平与治疗前相比均有统计学意义(t=-2.572、4.653、-11.039,P<0.05)。MoCA和MMSE总评分比较结果显示,治疗前WML、LI及WML+LI组的MoCA和MMSE评分结果均较对照组低(F=20.285、3.799、46.285、23.644,P<0.05),给与银杏叶提取液治疗后均显著增加,差异有统计学意义(t=-2.316、-2.911、-4.626、-4.162、-4.373、-11.157,P<0.05)。在WML+LI组中MMSE评分的提升具有统计学意义(t=-5.324,P<0.05)。CDR评分比较结果显示,对照组患者主要集中在无痴呆和可疑痴呆,WML、LI及WML+LI组患者主要分布在无痴呆、可疑痴呆、轻度痴呆及中度痴呆,均无重度痴呆患者。四组患者在无痴呆、可疑痴呆、轻度痴呆及中度痴呆人数分布上的差异均具有统计学意义(χ2=65.942、10.318、18.667、9.034,P<0.05),但在WML、LI及WML+LI组中差异无统计学意义(P>0.05)。结论银杏叶提取液能够有效降低不同类型CSVD患者血清中TGF-β、TNF-α及Aβ1-40短肽水平,改善患者的认知功能和临床预后,在WML+LI组患者中的疗效更甚。

Objective To compare the improvement of cognitive function of Ginkgo biloba extract in patients with different types of cerebral small vessel disease(CSVD).Methods From March 2016 to April 2018,123 patients with CSVD treated in the department of geriatric neurology of the second affiliated hospital of Xi’an jiaotong university were collected and divided into three groups according to type:white matter lesions(WML)group(n=43),lacunar brain Infarction(LI)group(n=36)and WML+LI group(n=44).44 cases of headache patients without imaging lesions were selected as control group during the same period.The clinical data of patients were collected,and serum transforming growth factorβ(TGF-β),tumor necrosis factorα(TNF-α)and Aβpeptide(1-40,Aβ1-40)short peptide levels were measured.Montreal cognitive scale(MoCA),mini mental state assessment scale(MMSE)and dementia rating scale(CDR)were used to assess patients’cognitive ability,mental state,and degree of dementia.Results There were no significant differences in age,gender,smoking history,hypertension,diabetes,hyperlipidemia,and family history among the four groups(P>0.05).The differences of expression of TGF-β,TNF-αand Aβ1-40 short peptides were statistically significant compared with those before treatment(F=17.064,30.336,28.808,P<0.01).The levels of TNF-αand Aβ1-40 short peptides in the WML and LI groups were statistically significant different after treated with Ginkgo biloba extract(t=2.459,2.713,-4.777,-5.942,P<0.05),but there was no statistical difference in the levels of TGF-β(P>0.05).The levels of TGF-β,TNF-αand Aβ1-40 short peptides in WML+LI group were significantly different compared with those before treatment(t=-2.572,4.653,-11.039,P<0.05).The results of the comparison of the MoCA and MMSE total scores showed that the MoCA and MMSE scores of the WML,LI,and WML+LI groups before treatment were lower than those of the control group(F=20.285,3.799,46.285,23.644,P<0.05).After treated with Ginkgo biloba extract,bothMoCA and MMSE scoressignificantly increased,the differences were statistically significant(t=-2.316,-2.911,-4.626,-4.162,-4.373,-11.157,P<0.05).The improvement of MMSE score in the WML+LI group was statistically different(t=-5.324,P<0.05).The comparison of CDR scores showed that patients in the control group were mainly concentrated in dementia-free and suspicious dementia,and patients in the WML,LI,and WML+LI groups were mainly distributed in patients without dementia,suspicious dementia,mild dementia,and moderate dementia.The differences between the four groups of patients in the distribution of no dementia,suspicious dementia,mild dementia,and moderate dementia were statistically significant(χ2=65.942,10.318,18.667,9.034,P<0.05),but there was no significant difference in the WML,LI,and WML+LI groups(P>0.05).Conclusion Ginkgo biloba extract can effectively reduce the levels of TGF-β,TNF-α,and Aβ1-40 short peptides in the serum of patients with different types of CSVD,improve the cognitive function and clinical prognosis of patients,and have a more effective effect on patients with WML+LI group.