不同剂量酒石酸卡巴拉汀改善阿尔茨海默病患者认知功能及其生活能力的差异

Difference of the effect of different dose tartaric acid Carberlatin in ameliorating the cognitive function and living ability in patients with Alzheimer disease

目的:比较不同剂量的酒石酸卡巴拉汀对阿尔茨海默病患者认知功能、精神异常以及日常生活能力改善作用的差异。方法:选择2001-01/2004-03在武警深圳支队卫生队内科门诊就诊的阿尔茨海默病患者22例,均自愿参加观察。按就诊顺序分为2组,酒石酸卡巴拉汀6mg组10例,酒石酸卡巴拉汀3mg组12例。酒石酸卡巴拉汀3mg组患者给予酒石酸卡巴拉汀,初始剂量1.5mg口服,2次/d,如无明显不适,2d后增至3mg,2次/d。酒石酸卡巴拉汀6mg组患者给予酒石酸卡巴拉汀,初始剂量1.5mg口服,2次/d,如无明显不适,1周后增至6mg,2次/d。两组患者于治疗前、治疗3个月后分别进行症状评估,并观察药物的副作用,采用阿尔茨海默病评定量表的认知次级量表(满分70分,通常将改善4分作为临床上抗痴呆药物显效的标准评价患者认知功能及精神行为;应用简易精神状态检查量表(据教育程度作出的划界分:文盲组17分、小学组20分、中学或以上组24分,低于划界分为认知功能受损)评价患者的认知功能和痴呆的严重程度;应用Blessed-Roth行为量表(满分36分,按文化程度评估认知功能缺损情况:文盲≥19分,小学≥23分,中学以上≥26分)检测患者日常生活自理能力。记录患者治疗期间出现的不适症状。结果:22例阿尔茨海默病患者全部进入结果分析,无脱落。①两组患者治疗前及治疗3个月后各量表评分比较:两组患者治疗后认知次级量表、Blessed-Roth行为量表评分均较治疗前显著降低犤16.4±3.2,20.1±4.2,15.1±2.1,17.8±2.9;26.3±6.3,26.1±6.2,19.8±2.2,20.2±2.3(t=2.246～4.487,P<0.05～0.01)犦,而简易精神状态量表评分较治疗前显著升高犤26.2±4.3,22.1±3.5;16.0±3.1,16.2±3.0(t=4.434,6.085,P<0.01)犦。②治疗3个月后两组患者各量表评分比较:酒石酸卡巴拉汀6mg组患者的认知次级量表、Blessed-Roth行为量表评分均显著低于酒石酸卡巴拉汀3mg组犤16.4±3.2,15.1±2.1;20.1±4.2,17.8±2.9(t=2.284,2.453,P<0.05)犦,而酒石酸卡巴拉汀6mg组患者的简易精神状态量表评分显著高于酒石酸卡巴拉汀3mg组犤26.2±4.3,22.1±3.5(t=2.468,P<0.05)犦。③不良反应与副作用:两组患者服药期间生命体征平稳,无明显副作用。结论:酒石酸卡巴拉汀能显著改善阿尔茨海默病患者的认知功能、日常生活自理能力及异常精神行为,不良反应较少,且大剂量应用时干预效果优于小剂量治疗。

AIM：To compare the difference ameliorative effects on the cognitive function, mental abnormality and activities of daily life （ADL） by tartaric acid Carberlatin of different dosages in patients with Alzheimer disease. METHODS：Between January 2001 and March 2004,22 patents of Alzixeirner disease,who were treated in the Department of Internal Medicine, Sanitary Train, Shenzhen Detachment of Chinese People＇s Police Force, participated in the study voluntarily, and they were divided into two groups according to their order of admission： tartaric acid Carberlatin 6 mg group （n=10） and tartaric acid Carberlatin 3 mg group （n=12）. All the patients were treated with oral tartaric acid Carberlatin, the initial dosage was 1.5 rag, twice a day, if there was no obvious uncomfort, the dosage was increased to 3 mg after 2 days in the tartaric acid Carberlatin 3 mg group, and to 6 mg after 1 week in the tartaric acid Carberlatin 6 mg group, twice a day. Before treatment and 3 months after treatment,the symptoms were evaluated and the side effects of the drug were observed;The cognitive function and mental behavior of the patients were assessed with the Alzheimer disease assessment scale-cognitive subseale （ADAS-cog, total score was 70 points, ameliorated by 4 points was always clinically taken as standards of the the obvious effect of antiementia drug）; The cognitive function and severity of dementia were evaluated with the mini-mental state examination （MMSE, classified according to the educational background：IT points for the illiterate group, 20 for the elementary school group,24 for the middle school and above group, and those lower than the standard as cognitive impairment）. The ADL of the patients was detected with the Blessed-Ruth behavior scale （total score was 36 points,the eognitive impairment was assessed with the educational background： ≥19 points for the illiterate group, ≥23 for the elementary school group,≥26 for the middle school and above group）.The uncomfortable symptom appeared during the treatment were recorded. RESULTS： All the 22 patients with Alzheimer disease were involved in the analysis of results. ① Comparison of the scores of the scales before treatment and 3 months after treatment：The scores of ADAS-eog and Blessed-Ruth behavior scale after treatment were significantly decreased as compared with those before treatment in both groups （16.4±3.2, 20.1±4.2, 15.1±2.1,17.8±2.9; 26.3±6.3, 26.1±6.2, 19.8±2.2, 20.2±2.3, t=2.246 4.487, P 〈 0.05-0.01）, but the score of MMSE was significantly increased （26.2±4.3, 22.1±3.5;16.0±3.1, 16.2±3.0, t=4.434, 6.085, P 〈 0.01）. ② Comparison of the scores of the scales between the two groups at 3 months after treatment： The scores of ADAS-cog and Blessed-Ruth behavior scale in the tartaric acid Carberlatin 6 mg group were significantly lower than those in the tartaric acid Carberlatin 3 mg group （16.4±_3.2, 15.1±2.1; 20.1±4.2, 17.8±2.9, t=2.284,2.453, P 〈 0.05）, but the score of MMSE was remarkably higher than that in the tartaric acid Carberlatin 3 mg group （26.2_±4.3, 22.1±_3.5, t=2.468, P 〈 0.05）. ③ Adverse events and side effects：The physical signs of the patients were stable, and there was no obvious side effects during the treatment, ent in both groups. CONCLUSION：Tartaric acid Carberlatin can significantly improve the cognitive function, ADL and exceptional spirit and behavior of the patients with Alzheimer diease,and there are fewer adverse events,and the interventionaleffect of high dosage is better than the low one.