从心肾论治阿尔茨海默病的临床效果(英文)

Clinical effect in treatment of Alzheimer disease based on the conditions of heart and kidney

背景:阿尔茨海默病患者临床症状是隐袭起病、持续进行性的智能衰退,以及行为和神经系统功能障碍,其贯穿始终的本质是记忆、智能的障碍。目的:探讨调心方、补肾方治疗阿尔茨海默病的疗效机制。设计:随机对照观察。单位:上海市中医老年医学研究所。对象:于1999-10/2000-01选择上海市中医老年医学研究所收治的60例阿尔茨海默病患者。方法:将60例阿尔茨海默病患者采用随机区组设计分为3组,每组20例,调心方、补肾方组每次服10mL,2次/d;多奈哌齐组患者服用多奈哌齐,1粒/次,1次/d,睡前服。3组疗程均为12周。观察治疗前后3组患者简易智能状态检查量表、日常生活能力量表和神经心理学量表(FULD物体记忆测验、快速词汇测验、数字广度测验、积木测验)积分以及操作性总评等项指标的变化。主要观察指标:各组患者简易智能状态检查量表、日常生活能力量表和神经心理学量表积分以及操作性总评等项指标的变化。结果:60例患者均进入结果分析。①简易智能评定结果:调心方、补肾方、多奈哌齐组治疗后简易智能状态检查量表分值均较治疗前降低(P<0.01)。3组治疗后总有效率接近,分别为70%,65%,75%(P>0.05)。②生活能力评定结果:调心方、补肾方、多奈哌齐组日常生活能力量表评分治疗后较治疗前均有显著性降低(P<0.05或P<0.01)。3组治疗后总有效率接近,分别为45%,45%,40%(P>0.05)。③操作性总评:调心方、补肾方、多奈哌齐组总有效率接近,分别为70%,65%,75%(P>0.05)。④神经心理学量表分值的比较:调心方、多奈哌齐组FULD物体记忆测验治疗后较治疗前均有显著性提高(P<0.05);3组快速词汇测验治疗后较治疗前均有显著性提高(P<0.05);调心方、多奈哌齐组数字广度测验治疗后较治疗前均有显著性提高(P<0.05或P<0.01);补肾方组积木测验治疗后较治疗前有显著性提高(P<0.05)。结论:调心方、补肾方、多奈哌齐均能改善阿尔茨海默病患者的认知功能和日常生活能力,调心方、补肾方是治疗阿尔茨海默病有效的中药制剂。

BACKGROUND： Clinically Alzheimer disease （AD） is characterized by obscurity in onset, decline of intelligence, and dysfunctions of behavior and nerve system. The essence of AD is impairment of memory and cognition. OBJECTIVE： To explore the effective mechanism of tiaoxin recipe （TXR） and bushen recipe （BSR） in treating AD. DESIGN： Randomized controlled study. SETTING： Shanghai Institute of Traditional Chinese Medicine for Geriatrics. PARTICIPANTS： Totally 60 AD patients were selected from Shanghai Institute of Traditional Chinese Medicine for Geriatrics from October 1999 to January 2000. METHODS： Sixty patients with AD were divided into 3 groups, with 20 in each group. The patients in TXR and BSR group took respectively TXR and BSR 10 mL once, 2 times per day. The patients in donepeziI （Dp） group took a Dp capsule once a day, h,s （Dp was produced in England Boots Company, 5 nag per capsule）. For a course consisted of 12 weeks. The changes of Mini mental state examination （MMSE） score, Activity of Daily Living Scale （ADL） score, neuropsychological testing （NPT） score, including FULD object-menaory evaluation （FOM）, rapid verbal retrieval （RVR）, digit span test （DS） and block design （BD）, as well as the overall operational evaluation before and after treatment were analyzed. MAIN OUTCOME MEASURES： Scores of MMSE, ADL, NPT and the overall operational evaluation. RESULTS： Totally 60 patients entered the final analysis. ① MMSE scores in the 3 groups were decreased after treatment as compared with those before treatment （P 〈 0.01）. Total effective rates were 70%, 65% and 75% respectively （P 〉 0.05）. ②ADL scores in the 3 groups were decreased after treatment as compared with those before treatment （P 〈 0.05 or P 〈 0.01）. Total effective rates were 45%, 45% and 40% respectively （P 〉 0.05）, ③ Total effective rates were 70%, 65% and 75% respectively （P 〉 0.05）, ④ Scores of FOM were increased in the TXR and the Dp group after treatment as compared with those before treatment （P 〈 0.05）. RVR scores in the three groups were increased after treatment as compared with those before treatment （P 〈 0.05）; DS scores were increased in TXR group and Dp group after treatment as compared with those before treatment （P 〈 0.05 or P 〈 0.01）; and BD scores in BSR group were increased after treatment as compared with those before treatment （P 〈 0.05）. CONCLUTION： TXR, BSR and Dp can improve cognitive function and daily living ability of AD patients, and TXR and BSR are effective TCM drugs in treating AD.