步长脑心通治疗血管性认知障碍患者的疗效分析

Efficacy of buchangnaoxintong capsule for the patients with vascular cognitive impairment

目的探讨步长脑心通对血管性认知障碍(VCI)患者的治疗效果及其作用机制。方法选取东南大学附属中大医院神经内科60例轻、中度VCI患者,随机分为治疗组30例,采用步长脑心通胶囊治疗,每次1.2 g,每日3次,口服,连续12周;对照组30例,采用尼莫地平片治疗,每次30 mg,每日3次,口服,连续12周。治疗期间,两组均不服用其他降脂药物、脑血管扩张药物及脑细胞代谢药物。所有入选的患者均观察其治疗前、治疗后4周、8周、12周的简易精神状态检查量表(MMSE)和长谷川痴呆量表(HDS)评分,并在上述4个时间点采集外周静脉血标本,检测血脂包括三酰甘油(TG)、总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)和高密度脂蛋白胆固醇(HDL-C)以及超敏C反应蛋白(hsCRP)。检测结果输入Excel表,采用SPSS 11.5统计软件包进行统计学分析。结果与自身治疗前相比,治疗组的MMSE评分在治疗8周(t=-4.367,P=0.000)、治疗12周(t=-8.354,P=0.000)明显升高;对照组在治疗4周(t=-2.610,P=0.012)、治疗8周(t=-5.491,P=0.000)和治疗12周(t=-10.627,P=0.000)均明显升高;两组间MMSE评分差异无统计学意义。治疗组的HDS评分在治疗12周(t=-2.734,P=0.008)明显升高;对照组在治疗8周(t=-2.886,P=0.005)、治疗12周(t=-5.775,P=0.000)明显升高;两组间的HDS评分无统计学差异。治疗组于治疗12周的血脂水平和hsCRP水平较治疗前有明显改善(TG:t=2.465,P=0.017;TC:t=2.828,P=0.006;LDL-C:t=3.174,P=0.002;HDL-C:t=-3.338,P=0.002;hsCRP:t=4.168,P=0.000);而对照组各时间点TG、TC、LDL-C、HDL-C及hsCRP水平治疗前后差异无统计学意义。结论步长脑心通对VCI有效,虽显效缓慢,但对认知功能总体的改善作用与尼莫地平相当,步长脑心通对VCI患者认知障碍的疗效,可能部分与调节血脂,降低血hsCRP水平有关。

Objective To observe the curative effect of buchangnaoxintong capsule for the patients with vascular cognitive impairment （VCI） and explore its mechanisms. Methods Sixty patients with mild to moderate VCI were randomly divided into 2 groups, 30 patients in treatment group and 30 patients in control group. Patients in treatment group were given buchangnaoxintong capsule orally, 1.2 g, three times a day, for 12 weeks. Patients of control group took nimodipine tablets, 30 rag, three times a day, for 12 weeks. During the treatment period, patients in both groups did not take any other lipid-lowering drugs, cerebral vasodilator and brain cell metabolic regulator. Mini-mental state examination （MMSE） and Hasegawa＇s dementia scale （lIDS） were tested before treatment, 4th week, 8th week and 12th week after the beginning of treatment. And the blood samples were collected at the same times for measuring serum lipids including triglyceride（TG） , total cholesterol （TC）, low density lipoprotein cholesterol （LDL-C） and high density lipoprotein cholesterol（HDL-C） and hypersensitivity C reactive protein（hsCRP）. The data were input to an Excel table and exported to SPSS 11. 5 statistical software package. Results Compared with before treatment, the MMSE score in treatment group increased significantly at 8th week （ t -- - 4. 367, P = 0. 000） and 12th week（t = -8. 354, P = 0. 000）, and MMSE score in control group increased significantly at 4th week（t= -2.610, P--0.012）, 8th week（t = -5.491, P=0.000） and 12th week（t = -10.627, P=0.000）. There was no statistical significance between treatment and control group. HDS score in treatment group was higher at 12th week（t = -2. 734, P =0. 008） than before treatment, and HDS score in control group was higher at 8th week（ t = - 2. 886, P = 0. 005 ） and 12th week （ t = - 5. 775, P = 0. 000） than before treatment. The HDS scores in two groups showed no statistical significance. In treatment group, the levels of serum lipids including TG （ t = 2. 465, P = 0. 017 ） , TC （ t = 2. 828, P = 0. 006 ） , LDL-C （ t = 3. 174, P =0.002） and HDL-C（t = -3. 338, P =0.002） and the level of hsCRP（t =4. 168, P =0.000） were improved significantly compared with before treatment. While in control group, the level of TG, TC, LDL-C, HDL-C and hsCRP at any time point had no significant change. Conclusions Buehangnaoxintong capsule has a certain effect in the treatment of patients with VCI, and its effectiveness is as same as nimodipine. The effects of Buchangnaoxintong capsule on cognitive function maybe related with its regulation of blood lipids and reducing the level of hsCRP.