加减薯蓣丸治疗非痴呆型血管性认知功能障碍的磁共振波谱研究

Magnetic resonance spectroscopy study of intervention on vascular cognitive impairment with no dementia treated by Modified Shuyu Pills

目的:观察加减薯蓣丸对非痴呆型血管性认知功能障碍(VCIND)患者的干预效果及磁共振波谱(MRS)的变化特点。方法:纳入符合VCIND诊断标准患者100例,随机分为治疗组(43例)和对照组(33例),在针对血管危险因素治疗的基础上,治疗组加用加减薯蓣丸,对照组加用盐酸多奈哌齐,疗程16周,观察患者用药前后简易智能精神状态检查量表(MMSE)评分及多体素1 H-MRS代谢值。结果:与本组治疗前比较,两组治疗后MMSE评分明显增加(P<0.01);治疗组经加减薯蓣丸干预后右角回、左丘脑Cho/Cr显著下降(P<0.05;P<0.01),右丘脑、海马NAA/Cr显著下降(P<0.01,P<0.05),对照组经盐酸多奈哌齐干预后左丘脑Cho/Cr显著下降(P<0.05)、右海马NAA/Cr显著下降(P<0.05)。结论:加减薯蓣丸可以有效干预VCIND的病程进展,其作用机制可能和药物对中枢胆碱能神经系统的调节及神经系统的修复有关。

Objective： To observe the intervention effects of Modified Shuyu Pills （MSP） on vascular cognitive impairment no dementia （VCIND） and the changes of magnetic resonance spectroscopy （MRS） in patients with VCIND. Methods： 100 patients with VCIND were randomly divided into experimental group （n=43） and control group （n=33）. On the basis of the treatment against risk factors, the experimental group was treated by MSP and the control group was treated by donepezil hydrochloride respectively. The duration was 16 weeks. The neuropsychological scales MMSE score and the metabolic values of MRS were observed before and after treatment. Results： The neuropsychological scales MMSE score of both treatment groups were increased compared with the score before treatment （P〈0,01）. After taking MSP, the levels of Cho/Cr in right angular gyrus and left thalamus were significantly lower than that before treatment （P〈0.05, P〈0.01）, the level of NAA/Cr in right thalamus and right hippocampus were significantly lower （P〈0.01, P〈0,05）; After taking donepezil hydrochloride, the level of Cho/Cr in left thalamus was significantly lower （P〈0.05）, and the level of NAA/Cr in right hippocampus was significantly lower （P〈0,05）. Conclusion： MSP could effectively intervene in the progression of VCIND and the mechanism might be associated with regulating the central cholinergic nervous system and repairing the nervous system.