通窍活血汤治疗瘀血内阻型血管性认知障碍的临床观察

Clinical Efficacy of Tongqiao Huoxuetang in Treating Blood Stasis Type Vascular Cognitive Impairment

目的:观察通窍活血汤治疗瘀血内阻型血管性认知障碍的临床疗效,探讨其作用机制。方法:将符合纳入标准的60例中医辨证为瘀血内阻型血管性认知障碍患者随机分为治疗组和对照组,每组各30例。基于内科基础治疗的同时,对照组予以盐酸多奈哌齐口服,起始量5 mg·d^-1,4周后加至10 mg·d^-1。治疗组在服用盐酸多奈哌齐的同时服用通窍活血汤,两组均治疗3个月,采用证候积分评价其症状变化,简易精神量表(MMSE)评价患者认知功能,日常生活能力量表(ADL)评价患者日常生活能力,颅脑磁共振动脉自旋标记灌注技术(MRI-ASL)检查了解局部血流灌注情况(CBF值)的变化,全自动生化分析仪测定血浆同型半胱氨酸水平。结果:(1)与本组治疗前相比,治疗组中医证候评分(SDSVD)改善明显(P <0. 05),组间比较治疗组改善程度明显优于对照组(P <0. 05);(2)患者的认知能力及日常生活能力较本组治疗前明显提高,2组MMSE评分及ADL评分较本组治疗前显著改善(P <0. 01),治疗组改善程度优于对照组(P <0. 05);(3)治疗组治疗后CBF值明显高于本组治疗前(P <0. 05)及对照组(P <0. 01);(4)治疗后治疗组血浆同型半胱氨酸水平较对照组明显下降(P <0. 05)。结论:通窍活血汤加减联合盐酸多奈哌齐能有效改善瘀血阻窍型血管性痴呆患者的认知能力、日常生活能力,改善其脑血流灌注及降低同型半胱氨酸水平,值得临床推广。

Objective: This study aims to observe the clinical efficacy of Tongqiao Huoxuetang in treating blood stasis resistance type vascular cognitive impairment,and explore its mechanism of action. Method: A total of 60 patients who met the inclusion standards and were diagnosed as blood stasis resistance type vascular cognitive impairment were randomly divided into treatment group and control group,30 patients in each group. Donepezil hydrochloride was administered orally in control group based on internal medicine treatment at an initial dose of 5 mg/day,changed to 10 mg/day 4 weeks later. Patients in treatment group additionally received Tongqiao Huoxuetang based on donepezil hydrochloride. Both groups were treated for 3 months. Changes of symptoms were assessed by syndrome scores;cognitive function was assessed by the mini-mental scale( MMSE);daily living ability was assessed by the activity of daily living scale( ADL),and changes of local blood perfusion( CBF value)was assessed by brain magnetic resonance perfusion imaging arterial spin labeling( MRI-ASL). Changes of homocysteine levels in plasma were measured by using an automated biochemical analyzer. Result:(1) The values of traditional Chinese medicine( TCM) syndrome scores( SDSVD) were significantly improved in both groups after treatment,and the improvement was more obvious than that of control group( P < 0. 05).(2) The cognitive ability and daily living ability of the patients were significantly improved;the MMSE scores and ADL scores were improved significantly in both groups after treatment( P < 0. 01),and improvement in treatment group was more obvious than that of control group( P < 0. 05).(3) The CBF value in treatment group was significantly higher after treatment( P < 0. 05),and also higher than that in control group( P < 0. 01).(4) Homocysteine level in plasma of treatment group was significantly lower than that of control group( P < 0. 05). Conclusion: The combination of Tongqiao Huoxuetang combined with donepezil hydrochloride can effectively improve the cognitive ability and daily living ability of the patients with vascular dementia,improve the cerebral blood flow perfusion and decrease the level of homocysteine,so it is worth popularizing in clinical practice.