盐酸美金刚对老年糖尿病患者血管性痴呆的临床疗效观察

目的观察盐酸美金刚对治疗老年2型糖尿病伴血管性痴呆（ VaD） 的疗效及其安全性.方法选取合并轻中度VaD 的老年2 型糖尿病患者共60 例,随机分成美金刚治疗组和奥拉西坦对照组（n=30）.治疗组口服盐酸美金刚,起始剂量是5 mg /d,每周递增 5mg,至第 4 w,剂量维持在 20 mg /d,共 24 w;对照组给予奥拉西坦0. 8 g,3 次 /d 口服,共24 w.在治疗前和治疗24w后进行简易智能痴呆量（MMSE）、 ADL 日常生活量表评分,比较治疗情况. 结果两组治疗前后MMSE、 ADL 评分分别进行比较,均有明显的改善（P〈0.05）;且盐酸美金刚治疗组的改善优于奥拉西坦组,两者差异有统计学意义（P〈0.05）.两组均分别有2例出现一过性轻度不良反应.两组的治疗对血糖及其它生化指标均无明显影响（P〉0.05）.结论盐酸美金刚对老年2型糖尿病伴轻中度VaD 患者的认知功能、日常行为能力有明显改善作用,安全性好且其疗效优奥拉西坦.

Objective： To observe the the efficacy and safety of memantine hydrochloride on treatment of vascular dementia（VaD） in the elderly type 2 diabetes patients. Methods 60 elderly patients with type 2 diabetes and mild to moderate vascular dementia were randomly divided into memantine group and oxiracetam group （n = 30）. The memantine group was given memantine hydrochloride, starting at the dose of 5 mg / d, by 5mg/w increasing in first 3 weeks, until the 4th week, the dose maintained in 20 mg / d, p.o.; the control group was treated with oxiracetam 0. 8 g, 3 times daily p.o. The whole course of treatment was 24 weeks. Mini-mentalstate examination （MMSE） and activities of daily living （ADL） score were evaluated before and after treatment. Results：MMSE and ADL scores were significantly improved after 24 weeks’ treatment in two groups respectively （P〈0.05） and the efficacy in memantine group was better than that in oxiracetam group （P〈0.05）. There were 2 cases of mild adverse reactions in the two groups, all of which were a transient response. The treatment of the two groups had no significant effect on blood glucose and other biochemical parameters. Conclusion：Memantine hydrochloride obviously improved the cognitive function, daily capacity in elderly patients with type 2 diabetes mellitus and mild to moderate vascular dementia. It was also safe and more effective than oxiracetam.