盐酸美金刚片联合天智颗粒治疗血管性痴呆的临床观察

Clinical Observation of Memantine Hydrochloride Tablets Combined with Tianzhi Granules in the Treatment of Vascular Dementia

目的:探讨盐酸美金刚片联合天智颗粒治疗血管性痴呆的临床疗效及安全性。方法:选取2014年6月-2016年6月我院收治的血管性痴呆患者94例作为研究对象,按照随机数字表法分为观察组和对照组,各47例。除基础药物治疗外,对照组患者给予天智颗粒5 g,po,tid;观察组患者在对照组基础上给予盐酸美金刚片起始剂量5 mg,每周增加5 mg,至治疗第4周时达维持剂量20 mg/d,po,qd。两组患者均连续治疗4周。观察两组患者的临床疗效以及治疗前后的简易智能状态检查量表(MMSE)、蒙特利尔认知评估量表(MoCA)、日常生活能力量表(ADL)评分,检测血清脑源性神经营养因子(BDNF)、丙二醛(MDA)、超氧化物歧化酶(SOD)水平,并记录不良反应发生情况。结果:观察组患者的临床总有效率(80.85%)显著高于对照组(61.70%),差异有统计学意义(P<0.05)。治疗前,两组患者MMSE、MoCA、ADL评分和BDNF、MDA、SOD水平比较,差异均无统计学意义(P>0.05);治疗后,两组患者MMSE、MoCA、ADL评分以及BDNF、SOD水平均显著增加,MDA水平显著降低,且观察组显著优于对照组,差异均有统计学意义(P<0.05)。两组患者均未见明显不良反应发生。结论:盐酸美金刚片联合天智颗粒治疗血管性痴呆的临床疗效显著,可提高患者的认知功能和日常活动能力,改善其BDNF、MDA和SOD水平,且安全性较高。

OBJECTIVE： To investigate the clinical efficacy and safety of Memantine hydrochloride tablets combined with Tianzhi granules in the treatment of vascular dementia. METHODS： A total of 94 patients with vascular dementia selected from our hospital during Jun. 2014-Jun. 2016 were divided into observation group and control group according to random number table, with 47 cases each. Besides basic therapy, control group was given Tianzhi granules 5 g, po, tid. Observation group was additionally given Memantine hydrochloride tablets with initial dose of 5 mg, increasing by 5 mg every week, maintaining dose of 20 mg/d at 4th week, po, qd, on the basis of control group. Both groups received treatment for consecutive 4 weeks. Clinical efficacies as well as MMSE, MoCA, ADL scores, the levels of brain-derived neurotrophic factor（BDNF）, malondialdehyde（MDA） and super- oxide dismutase（SOD） before and after treatment were observed in 2 groups. The occurrence of ADR was recorded. RESULTS： To- tal response rate of observation group （80.85%） was significantly higher than control group （61.70%）, with statistical significance （P〈0.05）. Before treatment, there was no statistical significance in MMSE, MoCA, ADL scores, the levels of BDNF, MDA or SOD between 2 groups （P〉0.05）. After treatment, MMSE, MoCA, ADL scores, the levels of BDNF and SOD in 2 groups were increased significantly, while MDA level was decreased significantly; observation group was significantly better than control group, with statistical significance （P〈0.05）. No obvious ADR was found in 2 groups. CONCLUSIONS： Memantine hydrochlo- ride tablets combined with Tianzhi granules in the treatment of vascular dementia show significant therapeutic efficacy, and can im- prove cognitive fimction, daily living activity and BDNF, MDA and SOD levels of patients with good safety.