艾地苯醌联合美金刚治疗血管性痴呆的临床研究

Clinical study of idebenone combined with memantine in treatment of vascular dementia

目的探讨艾地苯醌联合美金刚治疗血管性痴呆的临床效果。方法选取2016年1月—2018年6月西宁市第一人民医院收治的98例血管性痴呆患者,随机分为对照组和治疗组,每组各49例。对照组口服盐酸美金刚片,第1周晨服,5 mg/次,1次/d;第2周早晚服用,5 mg/次,2次/d;第3周晨服10 mg/次,下午服5 mg/d;第4周早晚服用,10 mg/次,2次/d,维持治疗。治疗组在对照组治疗基础上口服艾地苯醌片,30mg/次,3次/d。两组均连续治疗4周。观察两组的临床疗效,比较两组治疗前后血小板参数、简易精神状态检查(MMSE)评分、相关生化指标的变化情况。结果治疗后,对照组和治疗组的总有效率分别为77.6%、91.8%,两组比较差异具有统计学意义(P<0.05)。治疗后,两组血小板黏附率(PAd T)、血小板聚集率(PAg T)值均显著降低,但MMSE评分显著升高,同组治疗前后比较差异有统计学意义(P<0.05);治疗后,治疗组PAd T、PAg T值低于对照组,但MMSE评分高于对照组,两组比较差异具有统计学意义(P<0.05)。治疗后,两组血浆β淀粉样蛋白(Aβ)水平和血清一氧化氮(NO)水平较治疗前均显著升高,但血清同型半胱氨酸(Hcy)、丙二醛(MDA)、内皮素(ET)-1水平均显著降低,同组治疗前后比较差异有统计学意义(P<0.05);治疗后,治疗组Aβ、NO水平显著高于对照组,Hcy、MDA、ET-1显著低于对照组,两组比较差异具有统计学意义(P<0.05)。结论艾地苯醌联合美金刚治疗血管性痴呆具有较好的临床疗效,可有效改善患者血小板功能,减轻氧化应激损伤,正性调节血管内皮功能,具有一定的临床推广应用价值。

Objective To investigate the clinical effects of idebenone combined with memantine in treatment of vascular dementia. Methods Patients（98 cases） with vascular dementia in Xining NO.1 People’s Hospital from January 2016 to June 2018 were randomly divided into control（49 cases） and treatment（49 cases） groups. Patients in the control group were po administered with Memantine Hydrochloride Tablets, oral administration in the morning at the first week, 5 mg/time, once daily; oral administration in the morning and evening at the second week, 5 mg/time, twice daily; took 10 mg/time in the morning and 5 mg/time in the afternoon at the third week; oral administration in the morning and evening at the fourth week, 10 mg/time, twice daily, and maintained therapy. Patients in the treatment group were po administered with Idebenone Tablets on the basis of the control group, 30 mg/time, three times daily. Patients in two groups were treated for 4 weeks. After treatment, the clinical efficacy was evaluated, and the changes of platelet parameters, simple mental state examination（MMSE） scores, and related biochemical indicators in two groups before and after treatment were compared. Results After treatment, the clinical efficacy in the control and treatment group were 77.6% and 91.8%, and there were differences between two groups（P 〈 0.05）. After treatment, PAdT and PAgT were significantly decreased in two groups, but MMSE scores were significantly increased, and there were differences in the same group（P 〈 0.05）. After treatment, PAdT and PAgT in the treatment group were lower than those in the control group, but MMSE scores were higher than that in the control group, and there were differences between two groups（P 〈 0.05）. After treatment, Aβ and NO were significantly increased, but Hcy, MDA, and ET-1 were significantly decreased in two groups, and there were differences in the same group（P 〈 0.05）. After treatment, Aβ and NO in the treatment group were higher than that in the control group, but Hcy, MDA, and ET-1 were lower than those in the control group, but and there were differences between two groups（P 〈 0.05）. Conclusion Idebenone combined with memantine has significant clinical effect in treatment of vascular dementia, and can effectively improve the platelet function, also can alleviate oxidative stress injury, and regulate vascular endothelial function, which has a certain clinical application value.