瑞舒伐他汀联合盐酸美金刚治疗血管性痴呆的疗效观察

Therapeutic effect of rosuvastatin combined with memantine hydrochloride on vascular dementia

目的 探讨瑞舒伐他汀联合盐酸美金刚治疗血管性痴呆的疗效及安全性.方法 选择2016年1月至2018年1月武警浙江省总队嘉兴医院和海宁康华医院收治的血管性痴呆患者66例为研究对象,采用随机数字表法分为观察组和对照组各33例,两组患者均给予常规治疗,对照组给予瑞舒伐他汀治疗,观察组给予瑞舒伐他汀联合盐酸美金刚治疗,两组均治疗12周.比较两组患者治疗前后的日常生活能力量表(ADL)和蒙特利尔认知评估量表(MoCA)评分,氧化应激指标、炎性因子、脑流动力学指标变化情况,治疗后的临床疗效及不良反应发生情况.结果 观察组总有效率为87.88%(29/33),明显高于对照组的63.64%(21/33) (x2 =5.280,P=0.022);治疗后观察组的ADL、MoCA、超氧化物歧化酶(SOD)水平、脑动脉收缩期血流峰值速度(Vmax)、屏气指数(BHI)分别为(41.26 ±5.37)分、(24.23 ±1.71)分、(112.27±15.35) μU/L、(65.15 ±11.75) cm/s、(0.79±0.36),均高于对照组的(36.19±4.07)分、(20.25±1.46)、(93.84±12.76) μU/L、(59.15 ±11.74)cm/s、(0.58±0.26),差异均有统计学意义(t=4.322、10.168、5.304、2.075、2.846,均P<0.05);而丙二醛(MDA)、同型半胱氨酸、肿瘤坏死因子α(TNF-α)、白细胞介素6(IL-6)及IL-1β水平分别为(6.37±1.05) μmol/L、(31.36±9.59) μmol/L、(184.15±15.12) ng/L、(229.85±27.69) ng/L、(127.64±17.86) ng/L,均低于对照组的(7.32±1.07)μmol/L、(42.27±11.34)μmol/L、(208.72±15.26) ng/L、(262.75±25.64) ng/L、(148.75±18.64) ng/L,差异均有统计学意义(t=3.640、4.220、6.570、5.008、4.698,均P<0.05);两组的不良反应发生率差异无统计学意义(P>0.05).结论 瑞舒伐他汀联合盐酸美金刚治疗血管性痴呆患者临床疗效确切,可明显减轻氧化应激反应与炎性反应,改善患者脑血流动力学、认知功能,提高患者生活质量.

Objective To investigate the efficacy and safety of rosuvastatin combined with memantine hydrochloride in the treatment of vascular dementia.Methods Sixty-six patients with vascular dementia admitted to the Hospital of Zhejiang Provincial Armed Police Force and Haining Kanghua Hospital from January 2016 to January 2018 were enrolled.According to the digital table,the patients were divided into the observation group and the control group,with 33 cases in each group.Both two groups were given routine treatment.The control group was treated with rosuvastatin,and the observation group was given rosuvastatin combined with memantine hydrochloride.Both two groups were treated for 12 weeks.The ADL score and MoCA score,oxidative stress index,inflammatory factor,cerebral kinetic index changes,clinical efficacy and adverse reactions after treatment were compared between the two groups.Results The therapeutic effect of the observation group was 87.88% (29/33),which was significantly higher than 63.64% (21/33) of the control group (χ^2 =5.280,P =0.022).After treatment,the ADL,MoCA,SOD levels,Vmax and BHI of the observation group were (41.26 ± 5.37) points,(24.23 ± 1.71) points,(112.27 ± 15.35) μU/L,(65.15 ± 11.75) cm/s,(0.79 ± 0.36),respectively,which were higher than those of the control group [(36.19 ± 4.07) points,(20.25 ± 1.46) points,(93.84 ± 12.76) μU/L,(59.15 ± 11.74) cm/s,(0.58 ± 0.26)],the differences were statistically significant (t =4.322,10.168,5.304,2.075,2.846,all P < 0.05).The levels of MDA,HCy,TNF-α,IL-6 and IL-1β in the observation group were (6.37 ± 1.05) μmol/L,(31.36 ± 9.59) μmol/L,(184.15 ± 15.12) ng/L,(229.85 ± 27.69) ng/L,(127.64 ± 17.86) ng/L,respectively,which were lower than those in the control group [(7.32 ± 1.07) μmol/L,(42.27 ± 11.34) μmol/L,(208.72 ± 15.26) ng/L,(262.75 ± 25.64) ng/L,(148.75 ± 18.64) ng/L],the differences were statistically significant (t =3.640,4.220,6.570,5.008,4.698,all P < 0.05).There was no statistically significant difference in the incidence of adverse reactions between the two groups (P > 0.05).Conclusion The clinical efficacy of rosuvastatin combined with memantine hydrochloride in the treatment of patients with vascular dementia can significantly reduce oxidative stress and inflammatory response,improve cerebral hemodynamics and cognitive function,and improve patients' quality of life.