氢溴酸樟柳碱片治疗脑小血管病相关认知障碍的临床研究

Clinical study of anisodine hydrobromide in treatment of cognitive impairment associated with cerebral small vessel disease

目的观察氢溴酸樟柳碱片对脑小血管病相关认知功能障碍患者的临床效果。方法选取2017年12月至2019年3月于新乡医学院第一附属医院神经内科就诊的脑小血管病所致的认知功能障碍患者共162例为研究对象。按照随机数字表法随机分为对照组和观察组,每组各81例。对照组给予常规治疗加尼莫地平片(每次30 mg,一日3次,口服)治疗,观察组给予常规治疗加氢溴酸樟柳碱片(每次1 mg,一日2次,口服)治疗,两组均连用3个月。观察并比较两组用药前后临床总有效率、认知功能[简易精神状态量表(mini mental state examination,MMSE)、蒙特利尔认知评估量表(Montreal connitive assessment,MoCA)、临床痴呆评定量表(clinical dementia rating,CDR)]、日常生活能力量表(activity of daily living scale,ADL)评分以及血脂、空腹血糖、糖化血红蛋白、血压、血同型半胱氨酸及血清脂蛋白相关磷脂酶A2(lipoprotein associated phospholipase A2,Lp-PLA2)变化。记录两组不良反应发生情况。结果观察组总有效率高于对照组(P<0.05)。两组患者治疗后MMSE评分及MoCA评分均高于治疗前(P<0.05),CDR评分及ADL评分均低于治疗前(P<0.05);组间比较显示,观察组MMSE评分及MoCA评分高于对照组(P<0.05),CDR评分及ADL评分均低于对照组(P<0.05)。治疗后两组MoCA各分项得分均高于治疗前;组间比较显示,观察组视空间和执行、注意力、抽象概括能力、定向力、计算评分高于对照组(P<0.05)。治疗后,两组患者三酰甘油、低密度脂蛋白胆固醇、空腹血糖、糖化血红蛋白、收缩压、舒张压、血同型半胱氨酸及血清Lp-PLA2均较治疗前下降(P<0.05);组间比较显示,观察组血同型半胱氨酸及血清Lp-PLA2显著低于对照组(P<0.05)。两组药物不良反应发生率比较无统计学意义(P>0.05)。结论氢溴酸樟柳碱片对脑小血管病相关认知功能障碍患者安全有效,改善认知下降,提高日常生活能力,具有一定的临床应用价值。

Objective To observe the clinical efficacy of anisodine hydrobromide tablets in cognitive impairment of cerebral small vessel disease.Methods A total of 162 patients with cognitive impairment caused by cerebral small vessel disease were selected from December 2017 to March 2019 in the first affiliated hospital of Xinxiang medical university.They were divided into the control group and the observation group by the random number table,each group 81 cases.The control group was given regular treatment plus nimodipine tablets(30 mg each time,3 times a day,oral).The observation group was treated with routine treatment plus anisodine hydrobromide tablets(1 mg each time,twice a day,oral).Both groups were treated for 3 months.The clinical efficacy,cognitive function[mini mental state examination(MMSE),montreal connitive assessment(MoCA)and clinical dementia rating(CDR)],activity of daily living scale,blood lipids,fasting blood glucose,glycosylated hemoglobin,blood pressure,serum homocysteine and lipoprotein associated phospholipase A2(Lp-PLA2)were observed between the two groups before and after treatment.The adverse reactions in both groups were recorded.Results The clinical efficacy rate of the observation group was higher than that of the control group(P<0.05).After treatment,the MMSE and MoCA scores of the two groups were higher than before treatment(P<0.05),the CDR and ADL scores were lower than before treatment(P<0.05).The comparison between groups shows that the MMSE and MoCA scores of observation group were higher than those of control group(P<0.05),the CDR and ADL scores were lower than those of control group(P<0.05).After treatment,the score of MoCA in the two groups was higher than that before treatment(P<0.05).The comparison between the two groups showed that the visual space,execution,attention,abstract generalization,orientation and calculation scores of the observation group were higher than those of the control group(P<0.05).After treatment,the triglyceride,low density lipoprotein,fasting blood glucose,glycosylated hemoglobin,systolic blood pressure,diastolic blood pressure,blood homocysteine and serum Lp-PLA2 decreased in both groups,compared with those before treatment(P<0.05).The comparison between the two groups showed that the levels of serum homocysteine and serum Lp-PLA2 in the observation group were significantly lower than those in the control group(P<0.05).There was no significant difference in the incidence of adverse drug reactions between the two groups(P>0.05).Conclusion Anisodine hydrobromide tablets are safe and effective for patients with cognitive impairment of cerebral small vessel disease.It can improve cognitive decline and daily living ability,which has a certain clinical application value.