小剂量富马酸喹硫平联合多奈哌齐治疗伴攻击行为血管性痴呆患者的近期随访研究

Short-term follow-up study of low-dose Quetiapine Fumarate combined with Donepezil in patients with aggressive behavioral vascular dementia

目的探究小剂量富马酸喹硫平联合多奈哌齐治疗伴攻击行为血管性痴呆(VaD)患者的近期疗效。方法选取2015年5月至2019年2月沈阳市第七人民医院收治的伴攻击行为VaD患者124例进行回顾性研究,根据治疗方案不同将其不同分为两组:对照组和观察组,每组各62例。对照组患者给予多奈哌齐治疗,观察组患者给予小剂量富马酸喹硫平、多奈哌齐联合治疗。对比两组患者的临床疗效、不良反应及治疗前后痴呆病理行为评定量表(BEHAVE-AD)总分与攻击行为因子分、简明精神病评定量表(BPRS)评分、Hachinski缺血指数量表(HIS)评分、痴呆简易筛查量表(BSSD)评分、Cohen Mansfield激惹性问卷(CMAI)评分、自由基三项[超氧化物歧化酶(SOD)、脂质过氧化物(LPO)、谷胱甘肽过氧化物酶(GSH-Px)]变化。结果观察组患者的总有效率(91.94%)明显高于对照组(77.42%),差异具有统计学意义(P <0.05);观察组患者的不良反应发生率(37.10%)明显高于对照组(11.29%),差异具有统计学意义(P<0.05);治疗后,观察组患者的BEHAVE-AD总分(8.54±4.18)分、攻击行为因子分(1.06±0.72)分、BPRS评分(34.17±6.08)分、HIS评分(43.12±8.27)分、BSSD评分(33.25±6.41)分、CMAI评分(28.16±6.49)分均较对照组[(11.38±5.12)分、(1.53±0.85)分、(41.25±7.76)分、(49.26±9.05)分、(38.56±6.72)分、(37.53±8.84)分]低,差异具有统计学意义(P <0.05);治疗后,观察组患者的血清SOD(50.09±10.27) U/ml、GSH-PX(64.29±13.57) U/ml水平较对照组[(42.18±9.16) U/ml、(52.35±11.72) U/ml]高,血清LPO(3.61±0.72) nmol/L水平较对照组(4.53±0.85) nmol/L低,差异均具有统计学意义(P <0.05)。结论小剂量富马酸喹硫平联合多奈哌齐治疗伴攻击行为VaD患者,可抑制氧化应激效应,缓解各类精神症状、痴呆、易激惹、脑缺血症状,控制攻击行为,疗效显著。

Objective To investigate the short-term efficacy of low-dose Quetiapine Fumarate combined with Donepezil in the treatment of patients with aggressive behavioral vascular dementia (VaD).Methods A retrospective study of 124 patients with aggressive behavioral VaD admitted to the Seventh People’s Hospital of Shenyang City from May 2015 to February 2019 was conducted.According to different treatment schemes,the patients were divided into two groups:the control group and the observation group,with 62 cases in each group.The control group was treated with Donepezil,and the observation group was given a small dose of Quetiapine Fumarate combined with Donepezil.The efficacy,adverse reactions,the total score and aggressive behavior factor score of the Behavioral pathology in Alzheimer’s disease scale (BEHAVE-AD),Brief Psychiatric Rating Scale (BPRS) score,Hachinski Ischemic Scale (HIS) score,Brief Screening Scale for Dementia (BSSD) score,Cohen Mansfield Agitation Inventory (CMAI) score,and the change of free radical triad[superoxide dismutase (SOD),lipid peroxide (LPO),glutathione peroxidase (GSH-Px)]before and after treatment in the two groups were compared.Results The total effective rate of the observation group (91.94%) was significantly higher than that of the control group (77.42%),the difference was statistically significant (P<0.05);the incidence of adverse reactions (37.10%) in the observation group was significantly higher than that in the control group (11.29%),the difference was statistically significant (P<0.05);after treatment,the total BEHAVE-AD score (8.54±4.18) points,aggressive behavior factor score (1.06±0.72) points,BPRS score (34.17±6.08) points,HIS score (43.12±8.27) points,BSSD score (33.25±6.41) points,CMAI score (28.16±6.49) points of the observation group were lower than those of the control group[(11.38±5.12) points,(1.53±0.85) points,(41.25±7.76) points,(49.26±9.05) points,(38.56±6.72) points,(37.53±8.84) points],the differences were statistically significant(P<0.05);after treatment,the levels of serum SOD (50.09±10.27) U/ml and GSH-PX (64.29±13.57) U/ml in the observation group were higher than those in the control group[(42.18±9.16) U/ml,(52.35±11.72) U/ml],the serum LPO (3.61±0.72) nmol/L level was lower than that of the control group (4.53±0.85) nmol/L,and the differences were statistically significant (P<0.05).Conclusion Lowdose Quetiapine Fumarate combined with Donepezil in the treatment of VaD patients with aggressive behavior can inhibit the effect of oxidative stress and relieve various mental symptoms,dementia,irritability and cerebral ischemia symptoms,control aggressive behavior and has a significant effect.