重复经颅磁刺激联合常规抗痴呆治疗在老年血管性痴呆患者中的应用效果

Effects of repeated transcranial magnetic stimulation combined with conventional anti-dementia therapy in treatment of elderly patients with vascular dementia

目的观察重复经颅磁刺激联合常规抗痴呆治疗在老年血管性痴呆(VD)患者中的应用效果。方法选取190例老年VD患者,采用随机数字表法分为研究组与对照组,每组95例。对照组采用常规抗痴呆治疗,研究组在对照组治疗基础上加用重复经颅磁刺激。观察2组临床疗效、不良反应发生率,比较2组治疗前后认知功能[简易精神状态检查量表(MMSE)评分]、痴呆程度[长谷川痴呆量表(HDS)评分]、日常生活能力[日常生活能力量表(ADL)评分]、生活质量[卒中专用生活质量量表(SS-QOL)评分]以及血清肿瘤坏死因子-α(TNF-α)、半胱氨酸蛋白酶-3(Caspase-3)、过氧化脂(LPO)、基质金属蛋白酶-9(MMP-9)、血管紧张素-Ⅰ(Ang-Ⅰ)水平。结果研究组治疗总有效率高于对照组,差异有统计学意义(P<0.05);治疗后,研究组MMSE、HDS、ADL和SS-QOL评分均高于对照组,血清TNF-α、Caspase-3、LPO和MMP-9水平均低于对照组,血清Ang-Ⅰ水平高于对照组,差异有统计学意义(P<0.05);2组不良反应发生率比较,差异无统计学意义(P>0.05)。结论在常规抗痴呆治疗基础上联合应用重复经颅磁刺激,能进一步下调老年VD患者血清Caspase-3、TNF-α、LPO及MMP-9表达,促进Ang-Ⅰ水平升高,改善认知功能,减轻痴呆程度,疗效显著,且安全性良好,可有效改善患者预后。

Objective To observe the effect of repeated transcranial magnetic stimulation combined with conventional anti-dementia treatment in treatment of elderly patients with vascular dementia( VD). Methods A total of 190 elderly patients with VD were divided into study group and control group according to random number table method,with 95 cases in each group. The control group received conventional anti-dementia treatment,and the study group received repeated transcranial magnetic stimulation on the basis of the control group. The clinical effects and incidence of adverse reactions were observed. Cognitive function by Mini-mental State Examination( MMSE) score,dementia condition by Hasegawa Dementia Rating Scale( HDS) score,daily living ability by Activities of Daily Living( ADL) score,quality of life by Stroke Specific Quality of Life( SS-QOL) score and serum tumor necrosis factor-α( TNF-α),caspase-3,lipid peroxide( LPO),matrix metalloproteinase-9( MMP-9),and angiotensin-Ⅰ( Ang-Ⅰ) levels before and after treatment were compared between the two groups. Results The total effective rate of the study group was higher than that of the control group( P < 0. 05). The MMSE,HDS,ADL,and SS-QOL scores in the study group were higher than those in the control group after treatment( P < 0. 05),and serum levels of TNF-α,Caspase-3,LPO and MMP-9 in the study group were lower than those in the control group,and serum Ang-Ⅰ level was higher than that in the control group( P < 0. 05). There was no significant difference in the incidence of adverse reactions between the study group and the control group( P > 0. 05). Conclusion Repeated transcranial magnetic stimulation on the basis of conventional anti-dementia treatment can further down-regulate the expression levels of serum Caspase-3,TNF-α,LPO and MMP-9,increase level of Ang-Ⅰ,significantly improve the cognitive function,relieve the degree of dementia and effectively improve the prognosis of elderly VD patients. It has significant effect and higher safety.