参麻益智方联合西酞普兰治疗脑梗死合并认知功能障碍的疗效及其对炎性因子和氧化应激的影响研究

Efficacy of Shenma Yizhi Prescription Combined with Citalopram in the Treatment of Cerebral Infarction Complicated with Cognitive Dysfunction and Its Effect on Inflammatory Factors and Oxidative Stress

背景脑梗死合并认知功能障碍的治疗一直是临床研究的热点,长期西药治疗可导致不良反应增加,且无法有效改善临床症状,因此亟须探讨一种新的治疗方案。参麻益智方作为治疗血管性痴呆的经方,用于脑梗死合并认知功能障碍治疗的报道并不多见。目的探讨参麻益智方联合西酞普兰治疗脑梗死合并认知功能障碍的疗效及其对炎性因子、氧化应激的影响。方法选择2018年3月—2020年6月达州市中心医院神经内科收治的136例脑梗死合并认知功能障碍患者,采用随机数字表法将患者分为两组,对照组(68例)给予西酞普兰治疗,治疗组(68例)给予参麻益智方联合西酞普兰治疗,两组均连续治疗2个月。比较两组疗效,治疗前后认知功能评分及炎性因子、氧化应激指标和不良反应发生率。结果治疗组患者疗效优于对照组(u=2.459,P=0.014)。治疗前,两组患者蒙特利尔认知评估量表(MoCA)、简易智能精神状态检查量表(MMSE)评分、肿瘤坏死因子α(TNF-α)、白介素1β(IL-1β)、白介素6(IL-6)、C反应蛋白(CRP)、丙二醛(MDA)、晚期氧化蛋白产物(AOPP)、超氧化物歧化酶(SOD)、总抗氧化能力(T-AOC)、谷胱甘肽过氧化物酶(GSH-Px)水平比较,差异无统计学意义(P>0.05);两组治疗后MoCA评分、MMSE评分和SOD、T-AOC、GSH-Px水平分别较本组治疗前升高,TNF-α、IL-1β、IL-6、CRP、MDA、AOPP水平分别较本组治疗前降低(P<0.05);且治疗后,治疗组患者MoCA评分、MMSE评分和SOD、T-AOC、GSH-Px水平高于对照组,TNF-α、IL-1β、IL-6、CRP、MDA、AOPP水平低于对照组(P<0.05)。治疗组与对照组患者不良反应发生率比较,差异无统计学意义〔1.5%(1/68)比10.3%(7/68),χ^(2)=3.320,P=0.068〕。结论参麻益智方联合西酞普兰可提高抗氧化能力,降低炎性因子水平及减弱氧化应激反应,改善脑梗死合并认知功能障碍患者的认知功能,提高临床疗效,同时并不增加不良反应,为脑梗死合并认知功能障碍患者的治疗提供了新的推荐。

Background The treatment of cerebral infarction combined with cognitive dysfunction has always been a hot spot in clinical research.Long-term western medicine treatment can lead to increased adverse reactions and cannot effectively improve clinical symptoms.Therefore,it is urgent to explore a new treatment plan.As a prescription for the treatment of vascular dementia,Shenma Yizhi prescription is seldom reported in the treatment of cerebral infarction combined with cognitive dysfunction.Objective To investigate the efficacy of Shenma Yizhi prescription combined with citalopram in the treatment of cerebral infarction complicated with cognitive dysfunction and its effect on inflammatory factors and oxidative stress.Methods One hundred and thirty-six patients with cerebral infarction combined with cognitive dysfunction admitted to the Department of Neurology of Dazhou Central Hospital from March 2018 to June 2020 were selected and divided into two groups by random number table method.The control group(68 cases)was treated with citalopram,while the treatment group(68 cases)was treated with Shenma Yizhi prescription combined with citalopram,and both groups were treated for 2 months.The efficacy,cognitive function scores,inflammatory factors and oxidative stress indexes before and after treatment,and the incidence of adverse reactiens were compared between the two groups.Results The curative effect of the treatment group was better than that of the control group(u=2.459,P=0.014).Before treatment,there was no significant difference in Montreal Cognitive Assessment(MoCA)score,Mini-Mental State Examination(MMSE)score,serum levels of tumor necrosis factor-α(TNF-α),interleukin 1β(IL-1β),interleukin 6(IL-6),C-reactive protein(CRP),malondialdehyde(MDA),advanced oxidation protein products(AOPP),superoxide dismutase(SOD),total antioxidant capacity(T-AOC),and glutathione peroxidase(GSH-Px)between the two groups(P>0.05).MoCA score,MMSE score,and SOD,T-AOC,GSH-Px levels of the two groups after treatment were higher than those before treatment,TNF-α,IL-1β,IL-6,CRP,MDA,AOPP levels of the two groups after treatment were lower than those before treatment,respectively(P<0.05).After treatment,MoCA score,MMSE score,and SOD,T-AOC,GSH-Px levels in the treatment group were higher than those in the control group,TNF-α,IL-1β,IL-6,CRP,MDA,AOPP levels in the treatment group were lower than those in the control group(P<0.05).There was no significant difference in the incidence of adverse reactions between the treatment group and the control group〔1.5%(1/68)vs 10.3%(7/68),χ2=3.320,P=0.068〕.Conclusion Shenma Yizhi prescription combined with citalopram can improve antioxidant capacity,reduce inflammatory factors and oxidative stress,improve cognitive function of cerebral infarction complicated with cognitive dysfunction,and improve clinical efficacy,and do not increase adverse reactions,which provides a new recommendation for the treatment of patients with cerebral infarction combined with cognitive dysfunction.