益髓增智汤加减对肾虚血瘀证血管性痴呆患者认知功能、血清BDNF、ET水平的影响研究

Effect of Modified Yisui Zengzhi Decoction on Cognitive Function, Serum BDNF and ET Levels for Patients with Vascular Dementia of Kidney-deficiency Blood-stasis Syndrome

目的:观察益髓增智汤加减对肾虚血瘀证血管性痴呆(VD)患者认知功能、血清脑源性营养因子(BDNF)、内皮素(ET)水平的影响。方法:选取本院于2018年1月~2020年1月收治的肾虚血瘀证VD患者108例,采用随机数表法分为对照组和观察组,各54例。对照组口服尼莫地平治疗,观察组在服用尼莫地平的同时行益髓增智汤加减治疗,两组均治疗8周。采用简易智力状态量表(MMSE)及痴呆评定量表(CDR)对患者认知功能进行评价,并比较两组干预前后的ET、血清一氧化氮(NO)以及血清同型半胱氨酸(HCY)和BDNF、神经生长因子(NGF)、胶质细胞源性神经营养因子(GDNF)、神经元烯醇化酶(NSE)等神经营养因子水平变化,评价治疗效果及中医症状积分情况。结果:两组的临床有效率分别为90.74%和75.93%,观察组高于对照组(P<0.05)。8周后,观察组的智能减退、头痛如刺、口唇爪甲青紫等中医症状积分均低于对照组(P<0.05)。与治疗前相比,8周后两组的CDR评分下降,MMSE评分提高(P<0.05),且观察组的变化幅度大于对照组(P<0.05)。8周后观察组的ET、HCY水平均低于对照组,BDNF、NGF及GDNF水平均高于对照组(P<0.05)。结论:益髓增智汤加减治疗肾虚血瘀证血管性痴呆,可明显改善患者的神经因子和内皮素水平,提高认知功能和临床疗效。

Objective: To explore the effect of Modified Yisui Zengzhi Decoction on cognitive function, serum brain-derived nutritional factor(BDNF) and endothelin(ET) levels for patients with vascular dementia(VD) of kidney-deficiency blood-stasis syndrome.Methods: A total of 108 VD patients of kidney-deficiency blood-stasis syndrome who were admitted to the hospital from January 2018 to January 2020 were enrolled and divided into a controlled group and an observation group by the random number table method, 54 cases in each group.The controlled group was treated with oral nimodipine, while the observation group was additionally treated with Modified Yisui Zengzhi Decoction.Both groups were treated for 8 weeks.The cognitive function of patients were evaluated by mini-mental state examination(MMSE) and clinical dementia rating(CDR).The changes in levels of ET,serum nitric oxide(NO),homocysteine(HCY),BDNF,nerve growth factor(NGF),glial cell line-derived neurotrophicfactor(GDNF) and neuron specific enolase(NSE) before and after intervention were compared between the two groups.The curative effect and scores of TCM symptoms were evaluated.Results: The clinical response rate in the observation group was higher than that in the controlled group(90.74% vs 75.93%)(P<0.05).After 8 weeks, scores of TCM symptoms such as aponea, headaches, and cyanochroia of lips and paws in the observation group were lower than those in the controlled group(P<0.05).Compared with those before treatment, CDR score was decreased, while MMSE scores was increased after 8 weeks in both groups(P<0.05).And change amplitude in the observation group was greater than that in the controlled group(P<0.05).After 8 weeks, ET and HCY levels in the observation group were lower than those in the controlled group, while BDNF,NGF and GDNF levels were higher than those in the controlled group(P<0.05).Conclusion: Using Modified Yisui Zengzhi Decoction in the treatment of vascular dementia of kidney-deficiency blood-stasis syndrome can significantly improve levels of neurological factors and endothelin, improve cognitive function and clinical curative effect.