开心散联合盐酸多奈哌齐治疗老年相关性痴呆的临床分析

Clinical analysis of Kaixin powder combined with donepezil hydrochloride in the treatment of the elderly patients with vascular dementia

目的探讨“填髓益智”开心散治疗老年血管性痴呆(VD)患者的效果及对认知功能、Toll样受体4/核因子-κB(TLR4/NF-κB)信号通路相关分子表达的影响,为治疗VD提供方法。方法选择2020年1月—2021年8月于扬州市中医院就诊的92例老年VD患者作为研究对象,采用数字表法随机分为观察组(n=46)和对照组(n=46)。对照组采用多奈哌齐治疗,观察组采用“填髓益智”开心散联合多奈哌齐治疗,患者均接受治疗6周。比较2组治疗后的疗效;比较治疗前后2组患者的临床痴呆程度量表(CDR)评分和简易精神状态评价量表(MMSE)评分;采用实时定量-PCR法检测2组患者治疗前后血单核细胞中TLR4、NF-κB、NF-κB抑制蛋白(IκB)水平;检测患者血清白介素-6(IL-6)、白介素-8(IL-8)和肿瘤坏死因子-α(TNF-α)水平。对上述检测结果进行比较和分析。结果治疗后,观察组的治疗总有效率高于对照组(P<0.05);观察组MMSE评分比对照组的更高(P<0.05),CDR评分比对照组的更低(P<0.05);观察组血清IL-6、IL-8、TNF-α水平和血单核细胞TLR4、NF-κB mRNA相对表达量均比对照组的更低(P<0.05),血单核细胞IκB mRNA高于对照组(P<0.05)。结论采用“填髓益智”开心散治疗老年VD疗效显著,可提高患者认知功能,并降低TLR4/NF-κB信号通路相关TLR4、NF-κB蛋白及细胞因子IL-6、IL-8、TNF-α的表达。

Objective To explore the effect of Tiansui Yizhi Kaixin powder in the treatment of elderly patients with vascular dementia(VD)and its effects on cognitive function and expression of Toll-like receptor 4/nuclear factor-κB(TLR4/NF-κB)signaling pathway-related molecules,and provide a method for the treatment of VD.Methods A total of92 elderly patients with VD treated in Traditional Chinese Medicine Hospital of Yangzhou City were enrolled as the research subjects between January 2020 and August 2021.According to random number table method,they were divided into observation group(n=46)and control group(n=46).The control group was treated with donepezil and the observation group was treated with Tiansui Yizhi Kaixin powder and donepezil.All were treated for 6 weeks.The curative effect between the two groups was compared after treatment.The scores of Clinical Dementia Rating(CDR)scale and Mini-Mental State Examination(MMSE)scale were compared between the two groups before and after treatment.Real-time quantitative-PCR was used to detect the levels of TLR4,NF-κB and NF-κB inhibitory protein(IκB)in blood mononuclear cells of the two groups before and after treatment.The enzyme-linked immunosorbent assay was used to detect the levels of serum interleukin-6(IL-6),interleukin-8(IL-8)and tumor necrosis factor-a(TNF-α).The above test results of the two groups were compared and analyzed.Results After treatment,the total effective rate of the observation group was higher than that of the control group(P<0.05).MMSE score of the observation group was higher than that of the control group(P<0.05),while CDR score was lower than that of the control group(P<0.05).The levels of serum IL-6,IL-8 and TNF-α,and relative expression levels of TLR4 and NF-κB mRNA of the observation group were significantly lower than those of the control group(P<0.05),while IκB mRNA was higher than that of the control group(P<0.05).Conclusion Tiansui Yizhi Kaixin powder is effective in the treatment of VD in elderly patients,which can improve the cognitive function of patients and reduce the expression of TLR4/NF-κB signaling pathway-related TLR4,NF-κB protein and cytokines such as IL-6,IL-8,TNF-α.