养血清脑颗粒治疗阿尔茨海默病的疗效及对血管内皮生长因子的影响

Efficacy of Yangxue Qingnao Granule on Alzheimer’s Disease and Effect on VEGF Level

目的:观察阿尔茨海默病(AD)患者血清中血管内皮生长因子(VEGF)的含量变化,探讨养血清脑颗粒治疗AD的疗效及对VEGF的影响。方法:选择60例认知障碍患者,其中遗忘型轻度认知障碍(aMCI)及AD患者各30例;健康对照组30例为同期门诊收集的健康人员,蒙特利尔认知评估量表(MoCA)≥26分,年龄、性别及并发症情况与患者组比较差异无统计学意义。入组时,给予aMCI组、AD组及健康对照组静脉抽血,测定血清VEGF水平。再将aMCI患者及AD患者按照随机信封法分为对照组和观察组,两组均给予常规西医治疗(盐酸多奈哌齐5 mg·d^(-1)),观察组同时给予养血清脑颗粒口服治疗。治疗6个月后,比较对照组和观察组患者的临床疗效、认知量表评分及不良反应,再次静脉抽血检测治疗前后两组患者VEGF的变化情况。结果:AD痴呆患者血清中VEGF含量明显低于aMCI患者及健康对照组(P<0.05);aMCI患者血清VEGF水平也明显低于健康对照组(P<0.05)。经治疗后,观察组患者血清VEGF水平较本组治疗前明显升高(P<0.05),且明显高于对照组VEGF水平(P<0.05);以MoCA评估患者认知障碍程度,观察组患者的认知功能改善情况优于对照组,观察组治疗总有效率高于对照组(P<0.05),观察组经治疗后MoCA评分明显升高(P<0.05),且明显高于对照组(P<0.05)。观察组不良反应发生率与对照组比较差异无统计学意义。结论:AD痴呆患者血清中VEGF水平明显下降,aMCI患者血清中VEGF也明显下降,提示血管生成机制参与了AD的病理生理过程,且与AD发病早期阶段相关。养血清脑颗粒辅助治疗aMCI及AD痴呆患者具有较好的临床疗效,可有效改善认知功能,其机制可能与提高VEGF水平,促进血管生成,改善脑皮层微循环有关,且具有良好的安全性。

Objective: To observe the variation in content of vascular endothelial growth factor(VEGF)in patients with Alzheimer’s disease(AD)and to investigate efficacy of Yangxue Qingnao granule on AD and the effect on VEGF. Method: A total of 60 patients with cognitive impairment[30 of AD and 30 of amnestic mild cognitive impairment(aMCI)] were selected,and another 30 healthy people with Montreal Cognitive Assessment(MoCA)≥26 and age,gender,and complications insignificantly different from the patients were included as healthy control. The venous blood of aMCI group,AD group,and the healthy control group was collected at the enrollment to measure the level of serum VEGF. Then,the aMCI and AD patients were randomized into the observation group and the control group,with 30 patients in each group. The control group was given Donepezil Hydrochloride(5 mg·d^(-1)), while the observation group received Donepezil Hydrochloride(5 mg·d^(-1))and Yangxue Qingnao granule. MoCA was used to evaluate the severity of cognitive impairment. After the treatment for 6 months,the clinical efficacy and adverse reactions of the two groups were compared,and the serum VEGF levels were detected again by enzyme-linked immunosorbent assay(ELISA).Result: The serum content of VEGF in AD patients was significantly lower than that in aMCI patients and healthy people(P<0.05). Serum VEGF levels in aMCI patients were significantly decreased compared with those in healthy people(P<0.05). After treatment for 6 months,the serum VEGF level in the observation group was significantly higher than that before treatment,and was higher than that in the control group(P<0.05).MoCA scores in the observation group were higher than those in control group(P<0.05). The incidence of adverse reactions was insignificantly different between both groups. Conclusion: The serum levels of VEGF significantly decreased in aMCI and AD patients, suggesting that angiogenesis might be involved in the pathophysiological process of AD and correlated with the early stage of AD. Yangxue Qingnao granule,as a safe adjuvant therapy,showed ideal effect on aMCI and AD,as manifested by the improvement of cognitive function. The mechanism is the likelihood that it can elevate the expression of angiogenic factors such as VEGF,promote angiogenesis,and then improve the microcirculation of cortex.