参蓉补脑汤治疗老年痴呆疗效及对血脑屏障的影响

Efficacy of Shenrong Bunao decoction in the treatment of senile dementia and its effect on blood-brain barrier

目的观察参蓉补脑汤治疗老年痴呆的临床疗效及对血脑屏障的影响,研究其治疗老年痴呆的可能作用机制。方法选取2018年1月—2019年12月上海中医药大学附属市中医医院收治的126例老年痴呆患者作为研究对象,采用随机数字法分为对照组和观察组,每组63例。对照组采用盐酸多奈哌齐治疗,观察组在对照组治疗基础上联合参蓉补脑汤治疗,治疗周期均为3个月。检测2组脑脊液及血清中白蛋白(ALB)水平,评估血脑屏障损伤程度;测定2组血清炎性因子[肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)、超敏C反应蛋白(hs-CRP)]、氧化应激指标[超氧化物歧化酶(SOD)、丙二醛(MDA)、环氧化酶-2(COX-2)]、白细胞黏附因子(CD11b、CD18)及金属蛋白酶(MMP-9)水平;检测2组脑脊液中紧密连接蛋白-5(Claudin-5)、结合黏附因子(JAM-4)含量;比较2组患者认知功能及治疗有效率。结果与对照组及治疗前比较,观察组患者脑脊液ALB水平、脑脊液ALB/血清ALB比值(QALB)及血清TNF-α、IL-6、hs-CRP、MDA、COX-2、CD11b、CD18、MMP-9水平均显著降低(P均<0.05),血清SOD活性均显著升高(P均<0.05);观察组患者脑脊液中Claudin-5、JAM-4含量均显著高于治疗前及对照组(P均<0.05);观察组患者治疗总有效率为95.24%(60/63),高于对照组的90.48%(57/63),组间比较差异有统计学意义(P<0.05)。结论参蓉补脑汤治疗老年痴呆疗效显著,其治疗机制可能与抑制炎症反应,改善高氧化应激状态,上调紧密连接蛋白Claudin-5、JAM-4的表达,进而修复血脑屏障损伤有关。

Objective It is to observe the clinical efficacy of Shenrong Bunao decoction in the treatment of senile dementia and its effect on the blood-brain barrier,and to study its possible mechanism of action in the treatment of this disease.Methods A total of 126 senile dementia patients admitted to Shanghai Municipal Hospital of Traditional Chinese Medicine Affiliated to Shanghai University of Traditional Chinese Medicine from January 2018 to December 2019 were selected as the research objects,and were divided into control group and observation group by random number method,with 63 cases in each group.The control group was treated with donepezil hydrochloride,and the observation group was treated with Shenrong Bunao decoction on the basis of the treatment of the control group,both the treatment cycles were 3 months.The levels of albumin(ALB)in cerebrospinal fluid and serum of the two groups were detected to evaluate the degree of blood-brain barrier damage;the levels of serum inflammatory factors[tumor necrosis factor-α(TNF-α),interleukin-6(IL-6),high-sensitivity C-reactive protein(hs-CRP)],oxidative stress indicators[superoxide dismutase(SOD),malondialdehyde(MDA),cyclooxygenase-2(COX-2)],leukocyte adhesion factor(CD11b,CD18)and metalloproteinase(MMP-9)of the two groups were detected;the contents of Claudin-5(Claudin-5)and binding adhesion factor(JAM-4)in the cerebrospinal fluid of the two groups were detected;the cognitive function and treatment effective rate of the two groups were compared.Results Compared with the control group and before treatment,the levels of ALB in cerebrospinal fluid and the ratio of cerebrospinal fluid ALB/serum ALB(QALB)and the levels of serum TNF-α,IL-6,hs-CRP,MDA,COX-2,CD11b,CD18 and MMP-9 in the observation group were significantly decreased(all P<0.05),the activity of serum SOD was higher than that in the control group(P<0.05);the contents of Claudin-5 and JAM-4 in the cerebrospinal fluid of the observation group were significantly higher than those before treatment and the control group(all P<0.05);the total effective rate of patients in the observation group was 95.24%(60/63),which was significantly higher than 90.48%(57/63)in the control group,and the difference was significant between the groups(P<0.05).Conclusion Shenrong Bunao decoction has significant curative effect in the treatment of senile dementia,and its therapeutic mechanism may be related to inhibiting inflammatory response,improving hyperoxidative stress state,up-regulating the expression of tight junction proteins Claudin-5 and JAM-4,thereby repairing blood-brain barrier damage.