通络化痰汤联合依达拉奉治疗脑梗死后血管性认知障碍患者的临床疗效及对其认知功能及血清hs-CRP、TNF-α水平的影响

Effects of Tongluo Huatan Decoction Combined with Edaravone on Cognitive Function and Serum hs-CRP and TNF-ɑ Levels in Patients with Vascular Cognitive Impairment after Cerebral Infarction

目的研究通络化痰汤联合依达拉奉治疗脑梗死后血管性认知障碍患者的临床疗效及对其认知功能及血清超敏C反应蛋白(Hypersensitive C-reactive protein,hs-CRP)、肿瘤坏死因子-α(Tumor necrosis factor-α,TNF-α)水平的影响。方法选取2019年7月—2020年11月期间开封市中医院和河南中医药大学第三附属医院收治的96例脑梗死后血管性认知障碍患者,按随机数字表法分为对照组和研究组,每组各48例。对照组给予依达拉奉治疗,研究组在对照组基础上给予通络化痰汤治疗。治疗30 d后,观察比较两组患者治疗前后脑血流动力学指标[脉动指数(Pulsation index,PI)、大脑中动脉收缩期血流速度(Middle cerebral artery systolic blood flow velocity,Vs)、平均血流速率(Mean blood flow velocity,Vm)]、凝血酶原时间(Prothrombin time,PT)、纤维蛋白原(Fibrinogen,Fib)、炎症因子[超敏C反应蛋白(hs-CRP)、肿瘤坏死因子-α(TNF-α)]水平以及认知功能[蒙特利尔认知量表(Montreal Cognitive Assessment,MoCA)]、中医证候评分;比较两组患者临床疗效和不良反应发生情况。结果治疗后两组患者PI、Vs、Vm水平均高于治疗前,差异有统计学意义(P<0.05);且研究组PI、Vs、Vm水平高于对照组,差异有统计学意义(P<0.05)。治疗后两组患者PT高于治疗前,Fib水平低于治疗前,差异有统计学意义(P<0.05);且研究组PT高于对照组,Fib水平低于对照组,差异有统计学意义(P<0.05)。治疗后两组患者血清hs-CRP、TNF-α水平低于治疗前,MoCA评分高于治疗前,差异有统计学意义(P<0.05);且研究组血清hs-CRP、TNF-α水平低于对照组,MoCA评分高于对照组,差异有统计学意义(P<0.05)。治疗后两组患者中医证候积分均低于治疗前,差异有统计学意义(P<0.05);且研究组低于对照组,差异有统计学意义(P<0.05)。治疗后研究组临床总有效率89.58%(43/48)明显高于对照组70.83%(34/48),差异有统计学意义(P<0.05)。两组患者不良反应发生率比较,差异无统计学意义(P>0.05)。结论通络化痰汤联合依达拉奉应用于脑梗死后血管性认知障碍更有利于改善脑血流动力学、凝血功能、炎症反应、认知功能,疗效显著,且安全性佳。

Objective To explore the effects of Tongluo Huatan Decoction combined with edaravone on cognitive function,serum high-sensitivity C-reactive protein(hs-CRP)and tumor necrosis factor-α(TNF-ɑ)levels in patients with vascular cognitive impairment after cerebral infarction.Methods Ninety-six patients with vascular cognitive impairment after cerebral infarction admitted to Kaifeng Hospital of Traditional Chinese Medicine and the Third Affiliated Hospital of Henan University of Chinese Medicine from July 2019 to November 2020 were enrolled and divided into a control group(n=48)and a study group(n=48)according to a random number table.All patients were treated with edaravone,while those in the treatment group received additional Tongluo Huatan Decoction.After treatment for 30 days,the cerebral hemodynamic indexes[pulsation index(PI),middle cerebral artery systolic blood flow velocity(Vs),and mean blood flow velocity(Vm)],prothrombin time(PT),fibrinogen(Fib),levels of inflammatory factors[hs-CRP and TNF-ɑ],cognitive function[Montreal Cognitive Assessment(MoCA)],traditional Chinese medicine(TCM)syndrome scores,clinical efficacy,and adverse reactions of two groups before and after treatment were compared.Results After treatment,PI,Vs,and Vm levels of the two groups were higher than those before treatment(P<0.05),and the treatment group was higher than the control group(P<0.05).After treatment,the PT of the two groups was longer than that before treatment(P<0.05),and the PT of the treatment group was longer than that of the control group(P<0.05).After treatment,the Fib level of the two groups was lower than that before treatment(P<0.05),and the Fib level of the treatment group was lower than that of the control group(P<0.05).After treatment,the serum hs-CRP and TNF-ɑ levels of the two groups were lower than those before treatment(P<0.05),and the treatment group was lower than the control group(P<0.05).After treatment,the MoCA scores of the two groups were higher than those before treatment(P<0.05),and the treatment was higher than the control group(P<0.05).After treatment,the TCM syndrome scores of the two groups were lower than those before treatment(P<0.05),and the treatment group was lower than the control group(P<0.05).The total clinical effective rate of the treatment group was 89.58%(43/48),higher than 70.83%(34/48)of the control group(P<0.05).There was no significant difference in the incidence of adverse reactions between the two groups(P>0.05).Conclusion Tongluo Huatan Decoction combined with edaravone for vascular cognitive impairment after cerebral infarction is conducive to improving cerebral hemodynamics,coagulation function,inflammation,and cognitive function,with significant curative effect and good safety.