地黄饮子治疗肾虚血瘀型血管性痴呆的临床研究

Clinical study of Dihuangyinzi in the treatment of vascular dementia of kidney deficiency and blood stasis type

目的本研究旨在观察地黄饮子治疗血管性痴呆的临床疗效,并探讨其可能的作用机制。方法以2019年2月至2022年2月驻马店市中医院和河南省中医院收治的100例血管性痴呆患者为研究对象,按随机数字表将患者分为两组,对照组50例患者采用常规治疗,观察组50例患者采用地黄饮子治疗。治疗12周后,采用简明精神状态量表(MMSE)、蒙特利尔认知评估量表(Mo CA)和Barthel指数量表,评价患者认知功能和日常生活能力;检测血清认知功能相关递质血降钙素原基因肽(CGRP)与5-羟色胺(5-HT)水平;检测神经元凋亡相关因子B细胞淋巴瘤-2(BCL-2)及BCL-2相关X蛋白(Bax)、半胱氨酸蛋白酶(Caspase)-3水平;依据Mo CA评分改善程度进行临床疗效评价。结果治疗后,两组患者MMSE、Mo CA和Barthel指数等各项评分均较治疗前明显升高(P均<0.05),且观察组MMSE、Mo CA和Barthel指数等各项评分明显高于对照组(P均<0.05)。治疗后,两组患者血清认知相关递质CGRP、5-HT水平明显高于治疗前(P均<0.05),且观察组血清认知相关递质CGRP、5-HT水平明显高于对照组(P均<0.05)。治疗后,两组患者BCL-2水平较治疗前明显升高(P<0.05),且观察组血清BCL-2水平明显高于对照组(P<0.05);治疗后,两组Bax和Caspase-3水平较治疗前明显降低(P均<0.05),且观察组Bax和Caspase-3水平明显低于对照组(P均<0.05)。治疗后,观察组患者临床总有效率98.00%明显大于对照组患者临床总有效率78.00%(P<0.05)。结论地黄饮子对血管性痴呆患者的认知功能及其相关递质和神经元凋亡相关因子有明显的改善作用。

Objective To observe the clinical effect of Rehmannia decoction(Dihuang Yinzi)in the treatment of vascular dementia,and to explore its possible mechanism.Methods A total of 100 patients with vascular dementia admitted to Zhumadian Hospital of Traditional Chinese Medicine and Henan Provincial Hospital of Traditional Chinese Medicine from February 2019 to February 2022 were taken as the study objects.The patients were divided into two groups according to random number table:50 patients in the control group received conventional treatment,and 50 patients in the observation group received Dihuang Yinzi treatment.After 12 weeks of treatment,the Mini-Mental State Examination(MMSE),Montreal Cognitive Assessment Scale(MoCA)and Barthel Index were used to evaluate the cognitive function and daily living ability of the patients.The levels of serum procalcitonin gene peptide(CGRP)and 5-hydroxytryptamine(5-HT),which are related to cognitive function,were determined.The levels of B-cell lymphoma-2(BCL-2),BCL-2 associated X protein(Bax)and caspase-3 were detected.Clinical efficacy was evaluated according to the improvement degree of MoCA score.Results After treatment,MMSE,MoCA and Barthel index scores in 2 groups were significantly higher than before treatment(all P<0.05),and MMSE,MoCA and Barthel index scores in the observation group were significantly higher than those in the control group(all P<0.05).After treatment,the levels of serum cognitive-related transmitters CGRP and 5-HT in 2 groups were significantly higher than those before treatment(P<0.05),and the levels of serum cognitive-related transmitters CGRP and 5-HT in the observation group were significantly higher than those in the control group(P<0.05).After treatment,the levels of BCL-2 in 2 groups were significantly higher than those before treatment(P<0.05),and the serum level of BCL-2 in the observation group was significantly higher than that in the control group(P<0.05).After treatment,Bax and Caspase-3 levels in 2 groups were significantly decreased compared with those before treatment(P<0.05),and Bax and Caspase-3 levels in the observation group were significantly lower than those in the control group(P<0.05).After treatment,the total clinical effective rate of the observation group was 98.00%,which was significantly higher than that of the control group 78.00%(P<0.05).Conclusion Dihuang Yinzi can significantly improve the cognitive function,related neurotransmitters and apoptosis related factors of neurons in patients with vascular dementia.