芪参还五胶囊联合丁苯酞对痰瘀互结型早期血管性痴呆患者认知功能障碍及p38丝裂原活化蛋白激酶通路变化的影响

The Effects of Qishen Huanwu Capsule Combined with Butylphthalide on Cognitive Impairment and p38 MAPK Pathway in Patients with Phlegm Blood Stasis Syndrome of Early Vascular Dementia

目的探讨芪参还五胶囊联合丁苯酞对痰瘀互结型早期血管性痴呆患者认知功能的改善作用。方法选取2020年1月—2020年12月期间河北省沧州中西医结合医院治疗的痰瘀互结型早期血管性痴呆患者90例为研究对象,将入选患者按随机数字表法分为西药组44例和中西药联合组46例。西药组给予单纯的丁苯酞软胶囊治疗,中西药联合组在西药组的基础上增加芪参还五胶囊治疗,观察比较两组患者简易精神状态量表(Mini-Mental State Examination,MMSE)评分、血清超敏C反应蛋白(High sensitivity c-reactive protein,hs-CRP)、白细胞介素-6(Interleukin-6,IL-6)、神经元特异性烯醇化酶(Neuron specific enolase,NSE)水平、p38MAPK通路蛋白表达及日常生活能力量表(Activity of daily living scale,ADL)评分。结果治疗后两组患者智能各维度及总分均较治疗前升高,差异有统计学意义(P<0.05);且中西药联合组患者智能各维度及总分明显高于西药组,差异有统计学意义(P<0.05)。治疗后两组患者血清hs-CRP、IL-6、NSE水平均较治疗前明显降低,差异有统计学意义(P<0.05);且中西药联合组明显低于西药组,差异有统计学意义(P<0.05)。治疗后两组患者外周血P-p38MAPK、P-p38MAPK/p38MAPK蛋白表达量较治疗前明显降低,差异有统计学意义(P<0.05);p38MAPK蛋白表达量与治疗前比较,差异无统计学意义(P>0.05);且中西药联合组外周血P-p38MAPK、P-p38MAPK/p38MAPK蛋白表达量低于西药组,差异有统计学意义(P<0.05);p38MAPK蛋白表达量与西药组比较,差异无统计学意义(P>0.05)。治疗后两组患者生活基本技能各分项及总分均较治疗前降低,差异有统计学意义(P<0.05);且中西药联合组患者生活基本技能各分项及总分明显低于西药组,差异有统计学意义(P<0.05)。结论采用芪参还五胶囊联合丁苯酞对早期血管性痴呆患者(痰瘀互结型)进行治疗可以明显改善患者智能和生活基本技能,疗效确切,值得临床推广。

Objective To explore the effect of Qishen Huanwu capsule combined with butylphthalide on the cognitive function of Phlegm Blood Stasis Type in patients with early vascular dementia.Methods Ninety patients with vascular dementia treated in Hebei Cangzhou Hospital of Integrated Traditional Chinese and Western Medicine from January 2020to December 2020 were selected as the research object.The selected patients were randomly divided into western medicine group(n=44)and combined Chinese and Western medicine group(n=46).The western medicine group was treated with butylphthalein soft capsules alone.On the basis of the western medicine group,Qishenhuanwu capsule was added to the combined Chinese and Western medicine group..Mini-Mental State Examination score(MMSE),High sensitivity C-reactive protein(hs-CRP),Interleukin-6(IL-6)and Neuron specific enolase(NSE),p38MAPK pathway protein expression and Activity of daily living scale(ADL)of two groups were observed and compared.Results After treatment,compared with before treatment,the dimensions and total scores of intelligence in the two groups were increased,and compared with the western medicine group,the dimensions and total scores of intelligence in the combined Chinese and Western medicine group were increased(P<0.05).After treatment,serum hs-CRP,IL-6 and NSE levels in two groups were significantly decreased compared with before treatment(P<0.05)and the combination group of Chinese and Western medicine was significantly lower than that of Western medicine group(P<0.05).After treatment,the protein expression levels of P-P38MAPK and P-P38MapK/p38MAPK in peripheral blood of two groups were significantly decreased compared with before treatment(P<0.05);There was no significant difference in the expression level of p38MAPK protein compared with before treatment(P>0.05).The protein expression levels of P-P38MAPK and P-P38Mapk/p38MAPK in peripheral blood of the combined group were lower than those of the western group(P<0.05).There was no significant difference in the expression level of p38MAPK protein between the two groups(P>0.05).After treatment,compared with before treatment,the sub items and total scores of basic life skills in the two groups decreased,and compared with the western medicine group,the sub items and total scores of basic life skills in the combined Chinese and Western medicine group decreased(P<0.05).Conclusion Qishen Huanwu capsule combined with butylphthalide in the treatment of patients with early vascular dementia(phlegm and blood stasis type)can significantly improve patients′intelligence and basic life skills,with definite curative effect,which is worthy of clinical promotion.