恒清Ⅰ号方联合吡拉西坦治疗血管性认知障碍的作用机制研究

Study of Effects of HengqingⅠPrescription Combined with Piracetam Tablets on Patients with Vascular Cognitive Impairment

目的:探讨恒清Ⅰ号方联合吡拉西坦治疗血管性认知障碍(VCI)的作用机制。方法:选取2019年8月—2021年8月于上海市第六人民医院就诊的VCI病人240例,随机分为对照组(120例)和观察组(120例)。两组均给予基础治疗,对照组给予吡拉西坦片,观察组给予恒清Ⅰ号方联合吡拉西坦片,两组疗程均为3个月。评估治疗后两组疗效,分别于治疗前后检测两组的认知功能[简易精神状态检查量表(MMSE)]、日常生活能力[日常生活活动能力量表(ADL)]、神经功能缺损[美国国立卫生研究院脑卒中量表(NIHSS)]、脑血流灌注[基底节区脑血流量(CBF)、脑血流平均通过时间(MTT)、脑血流容积(CBV)]、电生理指标[P300潜伏期及波幅、(δ+θ)/(α+β)以及血清中的星形胶质源性蛋白(S100β)]、同型半胱氨酸(Hcy)、脑源性神经营养因子(BDNF)、胶质纤维酸性蛋白(GFAP)和β-淀粉样蛋白1-42(Aβ1-42)水平。结果:治疗后,观察组总有效率(86.44%)明显高于对照组(67.52%),差异有统计学意义(P<0.01)。与治疗前比较,治疗后两组病人MMSE、ADL评分升高,NIHSS评分降低(P<0.05或P<0.01);治疗后,与对照组比较,观察组MMSE、ADL评分升高,NIHSS评分降低(P<0.05)。与治疗前比较,观察组治疗后CBF、CBV升高,MTT下降(P<0.01);P300潜伏期、(δ+θ)/(α+β)下降,P300波幅升高(P<0.01);血清S100β、Hcy、GFAP和Aβ1-42水平下降,BDNF水平升高(P<0.01)。治疗后,与对照组比较,观察组CBF、CBV升高,MTT下降(P<0.01);P300潜伏期、(δ+θ)/(α+β)下降,P300波幅升高(P<0.01);血清S100β、Hcy、GFAP和Aβ1-42水平下降,BDNF水平升高(P<0.01)。治疗过程中,对照组、观察组不良反应发生率比较,差异无统计学意义(6.84%与5.08%,P>0.05)。结论:恒清Ⅰ号方联合吡拉西坦治疗VCI病人具有良好的临床疗效,可有效改善病人的认知功能、日常生活能力和神经功能缺损状况,且未见明显不良反应。其作用机制可能与降低VCI病人血清S100β、Hcy、GFAP和Aβ1-42水平及升高BDNF水平有关。

Objective:To investigate the effects and mechanism of HengqingⅠPrescription combined with Piracetam tablets on patients with vascular cognitive impairment(VCI).Methods:Two hundred and forty VCI patients were randomly divided into control group(120 cases)and observation group(120 cases).Both groups were treated with basic treatment.The control group was treated with Piracetam tablets on the basis of basic treatment,while the observation group was treated with HengqingⅠPrescription combined with Piracetam tablets on the basis of basic treatment.The treatment course of both groups were three months.The efficacy of both groups was evaluated after treatment.Cognitive function[Mini-Mental State Examination(MMSE)],daily living ability[Activity of Daily Living(ADL)],neurological impairment[National Institutes of Health Stroke Scale(NIHSS)],cerebral blood perfusion[cerebral Blood Flow(CBF),mean transit time(MTT),cerebral blood volume(CBV)],electrophysiological indexes[latency and amplitude of P300,(δ+θ)/(α+β)]and serum astroglia-derived protein(S100β),homocysteine(Hcy),brain-derived neurotrophic factor[brain derived neural nutrition factor(BDNF)],glial fibrillary acidic protein[glial fibrillary acidic protein(GFAP)]andβ-amyloid 1-42[amyloidβ-protein 1-42(Aβ1-42)]were detected in both groups before and after treatment.Results:After treatment,the total effective rate of the observation group(86.44%)was superior to that of the control group(67.52%)(P<0.01).Compared with data before treatment,MMSE and ADL scores increased,NIHSS scores decreased in both groups after treatment(P<0.05 or P<0.01).After treatment,compared with the control group,MMSE and ADL scores increased,NIHSS score decreased in the observation group(P<0.05).Compared with data before treatment,CBF and CBV in observation group increased after treatment,while MTT decreased(P<0.01).P300 latency,(δ+θ)/(α+β)ratio decreased,P300 amplitude increased(P<0.01),serum S100β,Hcy,GFAP,and Aβ1-42 levels decreased,BDNF level increased(P<0.01).After treatment,compared with control group,CBF and CBV in the observation group increased,while MTT decreased(P<0.01),P300 latency,(δ+θ)/(α+β)ratio decreased,and P300 amplitude increased(P<0.01).The levels of S100β,Hcy,GFAP,and Aβ1-42 in serum decreased,while the level of BDNF increased(P<0.01).During treatment,the incidence of adverse reactions in the control group and observation group were 6.84%and 5.08%(P>0.05).Conclusion:HengqingⅠPrescription combined with Piracetam tablets shows good clinical efficacy in the treatment of VCI patients,which can improve the cognitive function,daily living ability,and relieve neurological impairment of VCI patients without obvious adverse reactions.The mechanism may be related to decreasing levels of serum S100β,Hcy,GFAP and Aβ1-42 levels,and increasing level of serum BDNF in VCI patients.