开心散合剂治疗血管性痴呆临床观察

Efficacy observation of Kaixin powder mixture on vascular dementia

目的:观察开心散合剂治疗血管性痴呆(VaD)的临床疗效。方法:将符合纳入标准的90例VaD患者随机分为中药组、西药组、联合组各30例,中药组予开心散治疗,西药组予多奈哌齐治疗,联合组予开心散结合多奈哌齐治疗;疗程均为1个月。观察并比较各组患者治疗前后的NF-κB p65 mRNA表达、CRP、P-选择素及表观扩散系数(ADC)水平。结果:治疗后,中药组、联合组患者NF-κB p65 mRNA表达水平均下降(P﹤0.05),而西药组未见明显下降(P﹥0.05);3组患者CRP均下降(P﹤0.05);组间比较差异均无统计学意义(P﹥0.05);中药组、联合组均能降低P-选择素(P﹤0.05),而西药组P-选择素未降低(P﹥0.05);3组患者ROI区平均ADC值均下降(P﹤0.05),且联合组优于西药组(P﹤0.05)。结论:在常规治疗基础上,加用开心散合剂可调控NF-κB信号通路降低NF-κB p65mRNA表达,降低炎症因子CRP、P-选择素水平释放,减轻炎症反应,还可下调VaD患者ROI区平均ADC值,减轻脑白质损害,改善认知功能障碍。

Objective:To observe the clinical efficacy of Kaixin powder mixture on vascular dementia(VaD).Methods:90 cases of eligible patients with VaD were randomly divided into TCM group,western medicine group and combining group,30 cases in each group.TCM group was treated with Kaixin powder mixture,western medicine group was treated with donepezil,while combining group was treated with Kaixin powder mixture and donepezil.The course of treatment was one month.The levels of NF-κB p65mRNA expression,CRP,P-selectin and apparent diffusion coefficient(ADC)of patients in each group were observed and compared before and after treatment.Results:After treatment:the level of NF-κB p65mRNA expression of patients in TCM group and combining group was decreased(P﹤0.05),while there was no significant decrease in western medicine group(P﹥0.05);CRP of patients in all three groups was decreased(P﹤0.05),and the comparative difference among three groups was not statistically significant(P﹥0.05);P-selectin was decreased in both TCM group and combining group(P﹤0.05),but not in western medicine group(P﹥0.05);the average ADC value in ROI area of patients in all three groups was decreased(P﹤0.05),and the combining group was better than western medicine group(P﹤0.05).Conclusion:Kaixin powder mixture which is added on the basis of routine treatment can reduce the expression of NF-κB p65 mRNA by regulating NF-κB signaling pathway,reduce the release of levels of inflammatory factor CRP and P-selectin,alleviate inflammatory reaction,down-regulate the average ADC values in ROI area of patients,reduce the damage of white matter and improve cognitive dysfunction.