通窍活血汤对瘀血内阻型非痴呆型血管性认知障碍患者的影响研究

Effect of Tongqiao Huoxue Decoction on Patients with Vascular Cognitive Impairment No Dementia with Blood Stasis and Internal Resistance

目的探讨通窍活血汤对瘀血内阻型非痴呆型血管性认知障碍(VCIND)患者的影响。方法选取2018年9月—2021年9月柳州市中医医院神经内科收治的90例瘀血内阻型VCIND患者,采用随机数字表法将患者分配至对照组与观察组,每组45例。对照组患者接受基础治疗,观察组患者在对照组基础上接受通窍活血汤辨证施治,均连续治疗12周。比较两组临床疗效,治疗前后认知功能〔蒙特利尔认知评估量表(MoCA)、简易智力状态检查(MMSE)量表评分〕、颈部血管彩超检查指标〔颈部血管斑块数量、颈动脉内膜中膜厚度(CIMT)及颈总动脉、颈内动脉直径、收缩期峰值血流速度(PSV)、舒张末期血流速度(EDV)、时间平均峰值流速(TAmax)、搏动指数(PI)、阻力指数(RI)〕、血清对氧磷酶1(PON-1)、血清氧化型低密度脂蛋白(ox-LDL),治疗期间不良反应发生率。结果研究过程中观察组脱落1例、对照组脱落3例,最终观察组纳入44例、对照组纳入42例。观察组临床疗效优于对照组(P<0.05)。治疗后,两组MoCA、MMSE量表评分分别高于本组治疗前,且观察组MoCA、MMSE量表评分高于对照组(P<0.05)。治疗后,对照组颈内动脉PSV快于治疗前,颈总动脉PI、RI小于治疗前(P<0.05);治疗后,观察组颈部血管斑块数量少于治疗前,CIMT及颈总动脉、颈内动脉PI、RI小于治疗前,颈总动脉、颈内动脉PSV、EDV、TAmax快于治疗前(P<0.05)。治疗后,观察组颈部血管斑块数量少于对照组,CIMT及颈总动脉、颈内动脉PI、RI小于对照组,颈内动脉直径大于对照组,颈内动脉PSV、TAmax及颈总动脉PSV、EDV、TAmax快于对照组(P<0.05)。治疗后,两组血清PON-1分别高于本组治疗前,ox-LDL分别低于本组治疗前,且观察组血清PON-1高于对照组,ox-LDL低于对照组(P<0.05)。两组不良反应发生率比较,差异无统计学意义(P>0.05)。结论通窍活血汤能够提高瘀血内阻型VCIND患者的临床疗效,改善患者认知功能,且安全性较高,其机制可能与通过升高PON-1、降低ox-LDL而减轻颈部血管粥样硬化程度有关。

Objective To explore the effect of Tongqiao Huoxue decoction on patients with vascular cognitive impairment no dementia(VCIND)with blood stasis and internal resistance.Methods A total of 90 patients with VCIND with blood stasis and internal resistance admitted to the Department of Neurology in Liuzhou Hospital of Traditional Chinese Medicine from September 2018 to September 2021 were selected and divided into control group(n=45)and observation group(n=45)using random number table method.The patients in control group were given basic treatment,while the patients in observation group were treated with Tongqiao Huoxue decoction based on syndrome differentiation on the basis of control group.Both groups were continuously treated for 12 weeks.The clinical effect,the cognitive function[Montreal Cognitive Assessment(MoCA)and Mini-Mental State Examination(MMSE)Scale scores],cervical vascular color Doppler ultrasound examination indexes[number of cervical vascular plaques,carotid intima-media thickness(CIMT),and diameter,peak velocity of the systolic wave(PSV),end diastolic velocity(EDV),time average peak velocity(TAmax),pulsatility index(PI),resistance index(RI)of common carotid artery and internal carotid artery],and serum paraoxophosphorase-1(PON-1)and oxidized low-density lipoprotein(ox-LDL)before and after treatment,and the incidence of adverse reactions during the treatment were compared between the two groups.Results During the research process,there was 1 case of dropout in the observation group and 3 cases of dropout in the control group.Finally,44 cases were included in the observation group and 42 cases were included in the control group.The clinical efficacy of the observation group was better than that of the control group(P<0.05).After treatment,the MoCA and MMSE Scale scores in the two groups were higher than those before treatment,respectively,and the MoCA and MMSE Scale scores in observation group were higher than those in control group(P<0.05).After treatment,the PSV of internal carotid artery in the control group was faster than that before treatment,the PI and RI of the common carotid artery were smaller than those before treatment(P<0.05);after treatment,the number of cervical vascular plaques in the observation group was less than that before treatment,the CIMT and PI and RI of the common carotid artery and internal carotid artery were smaller than those before treatment,the PSV,EDV,TAmax of the common carotid artery and internal carotid artery were faster than those before treatment(P<0.05).After treatment,the number of cervical vascular plaques in observation group was less than that in control group,the CIMT and PI and RI of the common carotid artery and internal carotid artery were smaller than those in control group,the diameter of the common carotid artery was greater than that in control group,PSV and TAmax of the common carotid artery and PSV,EDV and TAmax of internal carotid artery were faster than those in control group(P<0.05).After treatment,the serum PON-1 in the two groups was higher than that before treatment,and the serum ox-LDL was lower than that before treatment,respectively,and the serum PON-1 in observation group was higher than that in control group,and the serum ox-LDL was lower than that in control group(P<0.05).There was no significant difference in the incidence of adverse reactions between the two groups(P>0.05).Conclusion Tongqiao Huoxue decoction can improve the clinical effect of patients with VCIND with blood stasis and internal resistance,improve cognitive function,and with higher safety,its mechanism may related to it can reduce the degree of neck atherosclerosis through increasing PON-1 and reducing ox-LDL.