天麻健脑颗粒联合高压氧对血管性痴呆患者炎症因子、MMP-9、Hcy和SOD表达的影响研究

Effects of Tianma Jiannao Granules Combined with Hyperbaric Oxygen on Expressions of Inflammatory Factors,Matrix Metalloproteinase 9,Homocysteine and Superoxide Dismutase in Patients with Vascular Dementia

【目的】探讨天麻健脑颗粒(由半夏白术天麻汤衍化)与高压氧联合治疗对血管性痴呆(vascular dementia,VD)患者认知功能、日常生活能力及血清炎症因子、基质金属蛋白酶9(MMP-9)、同型半胱氨酸(Hcy)和超氧化物歧化酶(SOD)表达的影响。【方法】将100例风痰瘀阻型VD患者随机分为试验组和对照组,每组各50例。2组患者均给予控制血压、降糖、调脂等对症治疗,对照组同时给予奥拉西坦胶囊口服治疗,观察组在对照组的基础上给予天麻健脑颗粒联合高压氧治疗,疗程为12周。观察2组患者治疗前后中医证候积分、简易精神状态量表(MMSE)评分、日常生活能力评定量表(ADL)评分和血清炎症因子、神经因子、凋亡因子及MMP-9、Hcy、SOD表达水平的变化情况。【结果】(1)量表评分方面,治疗后,2组患者的中医证候积分和ADL评分均较治疗前明显降低(P<0.05),MMSE评分均较治疗前明显升高(P<0.05),且试验组对中医证候积分和ADL评分的降低幅度及对MMSE评分的升高幅度均明显优于对照组(P<0.01)。(2)炎症因子方面,治疗后,2组患者的血清肿瘤坏死因子α(TNF-α)、C反应蛋白(CRP)、白细胞介素6(IL-6)水平均较治疗前明显降低(P<0.05),且试验组对血清TNF-α、CRP、IL-6水平的降低幅度均明显优于对照组(P<0.01)。(3)神经因子方面,治疗后,2组患者的血清去甲肾上腺素(NE)、多巴胺(DA)、5-羟色胺(5-HT)水平均较治疗前明显升高(P<0.05),且试验组对血清NE、DA、5-HT水平的升高幅度均明显优于对照组(P<0.01)。(4)凋亡因子方面,治疗后,2组患者的血清血红素加氧酶1(HO-1)水平均较治疗前明显升高(P<0.05),血清可溶性凋亡相关因子(sFAS)及其配体(sFASL)水平均较治疗前明显降低(P<0.05),且试验组对血清HO-1水平的升高幅度及对血清sFAS、sFASL水平的降低幅度均明显优于对照组(P<0.01)。(5)MMP-9、Hcy、SOD表达水平方面,治疗后,2组患者的血清SOD水平均较治疗前明显升高(P<0.05),血清MMP-9、Hcy水平均较治疗前明显降低(P<0.05),且试验组对血清SOD水平的升高幅度及对血清MMP-9、Hcy水平的降低幅度均明显优于对照组(P<0.01)。【结论】天麻健脑颗粒联合高压氧能够改善VD患者的认知功能与生活能力,并具有良好的抗炎、抗氧化、调节神经递质表达的作用。

Objective To investigate the effects of Tianma Jiannao Granules(derived from Banxia Baizhu Tianma Decoction)combined with hyperbaric oxygen on cognitive function,activities of daily living(ADL),and the expression levels of serum inflammatory factors,matrix metalloproteinase 9(MMP-9),homocysteine(Hcy)and superoxide dismutase(SOD)in patients with vascular dementia(VD).Methods A total of 100 VD patients with wind-phlegm and stasis obstruction type were randomly divided into a trial group and a control group,50 cases in each group.The patients in the two groups were given symptomatic treatment such as controlling blood pressure,lowering blood glucose and regulating blood lipid.Additionally,the control group was given Oxiracetam Capsules orally,and the trial group was given Tianma Jiannao Granules orally combined with hyperbaric oxygen therapy on the basis of treatment for the control group.The course of treatment covered 12 weeks.The changes of traditional Chinese medicine(TCM)syndrome scores,Mini-Mental State Examination(MMSE)scores,ADL scores,and the expression levels of serum inflammatory factors,neurotransmitters,apoptosis-related factors,MMP-9,Hcy and SOD in the two groups were observed before and after treatment.Results(1)The scale scoring showed that after treatment,the TCM syndrome scores and ADL scores of the two groups were significantly decreased compared with those before treatment(P<0.05),and the MMSE scores were significantly increased compared with those before treatment(P<0.05).The decrease of TCM syndrome scores and ADL scores and the increase of MMSE scores in the trial group were significantly superior to those in the control group(P<0.01)(.2)After treatment,the serum levels of inflammatory factors such as tumor necrosis factorα(TNF-α),C-reactive protein(CRP)and interleukin 6(IL-6)in the two groups were significantly decreased compared with those before treatment(P<0.05),and the decrease of serum TNF-α,CRP and IL-6 levels in the trial group was significantly superior to that in the control group(P<0.01).(3)After treatment,the serum levels of neurotransmitters such as norepinephrine(NE),dopamine(DA)and 5-hydroxytryptamine(5-HT)in the two groups were significantly increased compared with those before treatment(P<0.05),and the increase of serum NE,DA and 5-HT levels in the trial group was significantly superior to that in the control group(P<0.01).(4)After treatment,the serum level of apoptosis-related factor of heme oxygenase-1(HO-1)in the two groups was significantly increased compared with that before treatment(P<0.05),and the levels of serum soluble apoptosis-related factors(sFAS)and their ligands(sFASL)were significantly decreased compared with those before treatment(P<0.05).The increase of serum HO-1 level and the decrease of serum sFAS and sFASL levels in the trial group were significantly superior to those in the control group(P<0.01).(5)After treatment,the serum SOD level in the two groups was significantly increased compared with that before treatment(P<0.05),and the levels of serum MMP-9 and Hcy were significantly decreased compared with those before treatment(P<0.05).The increase of serum SOD level and the decrease of serum MMP-9 and Hcy levels in the trial group were significantly superior to those in the control group(P<0.01).Conclusion Tianma Jiannao Granules combined with hyperbaric oxygen is effective on improving the cognitive function and ADL of VD patients,and has certain effects on counteracting inflammatory response and oxidation and on regulating the expression of neurotransmitters.