补肾填精方联合甘露特钠及早期认知康复训练治疗轻中度肾精亏虚型阿尔茨海默病患者的临床研究

Clinical Study of Bushen Tianjing Recipe Combined with Sodium Oligomannate and Early Cognitive Rehabilitation Training on Patients with Mild to Moderate Alzheimer's Disease of Kidney Essence Deficiency

目的:探讨补肾填精方联合甘露特钠及早期认知康复训练对轻中度肾精亏虚型阿尔茨海默病(AD)患者认知功能及血清脑源性神经营养因子(BDNF)、可溶性低密度脂蛋白受体相关蛋白1(sLRP-1)水平的影响。方法:选取2023年1~12月期间于某院治疗的50例轻中度肾精亏虚型AD患者作为研究对象,采用随机数字表法分为对照组和观察组,每组25例,因研究过程中两组各脱落1例,最终均纳入24例患者。两组患者均给予早期认知康复训练(包括记忆力、智力和右脑训练),对照组患者给予甘露特钠胶囊治疗,观察组患者在对照组治疗基础上加用补肾填精方。比较两组患者认知功能[简易精神状态检查量表(MMSE)评分]、中医证候评分、自理能力[日常生活能力量表(ADL)评分]、磁共振波谱检查[右侧和左侧额叶N-乙酰天门冬氨酸/肌酸(NAA/Cr)、胆碱复合物/肌酸(Cho/Cr)]、血清指标(BDNF、sLRP-1、Tau蛋白)、临床疗效及不良反应发生情况。结果:治疗后,两组患者MMSE评分、ADL评分均升高,且观察组高于对照组(P<0.05);中医证候评分均降低,且观察组低于对照组(P<0.05);右侧和左侧额叶NAA/Cr均升高,且观察组高于对照组(P<0.05);两组患者治疗前后右侧和左侧额叶Cho/Cr比较均无统计学差异(P>0.05)。两组患者BDNF、sLRP-1水平均升高,且观察组高于对照组(P<0.05);Tau蛋白水平均降低,且观察组低于对照组(P<0.05)。观察组患者治疗总有效率(95.83%)高于对照组(75.00%,P<0.05)。用药期间,两组患者不良反应总发生率比较无统计学差异(P>0.05)。结论:补肾填精方联合甘露特钠及早期认知康复训练可显著提高轻中度肾精亏虚型AD患者的临床疗效,改善患者认知功能,提高自理能力,促进神经细胞修复,且未增加不良反应的发生风险。

Objective:To investigate the effects of Bushen Tianjing recipe combined with sodium oligomannate and early cognitive rehabilitation training on cognitive function and serum levels of brain-derived neurotrophic factor(BDNF)and soluble low density lipoprotein receptor related protein 1(sLRP-1)in patients with mild to moderate Alzheimer's disease(AD)of kidney essence deficiency syndrome.Methods:A total of 50 patients with mild to moderate AD of kidney essence deficiency syndrome treated in a hospital from January to December 2023 were selected and assigned to the control group and observation group by random number table method,with 25 patients in each group.Due to the loss of 1 patient in each group during the study,24 patients were eventually included.Both groups were given early cognitive rehabilitation training(including memory,intelligence and right brain training).The control group was treated with sodium oligomannate capsules,while the observation group was treated with Bushen Tianjing recipe in addition to the treatment given in the control group.The cognitive function[mini-mental state examination(MMSE)scale],traditional Chinese medicine(TCM)syndrome score,self-care ability[activity of daily living scale(ADL)score],magnetic resonance spectroscopy[N-acetyl-aspartate/creatine(NAA/Cr)and choline compound/creatine(Cho/Cr)in right and left frontal lobes],serum indicators(BDNF,sLRP-1 and Tau protein),clinical efficacy and occurrence of adverse reactions were compared between the two groups.Results:After treatment,the MMSE score and ADL score were increased in both groups,with the observation group showing higher scores than the control group(P<0.05).The TCM syndrome scores was decreased in both groups,with the observation group showing lower scores than the control group(P<0.05).The NAA/Cr levels in right and left frontal lobes were increased in both groups,with the observation group showing higher levels than the control group(P<0.05).There was no statistically significant difference in Cho/Cr levels of right and left frontal lobes between the two groups before and after treatment(P>0.05).BDNF and sLRP-1 levels were increased in both groups,with the observation group showing higher levels than the control group(P<0.05).The Tau protein levels was decreased in both groups,with the observation group showing lower levels than the control group(P<0.05).The total response rate in the observation group(95.83%)was higher than that in the control group(75.00%,P<0.05).During the medication period,there was no statistically significant difference was observed in the total incidence of adverse reactions between the two groups(P>0.05).Conclusion:Bushen Tianjing recipe combined with sodium oligomannate and early cognitive rehabilitation training in the treatment of patients with mild to moderate AD of kidney essence deficiency syndrome can significantly improve clinical efficacy,improve the cognitive function,enhance self-care ability,and promote nerve cell repair,without increasing the risk of adverse reactions.