加味星蒌承气汤联合丁苯酞治疗脑梗死后认知障碍的效果及对血清脑肠肽因子与同型半胱氨酸和β-淀粉样蛋白1-42水平的影响

The effect of modified Xinglou Chengqi decoction combined with butylphthalide in the treatment of cognitive impairment after cerebral infarction and its influence on serum brain-gut peptide factor, homocysteine and β-amyloid protein 1-42 levels

目的探讨加味星蒌承气汤联合丁苯酞治疗脑梗死后认知障碍的效果及对血清脑肠肽因子与同型半胱氨酸(Hcy)、β-淀粉样蛋白1-42(Aβ1-42)水平的影响。方法选取2019年1月至2023年11月河北省保定市第二医院收治的120例脑梗死后认知障碍患者,按照随机数字表法分为联合组、承气汤组、丁苯酞组,每组40例。3组均给予常规西医治疗,包括营养脑神经、抗血小板聚集、改善循环等。丁苯酞组采用丁苯酞治疗。承气汤组采用加味星蒌承气汤治疗。联合组采用加味星蒌承气汤和丁苯酞治疗,3组均治疗4周。比较3组患者中医疗效、西医疗效、神经功能、认知功能、日常生活能力、脑肠肽因子、Hcy、Aβ1-42、不良反应发生率。结果联合组中西医治疗总有效率均高于丁苯酞组和承气汤组,且承气汤组中医治疗总有效率高于丁苯酞组,差异均有统计学意义(均P<0.05)。治疗后,联合组神经功能评分低于承气汤组和丁苯酞组,蒙特利尔认知评估量表评分、日常生活能力评分均高于承气汤组和丁苯酞组,差异均有统计学意义(均P<0.05)。治疗后,联合组CGRP、5-羟色胺、胃动素均高于承气汤组和丁苯酞组,差异均有统计学意义(均P<0.05)。治疗后,联合组Hcy低于承气汤组和丁苯酞组,Aβ1-42高于承气汤组和丁苯酞组(均P<0.05)。联合组与承气汤组、丁苯酞组不良反应总发生率比较差异无统计学意义[5.0%(2/40)比2.5%(1/40)、5.0%(2/40)](χ^(2)=0.417,P=0.812)。结论加味星蒌承气汤联合丁苯酞治疗脑梗死后认知障碍效果显著,能调节脑肠肽因子表达,改善神经功能和认知功能,提高患者日常生活能力,且有较高安全性。

Objective To investigate the effect of modified Xinglou Chengqi decoction combined with butylphthalide in the treatment of cognitive impairment after cerebral infarction and its influence on serum brain-gut peptide factor,homocysteine(Hcy)andβ-amyloid protein 1-42(Aβ1-42).Methods A total of 120 patients with cognitive impairment after cerebral infarction admitted to the No.2 Hospital of Baoding,Hebei Province from January 2019 to November 2023 were selected.They were divided into combined group,Chengqi decoction group and butylphthalide group according to the random number table method,with 40 cases in each group.All the three groups were given conventional western medicine treatment,including cranial nerve nutrition,anti-platelet aggregation,and improving circulation.Butylphthalide group was treated with butylphthalide.The Chengqi decoction group was treated with modified Xinglou Chengqi decoction.The combined group was treated with modified Xinglou Chengqi decoction and butylphthalide,and the three groups were treated for 4 weeks.The efficacy of traditional Chinese medicine,western medicine,neurological function,cognitive function,daily living ability,brain-gut peptide factor,Hcy,Aβ1-42,and the incidence of adverse reactions were compared among the three groups.Results The total effective rate of traditional Chinese and western medicine treatment in the combined group were higher than those in the butylphthalide group and the Chengqi decoction group,and the total effective rate of traditional Chinese medicine treatment in the Chengqi decoction group was higher than that in the butylphthalide group(all P<0.05).After treatment,the neurological function score of the combined group was lower than those of the Chengqi decoction group and the butylphthalide group,and the Montreal cognitive Assessment scale score and daily living ability score were higher than those of the Chengqi decoction group and the butylphthalide group(all P<0.05).After treatment,the levels of CGRP,5-hydroxytryptamine and motilin in combined group were higher than those in Chengqi decoction group and butylphthalide group(all P<0.05).After treatment,Hcy in the combined group was lower than that in the Chengqi decoction group and butylphthalide group,and Aβ1-42 was higher than that in the Chengqi decoction group and butylphthalide group(all P<0.05).There was no significant difference in the total incidence of adverse reactions among the combined group,Chengqi decoction group and butylphthalide group[5.0%(2/40)vs 2.5%(1/40),5.0%(2/40)](χ^(2)=0.417,P=0.812).Conclusion Modified Xinglou Chengqi decoction combined with butylphthalide is effective in the treatment of cognitive impairment after cerebral infarction,which can regulate the expression of brain-gut peptide factors,improve neurological function and cognitive function,and improve the ability of daily living of patients,with high safety.