骨化三醇对脑白质疏松所致轻度认知功能障碍的疗效分析

Effect of Calcitriol on Mild Cognitive Impairment Correlation with Leukoaraiosis

目的探讨骨化三醇对脑白质疏松所致轻度认知功能障碍的疗效。方法脑白质疏松患者256例,根据轻度认知功能障碍诊断标准筛选出轻度认知功能障碍患者181例,随机分为对照组88例、干预组93例,干预组予骨化三醇0.25μg/d治疗,两组其它治疗原则及康复治疗方案相同;对两组病例进行为期12个月的对照干预治疗,并分别在入组前、入组后6个月及12个月进行蒙特利尔认知评估量表评分随访;比较分析两组患者治疗前后认知功能变化情况。结果 (1)256例脑白质疏松患者有181例诊断为轻度认知功能障碍(70.70%);随机分为对照组、干预组后随访12个月;最终纳入统计的共173例,其中对照组85例,干预组88例;所有在研患者未出现严重不良反应。(2)两组在延迟记忆项得分最低,抽象功能项、视空间与执行功能项降低较显著;蒙特利尔认知评估量表总分干预组6个月时改善不明显(19.23±2.42),12个月时由干预前的18.84±2.08增加至22.32±2.36(P<0.01),此时干预组与对照组比较差异有统计学意义(P<0.01);语言项评分干预组6个月时达2.37±0.86,与干预前(1.84±0.73)比较差异有统计学意义(P<0.01),12个月时达2.52±0.86,与干预前比较差异有统计学意义(P<0.01),且6个月时、12个月时与对照组比较亦有显著性差异;延迟记忆项干预组6个月时无明显改善(1.35±1.37),但12个月时评分从干预前的1.30±1.41显著增加至2.77±1.84(P<0.01),且干预后12个月与6个月比较差异有统计学意义(P<0.01),治疗后12个月干预组与对照组比较差异有统计学意义(1.41±1.46比2.77±1.84,P<0.01);两组各时间点抽象功能项、视空间与执行功能项评分变化不明显(P>0.05)。结论骨化三醇对脑白质疏松相关性轻度认知功能障碍患者认知功能有较好的改善作用,但起效较慢;功能改善较快的是语言能力;延迟记忆功能的恢复需要较长的治疗周期;而对抽象功能、视空间与执行功能的作用存在一定局限性。

Aim To study the effect of calcitriol for leukoaraiosis( LA) patients with mild cognitive impairment( MCI). Methods 256 patients with LA,181 patients with MCI were selected according to the diagnosis of MCI,and divided into two groups: control group( 85 cases),intervention group( 88 cases). Calcitriol 0. 25 μg / day was used in intervention group,other treatments and rehabilitation treatment were the same in two groups. Observation period to two groups was 12 months. And cognitive function was test by montreal cognitive assessment( Mo CA) score before include and6 months and 12 months before and after treatment. The changes of cognitive function were comparatively analysed before and after treatment between the two groups. Results( 1) 181 cases were diagnosed as MCI( 70. 70%) in 256 patients with LA,which were randomly divided into control group and intervention group,and got follow-up of 12 months; 173 cases were into the statistics eventually,85 cases in control group,88 cases in intervention group; All the patients into research had not appeared severe adverse reactions.( 2) The delayed memory score was the lowest in two groups,and abstract feature,visual space and executive function were reduced significantly. Mo CA score improvement was not obvious in intervention group at 6th month( 19. 23 ± 2. 42),but the score increased from 18. 84 ± 2. 08 before treatment to 22. 32 ± 2. 36 at 12 th month( P < 0. 01),when the scores between two groups were different significantly( P < 0. 01). The score of language increased in intervention group at 6th month,12 th month( 2. 37 ± 0. 86,2. 52 ± 0. 86),compared with that of before intervention( 1. 84 ± 0. 73,P < 0. 01). And at the two points,the language scores in intervention group were also different significantly compared with control group. For delayed memory,there were no obvious improvement in intervention group at 6th month( 1. 35 + 1. 37),but the score increased at 12 th month( 2. 77 ± 1. 84) compared with that before intervention( 1. 30 ±1. 41,P < 0. 01). At 12 th month the delayed memory scores were significantly different between two groups( 1. 41 ± 1. 46 vs 2. 77 ± 1. 84,P < 0. 01). The abstract function,visual space and executive function score in two groups had no significant change at each time point( P > 0. 05). Conclusions The calcitriol was effective on MCI correlation with LA,but the work was slow. The language ability improved faster,and delay memory function needed a long treatment cycle. It had a certain limitation for calcitriol to improve the abstract function,visual space and executive function.