针刺联合丁基苯酞胶囊对血管性痴呆患者认知功能及MRI 成像的影响

摘要

目的:探讨针刺联合丁基苯酞软胶囊对血管性痴呆患者认知功能及头颅磁共振(MRI)成像的影响.方法:选择我院收治的血管性痴呆患者94例作为研究对象,随机分为丁基苯酞组(丁基苯酞软胶囊治疗)和联合治疗组(在丁基苯酞组基础上配合针刺心包经穴位治疗) ,各47例,两组均给予控制血压、血脂、抗感染等基础干预,连续治疗8周.观察两组患者的临床疗效及不良反应发生情况,采用简易精神状态检查量表(MMSE) 、临床痴呆量表(CDR )评定认知功能,测量头颅MRI相关指标并检测血浆生长抑素(SS) 、精氨酸加压素(AVP)水平.结果:治疗后,与丁基苯酞组比较,联合治疗组临床有效率(78.72% 比93.62%)显著提高( P＝ 0.036 ) ;MMSE评分[(19.18 ± 3.24 )分比(21.15 ± 4.11)分]显著增加,CDR评分[(1. 51 ± 0. 26)分比(1.37 ± 0. 28)分]显著降低( P均＜0.05) ;MRI指标中三脑室宽度[(1. 12 ± 0.13)cm比(1. 03 ± 0.19)cm]显著减小,前角指数[(3.08 ± 0. 96)比(3.54 ± 0.85)] 、侧脑室体部宽度指数[(3.19 ± 0.18)比(3.32 ± 0.21)]显著增加( P＜0. 05或＜0.01) ;血浆SS[(133.59 ± 10. 11) pg／ml比(139. 14 ± 10.56) pg／ml] 、AVP[(35.37 ± 9. 12) pg／ml比(40. 25 ± 8.08) pg／ml]水平均显著升高( P＜0.05或＜0.01) ;两组均未出现严重不良反应.结论:针刺联合丁基苯酞软胶囊治疗可显著改善血管性痴呆患者认知功能及血浆SS 、AVP水平,抑制脑室扩张,促进脑功能恢复,且安全性高.%Objective :To explore influence of acupuncture combined butylphthalide soft capsule on cognitive function and head MRI imaging in patients with vascular dementia (VD).Methods : A total of 94 VD patients treated in our hospital were randomly and equally divided into butylphthalide group (received butylphthalide soft capsules ) and combined treatment group (received acupuncture pericardial acupoint treatment based on butylphthalide group ) ,both groups received controls of blood pressure and blood lipids ,anti—infection intervention ,and continuously treated for eight weeks .Mini—mental state ex—amination (MMSE) and clinical dementia rating scale (CDR) were used to assess cognitive function ,related head MRI in—dexes ,plasma levels of somatostatin (SS) and arginine vasopressin (AVP ) were measured.Results : Compared with bu—tylphthalide group after treatment ,there was significant rise in total effective rate (78.72% vs.93.62%) , P＝0.036 ;sig—nificant rise in MMSE score [ (19.18 ± 3.24) scores vs.(21.15 ± 4.11) scores] and significant reduction in CDR score [ (1.51 ± 0.26) scores vs.(1.37 ± 0.28) scores] , P＜0.05 both ;MRI indexes :significant reduction in width of three brain ventricles [(1.12 ± 0.13) cm vs.(1.03 ± 0.19) cm] ,and significant rise in anterior angle index [ (3.08 ± 0.96) vs. (3.54 ± 0.85)] and lateral brain ventricle body width index [ (3.19 ± 0.18) vs.(3.32 ± 0.21)] ,P＜0.05 or ＜0.01 ;sig—nificant rise in plasma levels of SS [ (133.59 ± 10.11) pg／ml vs.(139.14 ± 10.56) pg／ml] and AVP [ (35.37 ± 9.12) pg／ml vs.(40.25 ± 8.08) pg／ml] in combined treatment group , P＜0.05 or ＜0.01. There were no severe adverse reactions in either group .Conclusion : Acupuncture combined butylphthalide soft capsule can significantly improve cognitive function , plasma SS and AVP levels ,inhibit brain ventricle dilation ,promote brain function recovery in patients with vascular de—mentia ,and safety is high .