血管性认知损害中医证候特征及其与执行功能的关系

摘要

目的 探讨血管性认知损害患者的执行功能与中医证候的相关性.方法 选择患者139例,分为正常认知组(NC)(CDR = 0)31例(22.3%)、血管性认知损害(VCI-ND)组(CDR = 0.5)74例(53.2%)和血管性痴呆(VaD)组(CDR≥1)34例(24.5%),探讨患者的中医证候与执行功能的关系.结果 血管性认知损害的主要证候为肾精亏虚(60.8%)、痰浊蒙窍(52.9%)和瘀阻脑络(73.5%).VCI-ND组肾精亏虚积分(7.93±4.582)显著高于NC组(5.1±4.277,P<0.05),并显著低于VaD组(9.47±4.548 ,P<0.01);VCI-ND组痰浊蒙窍积分(3.65±3.89)显著低于VaD组(7.24±5.332,P<0.01),与NC组(2.26±3.076)比较无统计学意义(P>0.05);VCI-ND组瘀阻脑络积分(9.47±3.844)高于NC组(6.35±3.675,P<0.01),也显著高于VaD组(8.59±5.076, P<0.01);患者画钟试验(CDT)(2.83±1.384)和执行功能(MMSE)(4.04±1.237)得分均与痰浊蒙窍积分(4.78±4.679)负相关(P<0.05,P<0.01).结论 血管性认知损害的主要证候为肾精亏虚、痰浊蒙窍和瘀阻脑络,其中痰浊蒙窍与患者定向力、记忆力、注意力/ 计算力、语言功能关系密切,与执行功能的损害可能有关,故化痰开窍法可用于防治血管性认知损害.%Objective To investigate the correlation between executive function and TCM syndromes in patients with vascular cognitive impairment (VCI). Methods 139 patients were divided into normal cognitive group (NC) (CDR=0) (n=31, 22.3%), vascular cognitive impairment (VCI-ND) (CDR=0.5) (n = 74, 53.2%) and Vascular Dementia (VaD) group (CDR≥1) (n=34, 24.5%). Relationship between TCM syndromes and executive function in patients with VCI was explored. Results The main TCM syndromes of VCI were kidney essence deficiency (60.8%), phlegm-drowning (52.9%) and blood stasis (73.5%). The scores of kidney essence deficiency in VCI-ND group (7.93±4.582) in were significantly higher than those in NC group (5.1±4.277, P< 0.05) and significantly lower than that VaD group (9.47±4.548, P< 0.01). The scores of phlegm-drowning in the VCI-ND group (3.65±3.89) was significantly lower than that VaD group (7.24±5.332, P<0.01), and there was no significant difference between the control group and the NC group (2.26±3.076) (P> 0.05).The scores of blood stasis in the VCI-ND group(9.47±3.844) was significantly higher than that NC group (6.35±3.675, P<0.01), which was significantly higher than VaD group (8.59±5.076, P<0.05). The scores of Clock Drawing Test (CDT) in VCI group (2.83±1.384) and executive function (MMSE) (4.04±1.237) were negatively correlated with phlegm-blossom points (4.78±4.679) (r = -0.243, P<0.05; r = -0.338, P<0.01). Conclusion The main syndromes of VCI are kidney essence deficiency, phlegm- drowning and blood stasis. Phlegm-drowning is closely related to patient's orientation, memory, attention/computational power and language function, and may be the consequence of executive function impairment, so phlegm resuscitation method can be used to prevent vascular cognitive impairment