脑内微小病变不同干预模式的临床疗效比较  

Different Treatment Modes for Cerebral Microlesions: a Comparison of Clinical Efficacy

作　　者：曲红[1] 张玉倩[2,3] 周蔓蔓[1] 赵小英[4] 

机构地区：[1]上海市中西医结合医院内科,上海200082 [2]上海中医药大学研究生院,上海201203 [3]山东省滨州市中心医院神经内科,山东251700 [4]上海市虹口区凉城社区卫生服务中心内科,上海200434

出　　处：《中国中西医结合杂志》2013年第3期332-337,共6页Chinese Journal of Integrated Traditional and Western Medicine

基　　金：上海市卫生局中医药科研基金资助项目(No.2008L038A);上海市科学技术委员会中药现代化专项资助项目(No.10DZ1975300)

摘　　要：目的通过比较脑内微小病变的不同干预模式,尝试建立一种能有效控制脑内微小病变进展、预防脑梗死发病的诊疗模式。方法采用非随机对照研究方法,将408例存在多发的脑内微小病变者分为中药干预组(100例)、阿司匹林干预组(104例)、阴性对照组(100例)和非规范干预组(104例)。非规范干预组不予特定干预措施,其他3组均进行社区生活方式干预和血管性危险因子常规治疗;中药干预组加服桂枝茯苓丸加地龙粉剂,阿司匹林干预组加服阿司匹林。定期复查,比较各组脑内微小病变、血管性危险因子变化以及脑梗死发病率。结果中药干预组脑内微小病变总有效率为66.67%,明显高于阿司匹林干预组(52.32%)、阴性对照组(42.86%)和非规范干预组(37.04%);阿司匹林干预组明显高于非规范干预组,差异均有统计学意义(P<0.01,P<0.05)。治疗后,中药干预组LDL-C、TC和TG均明显低于阿司匹林干预组(P<0.05),LDL-C、TC明显低于阴性对照组(P<0.01),收缩压明显低于非规范干预组(P<0.05);阴性对照组收缩压和TC明显低于非规范干预组(P<0.05)。中药干预组脑梗死发病率为2.17%(2/92),明显低于阴性对照组(11.36%,10/88)和非规范干预组(14.44%,13/90),差异均有统计学意义(P<0.05),但与阿司匹林干预组(6.74%,6/89)比较,差异无统计学意义(P>0.05)。结论中药桂枝茯苓丸加地龙粉剂可以治疗脑内微小病变,控制血管性危险因素,并最终预防脑梗死发生。规范化的中药干预模式在治疗脑内微小病变预防脑梗死发病的几种模式中疗效最佳,或可在临床推广。Objective To tentatively establish a diagnosis and treatment mode for effectively controlling the progress of cerebral microlesions （CM） and preventing the incidence of cerebral infarction （CI） by comparing different intervention modes for treating CM. Methods Using a prospective, nonran- domized, controlled trial, 408 subjects with multiple CM were assigned to the Chinese medical pharmacy intervention group （Group A, 100 case）, the aspirin intervention group （Group B, 104 cases）, the nega- tive control group （Group C, 100 cases）, and the non-intervention group （Group D, 104 cases）. No in- tervention was given to those in Group D. Patients in the other 3 groups were intervened by life style and routine therapies of vasculogenic risk factors. Those in Group A took Guizhi Fuling Pill （GFP） and earth- worm powder additionally. Those in Group B took aspirin additionally. They were routinely followed-up. The CM, the changes of vasculogenic risk factors, and the incidence rate of CI were compared among the 4 groups, Results The total effective rate of CM was 66.67% in Group A, obviously higher than that of Group B （52.32%）, Group C （42.86%）, and Group D （37.04%）, respectively. It was obviously higher in Group B than in Group D, showing statistical difference （P 〈0.01, P 〈0.05）. After treatment, the ser-

关 键 词：脑内微小病变 脑梗死 桂枝茯苓丸 地龙 干预模式 

分 类 号：R743[医药卫生—神经病学与精神病学]