丁苯酞对急性缺血性脑卒中患者认知功能影响的临床观察  

Improving effect of Dl-3-butylphthalide on cognitive impairment in patients with acute ischemic stroke

作　　者：张平[1] 朱斌[1] 闫海清[1] 贵永堃[1] 牛晓露[1] 李彤[1] 

机构地区：[1]新乡医学院第一附属医院神经内科,河南卫辉453100

出　　处：《中华脑科疾病与康复杂志（电子版）》2014年第3期16-20,共5页Chinese Journal of Brain Diseases and Rehabilitation（Electronic Edition）

基　　金：河南省卫生厅科技攻关项目(2011020094)

摘　　要：目的观察丁苯酞对急性缺血性卒中患者认知功能的影响。方法首次发病的急性缺血性脑卒中患者104例，均为新乡医学院第一附属医院神经内科2012年10月至2013年6月连续住院患者。随机分为对照组54例和治疗组50例，均予以标准化治疗，治疗组在此基础上加服丁苯酞软胶囊。认知功能评定采用北京版蒙特利尔认知评估（MoCA）量表和简明智力状态检查（MMSE）量表，高敏C反应蛋白（hs-CRP）、同型半胱氨酸（Hcy）浓度测定，分别在治疗前及治疗后1个月进行。运用统计软件进行t检验 χ2检验、秩和检验及Logistic回归分析。结果治疗后1个月，治疗组患者血清Hcy、hs-CRP浓度较对照组明显下降（t=5．4273、4．3459，P均〈0．05）。治疗后治疗组及对照组认知功能损害及血管性痴呆分别占88％、87％和64％、70．4％。治疗组总体认知功能显著改善，其中命名、记忆力、注意力和语言能力改善显著（z值分别为-2．75、-3．09、-2．63、-2．82，P均〈0．05）。血清Hey浓度是急性缺血性卒中后1个月痴呆的危险因素（OR值为3．563，95％C10．799～5．637）。结论丁苯酞可显著改善急性缺血性卒中患者认知功能，其机制可能与降低血清Hcy浓度有关。Objective To observe the influence of D1-3-butylphthalide on cognitive impairment in patients with acute ischemic stroke. Methods One hundred and four cases of acute ischemic stroke were randomly divided into treatment group（50 cases treated with D1-3-butylphthalide and routine therapy, totally 20 days）and control group （54 cases treated with routine therapy）. The cognitive state was evaluated by Chinese version of Montreal Cognitive Assessment and Mini-mental State Examination before and 1 month after treatment, and the serum levels of homocysteine （Hcy） and high-sensitive C-reactive protein （hs-CRP） were investigated 1 month before and after treatment, Results The serum levels of Hey and hs-CRP of the treatment group was lower than that of the control group after lmonth（t =5.427 3,4. 345 9,all P 〈0. 05）. After treatment,there was difference in the rates of vascular cognitive impairment with no de-mentia 88%, 87% and 64%, 70.4%. The global cognitive function, style, memory, attention and langnage ability significantly improved in the treatment group（z = - 2. 75, - 3.09, - 2. 63, - 2. 82, all P 〈 0. 05 ）. Multiple stepwise regression analysis showed the concentration of serum Hey was a risk factor of dementia 1months after ischemic stroke （ OR 3. 563,95% CI 0. 799-5. 637 ）. Conclusion Our research indicates that D1-3- butylphthalide can improve cognitive probably through down regulating of Hey expression of serum.

关 键 词：卒中 认知障碍 半胱氨酸 丁苯酞 

分 类 号：R743.3[医药卫生—神经病学与精神病学]