归脾汤合血府逐瘀汤加减治疗脑梗死后轻度认知障碍的临床疗效  

Clinical Study on Modified Guipitang Combined with Xuefu Zhuyutang in Treating Mild Cognitive Impairment After Cerebral Infarction

作　　者：李文颢 吴知凡[1] 王凯[1] 张亚亚 孙晓生[1] 邝秀英[2] LI Wen-hao;WU Zhi-fan;WANG Kai;ZHANG Ya-ya;SUN Xiao-sheng;KUANG Xiu-ying(Guangzhou University of Chinese Medicine,Guangzhou 510006,China;The First Affiliated Hospital of Guangzhou University of Chinese Medicine,Guangzhou 510405,China)

机构地区：[1]广州中医药大学,广州510006 [2]广州中医药大学第一附属医院,广州510405

出　　处：《中国实验方剂学杂志》2022年第2期147-153,共7页Chinese Journal of Experimental Traditional Medical Formulae

基　　金：国家重点研发计划项目(2018YFC1704706)。

摘　　要：目的:观察归脾汤合血府逐瘀汤加减治疗脑梗死后轻度认知障碍(MCI)心脾两虚,血瘀阻络证的临床疗效及抗炎、抗氧化损伤作用。方法:将114例符合要求患者随机分为对照组和观察组,各57例。对照组,口服红鹿参片,4片/次,2次/d;观察组,口服归脾汤合血府逐瘀汤加减,1剂/d,均连续治疗8周。比较治疗前后蒙特利尔认知评估量表(MoCA),Rivermead行为记忆测验(RBMT),日常生活活动能力(ADL),连线测验-B(TMT-B),神经精神症状问卷(NPI)和中医证候(心脾两虚,血瘀阻络证)评分;检测治疗前后8-羟基脱氧鸟苷(8-OHDG),丙二醛(MDA),氧化低密度脂蛋白(ox-LDL),超氧化物歧化酶(SOD),同型半胱氨酸(Hcy),白细胞介素-8(IL-8),C-反应蛋白(CRP)和纤维蛋白原(FIB)水平。结果:观察组认知功能疗效总有效率为92.98%(53/57),高于对照组的78.95%(45/57),差异有统计学意义(χ^(2)=4.653,P<0.05);观察组认知功能恢复正常率为54.39%(31/57),高于对照组的33.33%(19/57),差异有统计学意义(χ^(2)=5.130,P<0.05)。与对照组比较,观察组MoCA,RBMT和ADL评分均显著升高(P<0.01);TMT-B时间显著缩短(P<0.01);中医证候评分,NPI-1和NPI-2评分显著降低(P<0.01);观察组SOD水平显著升高(P<0.01),8-OHDG,ox-LDL,MDA,Hcy,IL-8,CRP和FIB水平显著降低(P<0.01)。结论:归脾汤合血府逐瘀汤加减治疗脑梗死后MCI心脾两虚,血瘀阻络证患者可显著改善认知功能,并具有抗炎和抗氧化损伤作用,临床疗效优于红鹿参片。Objective:To observe the clinical efficacy and anti-inflammatory and anti-oxidant effect of modified Guipitang combined with Xuefu Zhuyutang in the treatment of mild cognitive impairment(MCI)after cerebral infarction with syndromes of heart and spleen deficiency and blood stasis blocking collateral.Method:A total of 114 eligible patients were randomly divided into a control group and an observation group,with 57 cases in each group.Patients in the control group were given red deer ginseng tablets(po),4 tablets/time,2 times/day.Patients in the observation group were given modified Guipitang combined with Xuefu Zhuyutang(po,1 dose/day)for continuous 8 weeks.This study compared the scores of montreal cognitive assessment(MoCA)scale,Rivermead behavioral memory test(RBMT),activities of daily living(ADL),trail making test B(TMT-B),neuropsychiatric inventory questionnaire(NPI)and scores of traditional Chinese medcine(TCM)syndrome with syndromes of heart and spleen deficiency and blood stasis blocking collateral before and after treatment.Then we further detected the levels of 8-hydroxydeoxyguanosine(8-OHDG),malondialdehyde(MDA),oxidized low density lipoprotein(ox-LDL),superoxide dismutase(SOD),homocysteine(Hcy),interleukin-8(IL-8),C-reactive protein(CRP)and fibrinogen(FIB)levels before and after treatment.Result:The total effective rate for the treatment of cognitive function impairment in the observation group was 92.98%(53/57),which was higher than 78.95%(45/57)in the control group(χ^(2)=4.653,P<0.05).The recovery rate of cognitive function in the observation group was 54.39%(31/57),which was higher than 33.33%(19/57)in the control group(χ^(2)=5.130,P<0.05).The MoCA,RBMT and ADL scores of the observation group were higher than those of the control group(P<0.01),and the TMT-B time of the former was shorter than that of the latter(P<0.01).In addition,the observation group showed lower scores of TCM syndrome,NPI-1 and NPI-2 scores than the control group(P<0.01).The SOD level of the observation group was higher than tha

关 键 词：轻度认知障碍 脑梗死 心脾两虚 血瘀阻络证 归脾汤 血府逐瘀汤 炎症因子 氧化应激 

分 类 号：R22[医药卫生—中医基础理论] R242[医药卫生—中医学]