地黄益智方治疗卒中后认知障碍非痴呆肾精亏虚证的临床研究  

Clinical study on the treatment of post-stroke cognitive impairment non-dementia in kidney essence deficiency patients with Dihuang Yizhi formula

作　　者：孙羿帼 顾超[1] 马静毅 王春旭 余阳洋[1] 高晨[1] SUN Yiguo;GU Chao;MA Jingyi;WANG Chunxu;YU Yangyang;GAO Chen(Longhua Hospital,Shanghai University of Traditional Chinese Medicine,Shanghai 200032,China)

机构地区：[1]上海中医药大学附属龙华医院,上海200032

出　　处：《北京中医药大学学报》2022年第7期663-669,共7页Journal of Beijing University of Traditional Chinese Medicine

基　　金：上海市科学技术委员会医学引导项目(No.16401931400);上海市人才发展资金资助项目(No.2021065);上海市“医苑新星”青年医学人才培养资助计划项目(沪卫人事[2020]087号);上海中医药大学附属龙华医院爱建基金项目(No.AJ063)。

摘　　要：目的 观察地黄益智方对卒中后认知障碍非痴呆(PSCIND)肾精亏虚证患者的临床疗效。方法 选取2019年7月—2021年1月就诊于上海中医药大学附属龙华医院记忆障碍专病门诊、神经内科普通门诊以及住院的PSCIND肾精亏虚证患者,共116例,按照随机数字表法分为试验组和对照组,各58例。其中试验组服用地黄益智方,对照组服用吡拉西坦片,共治疗6个月。观察2组患者治疗前、治疗3个月后、治疗6个月后简易精神状态检查量表(MMSE)评分、蒙特利尔认知评估量表(MoCA)评分、照顾者负担量表(ZBI)评分和日常生活能力评定量表(ADL)评分以及中医证候积分量表评分的变化情况。结果 治疗期间试验组脱落5例、对照组脱落4例,最终试验组53例、对照组54例完成本研究。与治疗前比较,治疗6个月后2组患者均有MMSE、MoCA评分的升高(P<0.05),评分升高与时间有关(P<0.01)。治疗3个月后试验组患者ZBI评分即有降低(P<0.01),治疗6个月后仍仅有试验组患者的ZBI评分下降(P<0.01),ZBI评分的下降与时间及分组和时间交互作用有关(P<0.01)。在MoCA亚项统计中,治疗6个月后,命名(P<0.05)、注意力与计算力(P<0.01)、语言和抽象(P<0.01)方面评分的升高与时间有关,延迟回忆评分的升高与分组和时间的交互作用相关(P<0.01)。与治疗前比较,治疗6个月后试验组患者ADL评分下降(P<0.01),ADL评分的下降与时间(P<0.01)及分组和时间交互作用(P<0.05)相关。与治疗前比较,治疗3个月后试验组患者的中医证候积分即有降低(P<0.01),治疗6个月后2组患者的中医证候积分均有降低(P<0.01),中医证候积分的下降与时间及分组和时间交互作用相关(P<0.01)。2组患者治疗前后各项安全性指标均正常。结论 “补肾填精”理论指导下的地黄益智方可以改善PSCIND患者认知功能,提高患者生活质量,减轻照料者负担,较对照组有一定的优势。Objective We aimed to observe the efficacy of Dihuang Yizhi formula in post-stroke cognitive impairment non-dementia(PSCIND) in kidney essence deficiency patients.Methods A total of 116 patients with PSCIND admitted to Longhua hospital between July 2019 and January 2021 were randomized into the experimental group(n=58) and the control group(n=58).In the experimental group, Dihuang Yizhi formula was used;in the control group, piracetam tablets were used for a course of 6 months.All patients were assessed with the Mini-Mental State Examination(MMSE), the Montreal Cognitive Assessment(MoCA) scale, the Zarit Burden Inventory(ZBI), the Ability to perform Daily Living(ADL) scale, and the traditional Chinese medicine(TCM) syndrome score before, at 3 months, and at 6 months of treatment.Results During the treatment, five cases fell off in the experimental group and four cases in the control group. Finally, 53 cases in the experimental group and 54 cases in the control group completed this study. Compared with before treatment, patients in both groups had elevated MMSE and MoCA scores after 6 months of treatment(P<0.05), with the increase in MMSE and MoCA scores being correlated with time(P<0.01).The ZBI scores of the patients in the experimental group decreased after 3 months of treatment(P<0.01), and after 6 months of treatment, only the ZBI scores of the patients in the experimental group decreased(P<0.01).The decrease in ZBI was associated with time and group × time interactions(P<0.01).In the MoCA sub-items, after 6 months of treatment, increases in scores of naming(P<0.05), memory and calculation(P<0.01), and language and abstraction(P<0.01) were related to time, whereas increases in scores of delayed recall were related to group × time interactions(P<0.01).After 6 months of treatment, ADL scores decreased in the experimental group(P<0.01), and the decrease in ADL scores was associated with time(P<0.01) and group × time interactions(P<0.05).After 3 months of treatment, the TCM syndrome scores of patients in the e

关 键 词：补肾填精 地黄益智方 卒中后认知障碍非痴呆 卒中后认知障碍 广义估计方程 

分 类 号：R285.6[医药卫生—中药学]