多奈哌齐联合法舒地尔对血管性认知障碍患者的疗效及对血清TNF-α、hs-CRP及IL-6影响

发布时间：2018-03-09 20:38

本文选题：法舒地尔　切入点：血管性认知障碍　出处：《河北医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:认知障碍是一种常见的老年性疾病,而血管性认知障碍是指与脑血管疾病有关的认知障碍的综合征,其严重程度可由轻度的认知障碍发展为痴呆。探索新型的药物或治疗方法对于改善血管性认知障碍患者的生活质量,并有效控制老年痴呆发病率具有重大意义。本文旨在探讨盐酸多奈哌齐联合法舒地尔对血管性认知障碍患者的治疗效果及对血清中TNF-α、hs-CRP及IL-6水平的影响。方法:选取2016年1月~2016年12月在保定市第一中心医院老年病科住院的60例血管性认知障碍患者,采用随机数字表法随机将患者分为两组,即观察组和对照组,每组各30例;对照组即多奈哌齐组,患者口服盐酸多奈哌齐5 mg,每日一次;观察组为联合法舒地尔组,患者在口服盐酸多奈哌齐基础上加用盐酸法舒地尔30mg,每日一次,静脉滴注21天。利用MMSE以及ADAS-cog双量表的评分方法来比较两组患者的治疗效果;两组患者分别在治疗前、治疗后采取静脉血,检测血清TNF-α、IL-6及hs-CRP炎性细胞因子的变化,采用放射免疫分析法测定血清中TNF-α及IL-6水平;采用免疫比浊法测定血清中hs-CRP水平。结果:联合法舒地尔组和多奈哌齐组均能够不同程度地改善血管性认知障碍患者的认知功能:将两组患者治疗前后的MMSE、ADAS-cog评分进行比较,发现治疗后MMSE评分均较治疗前有所提高,而ADAS-cog评分均较治疗前有所降低,差异均具有统计学意义(P0.05);将两组患者治疗后的MMSE、ADAS-cog评分进行比较,联合法舒地尔组患者的MMSE评分明显高于多奈哌齐组患者,而ADAS-cog评分明显低于多奈哌齐组患者,差异均具有统计学意义(P0.05)。多奈哌齐组患者在时间定向能力和地点定向能力两个方面取得显著改善(P0.01),在记忆力和执行能力两个方面也取得一定改善(P0.05),而在语言能力和计算能力两个方面未取得有效改善;而联合法舒地尔组患者在时间定向能力、地点定向能力以及执行能力三个方面都取得显著改善(P0.01),在语言能力、记忆力和计算能力三个方面也取得一定改善(P0.05)。联合法舒地尔组患者在时间定向能力、地点定向能力、语言能力、计算能力以及执行能力五个方面取得的功能改善都要优于多奈哌齐组治疗的患者。与本组治疗前相比,两组患者体内血清中TNF-α、IL-6及hs-CRP等细胞炎症因子的水平均明显降低(P0.05);同时,治疗后联合法舒地尔组患者体内TNF-α、IL-6及hs-CRP的血清浓度较单用多奈哌齐组患者显著降低(P0.05)。结论:多奈哌齐联合法舒地尔与单用多奈哌齐相比较,能更好地改善血管性认知功能障碍患者的认知功能,并可显著降低血清炎性因子的水平,提示法舒地尔对血管性认知障碍有改善作用。本研究为临床治疗血管性认知功能障碍提供了药物选择。
[Abstract]:Objective: cognitive impairment is a common disease in the elderly, and vascular cognitive impairment is a syndrome refers to cognitive impairment associated with cerebral vascular disease, the severity of the development of mild cognitive impairment to dementia. To explore a new drug or treatment for patients with vascular cognitive impairment and quality of life. To effectively control the incidence of dementia is of great significance. This paper aims to explore the donepezil combined method of fasudil on vascular cognitive impairment in the treatment effect and the serum levels of TNF- alpha, effects of hs-CRP and IL-6 level. Methods: January 2016 ~2016 year in December 60 cases of vascular cognitive impairment in patients with geriatric inpatients in Baoding First Central Hospital. According to the random number table method were randomly divided into two groups, treatment group and control group, 30 cases in each group; the control group with oral donepezil hydrochloride group. In 5 mg, once a day; the observation group and fasudil group, in patients treated with donepezil hydrochloride combined with fasudil hydrochloride 30mg, once a day, intravenous drip for 21 days. The scoring method using MMSE and ADAS-cog double scale to compare the therapeutic effect of two groups of patients were in the group; two take the venous blood before treatment, after treatment, serum levels of TNF- alpha, IL-6 and hs-CRP changes of inflammatory cytokines, determination of TNF- alpha and IL-6 in serum by radioimmunoassay; the serum levels of hs-CRP in the immune turbidimetric method. Results: the combination of fasudil group and donepezil group were improved in different degree the cognitive function of patients with vascular cognitive impairment: two groups of patients before and after treatment were compared with MMSE, ADAS-cog scores, MMSE scores were found after treatment than before treatment increased, while the ADAS-cog score was significantly higher than before treatment Decreased, the differences were statistically significant (P0.05); the two groups after treatment were compared with MMSE, ADAS-cog score, and fasudil group of patients with MMSE was significantly higher than that of donepezil group, ADAS-cog score was lower than donepezil group, the differences were statistically significant (P0.05) has made significant improvements in two aspects. Time and place in the directional orientation ability of donepezil group (P0.01), two patients in the aspects of memory and executive ability have been improved (P0.05), and did not improve in two aspects of language and computing ability; and combined with fasudil group patients in time orientation ability, have achieved significant improvement in three aspects place orientation ability and executive ability (P0.01), in the three aspects of language ability, memory and computing ability have been improved (P0.05). Patients in group when combined with fasudil hydrochloride Between the orientation ability and place orientation ability, language ability is superior to the group of patients treated with donepezil has five aspects of computing ability and the ability to execute the function improved. Compared with the group before treatment, two groups of serum alpha TNF-, IL-6 and hs-CRP cell inflammatory factor levels were significantly reduced (P0.05) at the same time, after treatment; combined with fasudil group patients TNF- alpha, serum concentrations of IL-6 and hs-CRP compared with donepezil group were significantly decreased (P0.05). Conclusion: donepezil combined and fasudil with donepezil compared, can improve vascular cognitive dysfunction and cognitive function. Significantly decreased the level of serum inflammatory factor, suggesting that fasudil had effect on vascular cognitive impairment. This study provides a selection of drugs for clinical treatment of vascular cognitive impairment.

【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R749.13

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