左氨氯地平对血管性认知障碍的影响及机制探讨

发布时间：2018-06-26 06:36

本文选题：左氨氯地平 + 血管性认知障碍　；参考：《山西医科大学》2014年硕士论文

【摘要】：目的：研究左氨氯地平对血管性认知障碍患者认知功能的影响。通过测量血管内皮功能相关指标血浆内皮素及血管内皮生长因子水平的变化，探讨左氨氯地平对认知功能影响的可能途径。方法：选取2011年9月~2013年12月就诊我院神经内科的合并有高血压病的血管性认知障碍患者95例。将95例研究对象根据入选时间分为A组（47人）和B组（48人），A组给予口服左氨氯地平，B组给予口服非钙离子阻滞剂类降血压药物。控制血压在140-110/90-60mmHg范围。用药时间6个月。通过自制调查表记录研究对象的年龄、性别、受教育年限、收缩压、舒张压、服用其他改善认知功能药物等一般资料。使用简易智能状态量表（mini-Mental State Examination，MMSE）对所有研究对象治疗前后的认知功能状态评分。收集所有患者治疗前后早晨7时空腹肘静脉血。采用酶联免疫法测定所有静脉血的血浆内皮素（plasma endothelin，ET)和血管内皮生长因子（vascular endothelial growthfactor,VEGF)水平。对收集和测定的数据建立数据库，并进行统计学分析。结果：（1）两组在年龄、性别、受教育年限、收缩压、舒张压、服用其他改善认知功能药物等一般资料方面均无统计学差异。（2）经pearson相关分析发现治疗前MMSE评分与ET成明显负相关（r=-0.454,P0.01)；与VEGF成明显正相关（r=0.418,P0.01)。（3）治疗前，MMSE评分A组为21.9±2.8、B组21.3±2.4；ET值A组为96.1±9.1pg/ml、B组93.2±9.2pg/ml；VEGF值A组为194.3±5.3pg/ml、B组196.2±4.9pg/ml，，A组和B组比较三项均无统计学差异（P0.05）。A组治疗前MMSE评分与治疗后比较差异无统计学意义（P0.05），B组有统计学差异(P0.05)。A组治疗前ET值、VEGF值与治疗后比较差异均有统计学意义（P0.05)，B组无统计学差异(P0.05)。（4）两组MMSE评分治疗前后差值比较差异有统计学意义（P0.05)，两组ET值、VEGF值治疗前后差值比较差异均有统计学意义（P0.05)。（5）根据入选时的MMSE评分值将A组进一步分为≥24分组和24分组，≥24分组患者治疗后MMSE评分较治疗前提高且有统计学差异(P0.05)；24分组治疗前后MMSE评分比较差异无统计学意义（P0.05)。两个亚组的MMSE差值、ET值差值比较差异有统计学意义(P0.05)。两个亚组的VEGF差值比较差异无统计学意义(P0.05)。结论：左氨氯地平较非钙离子拮抗剂有利于延缓血管性认知功能障碍的进展。左氨氯地平对轻度血管性认知障碍的保护作用较重度血管性认知障碍明显。左氨氯地平对血管性认知障碍认知功能的影响可能通过降低血浆内皮素（ET)、增高血管内皮生长因子（VEGF),改善血管内皮功能发挥作用。
[Abstract]:Objective : To study the effects of left amlodipine on cognitive function in patients with vascular cognitive impairment .

Methods : 95 patients with vascular cognitive impairment admitted to our hospital from September 2011 to December 2013 were selected . 95 patients were divided into group A ( 47 ) and group B ( 48 ) according to the time of enrollment . The control blood pressure was 140 - 110 / 90 - 60mmHg . The control blood pressure was 140 - 110 / 90 - 60mmHg . The blood pressure was measured in the range of 140 - 110 / 90 - 60mmHg . The levels of plasma endothelin ( ET ) and vascular endothelial growth factor ( VEGF ) were measured by enzyme - linked immunosorbent assay ( ELISA ) .

Results : ( 1 ) There was no statistical difference between the two groups ( r = - 0.454 , P0.01 ) .
There was positive correlation with VEGF ( r = 0.418 , P0.01 ) . ( 3 ) MMSE score in group A was 21 . 9 卤 2.8 and group B was 21.3 卤 2.4 before treatment .
ET value A was 96.1 卤 9.1 pg / ml and group B was 93.2 卤 9.2 pg / ml ;
There was no significant difference between the two groups ( P0.05 ) . There was no significant difference between the two groups ( P0.05 ) .
There was no significant difference in MMSE score between the two subgroups ( P0.05 ) . There was no significant difference between the two subgroups ( P0.05 ) .

Conclusion : Levamlodipine is helpful to delay the progression of vascular cognitive impairment . The effect of left amlodipine on the cognitive function of vascular cognitive impairment is obvious . The effect of left amlodipine on the cognitive function of vascular cognitive impairment may play a role in reducing plasma endothelin ( ET ) , increasing vascular endothelial growth factor ( VEGF ) , and improving vascular endothelial function .
【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R749.13

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