加减薯蓣丸治疗血管性痴呆的磁共振波谱研究
发布时间：2018-07-13 14:48
【摘要】：目的:血管性痴呆是临床实践中面临的一种常见痴呆类型,越来越受到重视。但目前尚缺乏有效的治疗手段,中医药治疗本病具有优势。本研究拟通过磁共振波谱(MRS)检查的方法,尝试探讨加减薯蓣丸治疗轻中度血管性痴呆的有效性及其作用机制。方法:本研究纳入湖北省中医院2015年12月至2016年12月门诊及住院符合标准的受试者共80人,其中血管性痴呆患者60人(肾精亏虚证、痰浊阻窍证、瘀血阻络证各20人),正常组20人。80名受试者干预前均予以神经精神评估、中医症候评估、肝肾功能、心电图等安全性检查和颅脑双侧丘脑、额叶MRS检查(选择多体素,点分辨自旋回波序列)。60例血管性痴呆患者在针对基础疾病进行治疗的同时,予以加减薯蓣丸(由湖北省中医院制剂科制成合剂),每次15ml,每日两次,口服,疗程12周。观察:1.血管性痴呆患者治疗前颅脑MRS与正常组的差异;2.治疗前后血管性痴呆患者简易精神状态量表(MMSE)、血管性痴呆中医辨证量表(SDSVD)、颅脑MRS的变化及不良反应情况。结果:1.在受试者随访过程中,肾精亏虚证患者脱落2例(漏服药物1例,检查不配合1例),痰浊阻窍证患者脱落3例(检查不配合2例,罹患其他疾病1例),瘀血阻络证患者脱落3例(漏服药物1例,检查不配合2例)。2.与正常组相比较,在右侧额叶,三组Va D患者Cho/Cr值较正常组有不同程度的上升(肾精亏虚P=0.000,痰浊阻窍P=0.000,瘀血阻络P=0.001),NAA/Cr值较正常组有不同程度的下降(肾精亏虚P=0.000,痰浊阻窍P=0.000,瘀血阻络P=0.002),且均有统计学差异。在左侧额叶,也可观察到和右侧额叶类似的情况。Va D患者Cho/Cr值较正常组有不同程度的上升(肾精亏虚P=0.001,痰浊阻窍P=0.000,瘀血阻络P=0.032),NAA/Cr值较正常组有不同程度的下降(肾精亏虚P=0.000,痰浊阻窍P=0.001,瘀血阻络P=0.009),且均有统计学差异。3.三组Va D患者相比较,在右侧额叶可见肾精亏虚证患者NAA/Cr值较瘀血阻络证患者(P=0.034)和痰浊阻窍证患者(P=0.006)有明显下降。4.经治疗后3组Va D患者MMSE评分和SDSVD评分均有明显好转(P0.05)。5.三组Va D患者经加减薯蓣丸干预治疗后,在右侧额叶NAA/Cr值较治疗前均有不同程度升高(肾精亏虚P=0.001,痰浊阻窍P=0.001,瘀血阻络P=0.008);在左侧额叶,NAA/Cr值仅有肾精亏虚证患者较前升高(P=0.026)具有统计学意义,但与正常组相比较仍有统计学差异P0.05。6.三组Va D患者的血常规、尿常规、大便常规,肝功能,肾功能检查及心电图检查在受试过程中都没有发现异常情况。结论:1.1H-MRS可作为一种无创、客观的检查方式,运用于血管性痴呆患者的诊断和疗效评估当中,并且提示血管性痴呆可能与额叶神经元代谢功能异常有关。2.加减薯蓣丸在安全有效的改善血管性痴呆患者认知功能的同时,还能从整体出发,改善患者的其他症状。3.加减薯蓣丸改善血管性痴呆患者认知功能的机制可能与修复神经元功能有关。
[Abstract]:Objective: vascular dementia is a common type of dementia in clinical practice. However, there is still a lack of effective treatment, traditional Chinese medicine treatment of this disease has an advantage. In this study, magnetic resonance spectroscopy (Mrs) was used to explore the efficacy and mechanism of Dioscorea zingiberensis pills in the treatment of mild and moderate vascular dementia. Methods: from December 2015 to December 2016, 80 subjects were enrolled in this study, including 60 patients with vascular dementia (kidney essence deficiency syndrome, phlegm turbid obstruction of orifices syndrome). 20 cases of blood stasis and obstruction of collaterals), 20 subjects of normal group. 80 subjects of normal group were given neuropsychiatric evaluation, traditional Chinese medicine symptom evaluation, liver and kidney function, electrocardiogram and other safety examination, and brain bilateral thalamus, frontal lobe Mrs examination before intervention. Point-resolved spin echo sequence. 60 patients with vascular dementia were treated with Dioscorea zingiberensis pill (made from preparation department of Hubei Provincial Hospital of traditional Chinese Medicine), 15ml, twice a day, orally for 12 weeks, while the patients were treated with Dioscorea zingiberensis Pill. Observe one. The difference of craniocerebral Mrs between patients with vascular dementia and normal group before treatment is 2. 5%. The changes of MMSE, SDSVD, Mrs and adverse reactions in patients with vascular dementia before and after treatment. The result is 1: 1. During the follow-up, 2 patients with deficiency of kidney essence (1 patient with missing drug, 1 patient without examination) and 3 patients with phlegm turbid obstruction of orifices (2 patients without examination), 2 patients with deficiency of kidney essence (1 patient with missing drug, 1 patient without examination) and 3 patients with phlegm turbid obstruction syndrome (2 patients without examination), Other diseases occurred in 1 case, blood stasis and collaterals obstruction in 3 cases (1 case of drug leakage, 2 cases of uncoordinated examination) .2. In the right frontal lobe, Compared with the normal group, the values of Chor / Cr in the three groups were increased in varying degrees (deficiency of kidney essence, stagnation of phlegm, obstruction of resuscitation, P0. 000, P0. 001). The values of NAA / Cr in the three groups were significantly lower than those in the normal group (P 0. 000 for deficiency of kidney essence, 0. 000 for phlegm, 0. 000 for phlegm and P 0. 002 for blood stasis). In the left frontal lobe, It was also observed that in patients with right frontal lobe, the value of Chor / Cr in patients with Va D was increased in varying degrees than that in the normal group (kidney essence deficiency P0. 001, phlegm turbidity obstruction of orifices P0. 000, blood stasis obstruction of collaterals P0. 032). The value of NAA / Cr in patients with VAD was lower than that in the normal group (kidney essence deficiency P0. 000, phlegm turbidity P0. 000). Obstruction of orifices Pu 0.001, blood stasis blocking collaterals P0. 009), and there is a statistical difference. 3. Compared with the three groups of Vad patients, NAA / Cr value in the right frontal lobe patients with deficiency of kidney essence was significantly lower than that in patients with stagnation of blood and obstruction of collaterals (P0. 034) and patients with phlegm turbid obstruction of orifices (P0. 006). After treatment, MMSE score and SDSVD score of Vad patients in 3 groups improved significantly (P0.05). Three groups of Va D patients were treated with Dioscorea zingiberensis Pill. NAA / Cr in the right frontal lobe was significantly higher than that before treatment (deficiency of kidney essence 0.001, phlegm obstructing resuscitation P 0.001, blood stasis obstructing collaterals P 0.008), and NAA / Cr in left frontal lobe was significantly higher than that in patients with deficiency of kidney essence (P0. 026). But compared with the normal group, there is still a statistical difference (P0.05.6). The blood routine, urine routine, stool routine, liver function, renal function and electrocardiogram were not abnormal in the three groups. Conclusion 1. 1H-MRS can be used as a noninvasive and objective examination method in the diagnosis and evaluation of the curative effect of vascular dementia patients, and suggests that vascular dementia may be related to abnormal metabolic function of frontal neurons. Addition and subtraction Dioscorea Zingiberensis pills can improve the cognitive function of vascular dementia patients, but also improve the other symptoms. 3. The mechanism of Dioscorea zingiberensis Pill in improving the cognitive function of vascular dementia patients may be related to the function of repair neurons.
【学位授予单位】：湖北中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R277.7
本文编号：2119757
[Abstract]:Objective: vascular dementia is a common type of dementia in clinical practice. However, there is still a lack of effective treatment, traditional Chinese medicine treatment of this disease has an advantage. In this study, magnetic resonance spectroscopy (Mrs) was used to explore the efficacy and mechanism of Dioscorea zingiberensis pills in the treatment of mild and moderate vascular dementia. Methods: from December 2015 to December 2016, 80 subjects were enrolled in this study, including 60 patients with vascular dementia (kidney essence deficiency syndrome, phlegm turbid obstruction of orifices syndrome). 20 cases of blood stasis and obstruction of collaterals), 20 subjects of normal group. 80 subjects of normal group were given neuropsychiatric evaluation, traditional Chinese medicine symptom evaluation, liver and kidney function, electrocardiogram and other safety examination, and brain bilateral thalamus, frontal lobe Mrs examination before intervention. Point-resolved spin echo sequence. 60 patients with vascular dementia were treated with Dioscorea zingiberensis pill (made from preparation department of Hubei Provincial Hospital of traditional Chinese Medicine), 15ml, twice a day, orally for 12 weeks, while the patients were treated with Dioscorea zingiberensis Pill. Observe one. The difference of craniocerebral Mrs between patients with vascular dementia and normal group before treatment is 2. 5%. The changes of MMSE, SDSVD, Mrs and adverse reactions in patients with vascular dementia before and after treatment. The result is 1: 1. During the follow-up, 2 patients with deficiency of kidney essence (1 patient with missing drug, 1 patient without examination) and 3 patients with phlegm turbid obstruction of orifices (2 patients without examination), 2 patients with deficiency of kidney essence (1 patient with missing drug, 1 patient without examination) and 3 patients with phlegm turbid obstruction syndrome (2 patients without examination), Other diseases occurred in 1 case, blood stasis and collaterals obstruction in 3 cases (1 case of drug leakage, 2 cases of uncoordinated examination) .2. In the right frontal lobe, Compared with the normal group, the values of Chor / Cr in the three groups were increased in varying degrees (deficiency of kidney essence, stagnation of phlegm, obstruction of resuscitation, P0. 000, P0. 001). The values of NAA / Cr in the three groups were significantly lower than those in the normal group (P 0. 000 for deficiency of kidney essence, 0. 000 for phlegm, 0. 000 for phlegm and P 0. 002 for blood stasis). In the left frontal lobe, It was also observed that in patients with right frontal lobe, the value of Chor / Cr in patients with Va D was increased in varying degrees than that in the normal group (kidney essence deficiency P0. 001, phlegm turbidity obstruction of orifices P0. 000, blood stasis obstruction of collaterals P0. 032). The value of NAA / Cr in patients with VAD was lower than that in the normal group (kidney essence deficiency P0. 000, phlegm turbidity P0. 000). Obstruction of orifices Pu 0.001, blood stasis blocking collaterals P0. 009), and there is a statistical difference. 3. Compared with the three groups of Vad patients, NAA / Cr value in the right frontal lobe patients with deficiency of kidney essence was significantly lower than that in patients with stagnation of blood and obstruction of collaterals (P0. 034) and patients with phlegm turbid obstruction of orifices (P0. 006). After treatment, MMSE score and SDSVD score of Vad patients in 3 groups improved significantly (P0.05). Three groups of Va D patients were treated with Dioscorea zingiberensis Pill. NAA / Cr in the right frontal lobe was significantly higher than that before treatment (deficiency of kidney essence 0.001, phlegm obstructing resuscitation P 0.001, blood stasis obstructing collaterals P 0.008), and NAA / Cr in left frontal lobe was significantly higher than that in patients with deficiency of kidney essence (P0. 026). But compared with the normal group, there is still a statistical difference (P0.05.6). The blood routine, urine routine, stool routine, liver function, renal function and electrocardiogram were not abnormal in the three groups. Conclusion 1. 1H-MRS can be used as a noninvasive and objective examination method in the diagnosis and evaluation of the curative effect of vascular dementia patients, and suggests that vascular dementia may be related to abnormal metabolic function of frontal neurons. Addition and subtraction Dioscorea Zingiberensis pills can improve the cognitive function of vascular dementia patients, but also improve the other symptoms. 3. The mechanism of Dioscorea zingiberensis Pill in improving the cognitive function of vascular dementia patients may be related to the function of repair neurons.
【学位授予单位】：湖北中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R277.7
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