补肾通络汤治疗阿尔茨海默病40例的临床分析

Clinical Analysis of Bushen Tongluo Decoction in Treating 40 Patients with Alzheimer Disease

摘要:

目的: 探讨补肾通络汤治疗阿尔茨海默病(AD)肾精亏虚,痰凝血瘀证的临床分析及对炎症反应和氧化应激的影响. 方法: 将80例AD患者随机按数字表法分为对照组和中西医结合组各40例.对照组口服盐酸多奈哌齐片,10 mg·d^-1;吡拉西坦片,0.8 g/次,3次/d.中西医结合组在对照组治疗的基础上加用补肾通络汤,每天1剂.两组均进行6个月的持续治疗.采用简易精神状态量表(MMSE)和阿尔茨海默病认知功能评价量表(ADAS-cog)评价智能改变情况;采用日常生活能力量表(ADL)评价患者生活自理能力;采用神经精神量表(NPI)评估精神病理变化;检测丙二醛(MDA),超氧化物歧化酶(SOD),肿瘤坏死因子 α(TNF-α),白细胞介素-1,6(IL-1,IL-6)水平.以上指标治疗前后各进行1次评价. 结果: 经Ridit分析,中西医结合组临床疗效优于对照组(P <0.05);治疗后两组MMSE量表评分较治疗前升高,中西医结合组上升更为显著(P <0.01);治疗后两组ADAS-cog,ADL和NPI量表评分均较治疗前下降,中西医结合组ADAS-cog,ADL和NPI量表评分均低于对照组(P <0.01);治疗后两组血清SOD水平较治疗前升高,中西医结合组SOD水平高于对照组(P <0.01);治疗后两组血清TNF-α,IL-1,IL-6和MDA水平均较治疗前下降,治疗后中西医结合组TNF-α,IL-1,IL-6和MDA水平低于对照组(P <0.01). 结论: 在多奈哌齐联合吡拉西坦治疗的基础上,补肾通络汤治疗轻、中度AD(肾精亏虚,痰凝血瘀证)患者能减轻症状,提高患者认识和生活自理能力,临床疗效优于单纯西医治疗,其作用机制可能是通过抑制炎症反应和减轻氧化应激损伤来实现的.

Abstract:

Objective: To discuss the clinical efficacy of Bushen Tongluo decoction in treating patients with Alzheimer disease (AD), and to investigate its influence on inflammation and oxidative stress. Method: Ninety-seven patients with AD were randomly divided into the control group (40 cases) and the combination group with traditional Chinese combined Western medicine treatment (40 cases) by a random number table. Patients in the control group received 10 mg donepezil hydrochloride tablets and 0.8 g piracetam tablets thrice daily. On the basis of the control group, patients in the combination group does modified Bushen Tongluo decoction once daily. All patients in both two groups received 6 months of treatment. The intelligence changes were evaluated through mini mental state examination (MMSE) and cognitive function in Alzheimer's disease rating scale (ADAS-cog). The patients' life self-care ability was assessed by using activity of daily living scale (ADL). The psychopathology changes were estimated via neuropsychological scale (NPI). Levels of malondialdehyde (MDA), superoxide dismutase (SOD), tumor necrosis factor α (TNF-α), interleukin-1, 6 (IL-1, IL-6) were detected. The above indicators were tested once before and after treatment. Result: The clinical curative effect in the combination group was superior to that in the control group (P <0.05). After therapy, MMSE scale score in two groups went up as compared before, while the results were more obvious in the combination group (P <0.01). The ADAS-cog, ADL and NPI scale scores declined in two groups, while the results in the combination group were lower than those in the control group (P <0.01). After treatment, serum SOD level in two groups rose, while the result was better in the combination group (P <0.01). The standard of TNF-α, IL-1, IL-6 and MDA in the combination group was inferior to those in the control group (P <0.01). Conclusion: Based on the therapy of donepezil hydrochloride tablets combined piracetam tablets, the modified Bushen Tongluo decoction could reduce symptoms improve cognitive ability and the ability of daily life in patients with mild and moderate AD. The clinical curative effect was superior to using western medicine treatment alone. Its mechanism may be related to inhibiting the inflammatory response and reducing the oxidative stress injury.