Retrospective Study on the Treatment of Vascular Parkinsonism Mild Cognitive Impairment with Naoluotong Paste
-
摘要:
目的 回顾性观察血管性帕金森综合征轻度认知障碍(Vascular Parkinsonism mild cognitive impairment, VP-MCI)的中医证型分布特点及分析脑络通浸膏治疗该病的痰浊阻窍证和瘀血阻络证的临床疗效。 方法 收集确诊的108例VP-MCI病例, 分析其中医证型及分布特点。纳入符合痰浊阻窍证和瘀血阻络证的75例VP-MCI的病例按脑络通浸膏联合多奈哌齐治疗和多奈哌齐单药治疗分为治疗组和对照组, 疗程为4周。观察2组治疗前后中医证候评分及简易精神状态量表(Mini mental state examination, MMSE)、蒙特利尔认知评估量表(Montreal cognitive assessment, MoCA)和统一帕金森病评分量表(Movement disorder society unified Parkinson's disease rating scale, MDS-UPDRS)评分情况; 双侧头颈部血管血流速度的变化情况。 结果 108例VP-MCI患者中医辨证为痰浊阻窍证和瘀血阻络证者占69.44%。治疗后, 治疗组主要中医证候积分明显减少(P < 0.05，P < 0.01), 优于对照组(P < 0.05，P < 0.01); 治疗组MoCA评分明显提高(P < 0.01), 优于对照组(P < 0.05);治疗组双侧大脑前动脉(ACA)和大脑中动脉(MCA)的平均血流速度较治疗前明显提高(P < 0.05), 优于对照组(P < 0.05)。 结论 VP-MCI的主要中医证型为痰浊阻窍证和瘀血阻络证。脑络通浸膏联合多奈哌齐可明显改善痰浊阻窍证和瘀血阻络证VP-MCI患者的脑血流和认知水平。 Abstract:OBJECTIVE To retrospectively observe the distribution characteristics of syndrome pattern in Chinese medicine of vascular Parkinsonism mild cognitive impairment (VP-MCI) and to analyze the clinical efficacy of Naoluotong paste in the treatment of brain blockage caused by phlegm and collateral blockage caused by blood stasis. METHODS A total of 108 cases of VP-MCI were collected and analyzed for their syndrome patterns in Chinese medicine and distribution characteristics. Among them, 75 cases of VP-MCI with brain blockage caused by phlegm and collateral blockage caused by blood stasis were divided into treatment and control groups according to the treatment of Naoluotong paste combined with donepezil and donepezil alone. The treatment course was 4 weeks. The traditional Chinese medicine (TCM) syndrome scores, Mini MentalState Examination (MMSE), Montreal Cognitive Assessment (MoCA), Movement Disorder Society Unified Parkinson's Disease Rating Scale (MDS-UPDRS), as well as changes in blood flow velocity in the bilateral cephalic and cervical vessels were observed before and after treatment in both groups. RESULTS In 108 patients with VP-MCI, 69.44% of them were identified as brain blockage caused by phlegm and collateral blockage caused by blood stasis. After treatment, the main TCM syndrome scores were significantly reduced in the treatment group (P < 0.05, P < 0.01), whose result was better than that in the control group (P < 0.05, P < 0.01). Besides, the MoCA score in the treatment group was significantly increased (P < 0.01), whose result was better than that in the control group (P < 0.05). The mean blood flow in the anterior cerebral artery (ACA) and middle cerebral artery (MCA) were significantly improved in the treatment group. The mean blood flow velocity of bilateral anterior cerebral artery (ACA) and middle cerebral artery (MCA) in the treatment group was significantly higher than that before treatment (P < 0.05), and compared with the control group(P < 0.05). CONCLUSION The main syndrome pattern in Chinese medicine of VP-MCI is brain blockage caused by phlegm and collateral blockage caused by blood stasis. Naoluotong paste combined with donepezil can significantly improve cerebral blood flow and cognition level in VP-MCI patients with brain blockage caused by phlegm and collateral blockage caused by blood stasis. -
图 1 108例VP-MCI患者中医证型构成及分布
Figure 1. TCM syndrome type composition and distribution of 108 VP-MCI patients
表 1 2组患者治疗前后中医证候积分比较(x±s)
Table 1. Comparison of the TCM syndrome scores before and after treatment between the 2 groups(x±s)
组别 时间 遗忘 少语 头昏 口多黏涎 体胖 疼痛 舌紫暗 治疗组 治疗前 3.75±0.69 1.24±0.39 1.71±0.44 1.44±0.42 3.53±0.77 3.85±0.75 3.98±0.82 治疗后 2.43±0.55**## 1.20±0.33 1.13±0.37*# 1.21±0.33*# 3.29±0.85 2.34±0.83*# 2.41±0.76*# 对照组 治疗前 4.11±0.43 1.35±0.52 1.87±0.29 1.58±0.37 4.01±0.92 3.75±0.71 3.22±0.87 治疗后 3.62±0.58 1.56±0.41 1.65±0.48 1.52±0.31 3.14±0.51 3.31±0.68 3.87±0.73 注: 组内比较, *P < 0.05, **P < 0.01; 组间比较, #P < 0.05, ##P < 0.01。 
下载: 导出CSV
表 2 2组患者治疗前后MMSE、MoCA、MDS-UPDRS评分比较(x±s)
Table 2. Comparison of MMSE, MoCA, and MDS-UPDRS scores before and after treatment in 2 groups(x±s)
组别 时间 MMSE MoCA MDS-UPDRS 观察组 治疗前 21.31±2.34 21.35±2.40 44.16±7.12 治疗后 23.61±2.02 26.32±1.14**# 33.25±5.34 对照组 治疗前 21.52±2.33 21.71±2.27 45.32±8.27 治疗后 22.27±1.30 22.58±2.32 35.20±7.09 注: 组内比较, **P < 0.01; 组间比较, #P < 0.05。
下载: 导出CSV
表 3 2组患者治疗前后双侧ICA、ACA、MCA的Vp和Vm比较(x±s, cm·s-1)
Table 3. Comparison of Vp and Vm of bilateral ICA, ACA, and MCA before and after treatment in 2 groups(x±s, cm·s-1)
组别 时间 部位 ICA ACA MCA Vp Vm Vp Vm Vp Vm 观察组 治疗前 右侧 72.31±6.12 35.16±7.27 61.66±7.22 45.80±8.29 94.38±8.09 56.12±8.04 左侧 67.22±7.30 41.35±7.43 58.39±9.32 43.22±6.66 96.57±8.29 61.34±6.77 治疗后 右侧 81.42±6.21 49.52±9.01 75.54±6.75 68.25±5.87*# 102.77±10.02 79.53±9.06*# 左侧 76.37±7.42 46.25±6.15 67.33±5.88 65.13±7.27*# 96.62±8.13 87.61±7.72*# 对照组 治疗前 右侧 68.28±9.45 37.72±5.99 59.32±7.74 40.44±6.95 98.36±6.84 53.74±6.99 左侧 70.55±5.07 33.69±8.31 64.62±8.50 39.76±7.33 113.65±9.29 58.81±7.07 治疗后 右侧 78.21±6.32 44.52±7.09 71.75±7.71 51.16±5.88 121.72±7.66 52.89±6.98 左侧 81.40±5.49 39.73±8.76 73.31±7.53 45.08±8.90 116.93±8.37 60.35±8.31 注: 组内比较, *P < 0.05; 组间比较, #P < 0.05。
下载: 导出CSV
-
[1] TYSNES OB, STORSTEIN A. Epidemiology of parkinson's disease[J]. J Neural Transm, 2017, 124(8): 901-905. doi: 10.1007/s00702-017-1686-y [2] LITVAN I, GOLDMAN JG, TROSTER AI, et al. Diagnostic criteria for mild cognitive impairment in Parkinson's disease: Movement Disorder Society Task Force guidelines[J]. Mov Disord, 2012, 27(3): 349-356. doi: 10.1002/mds.24893 [3] SAWADA H, OEDA T, KOHSAKA M, et al. Early use of donepezil against psychosis and cognitive decline in Parkinson's disease: A randomised controlled trial for 2 years[J]. J Neurol Neurosurg Psychiatry, 2018, 89(12): 1332-1340. doi: 10.1136/jnnp-2018-318107 [4] 郭海英. 血管性痴呆中医治疗原则探讨[J]. 南京中医药大学学报, 2005, 21(4): 221-222. doi: 10.3969/j.issn.1000-5005.2005.04.006GUO HY. Discussion on TCM treatment principles of vascular dementia[J]. J Nanjing Univ Tradit Chin Med, 2005, 21(4): 221-222. doi: 10.3969/j.issn.1000-5005.2005.04.006 [5] 中华医学会神经病学分会帕金森病及运动障碍学组. 中国血管性帕金森综合征诊断与治疗专家共识[J]. 中华神经科杂志, 2017, 50 (5): 326-330. doi: 10.3760/cma.j.issn.1006-7876.2017.05.003Parkinson's Disease and movement Disorders Group, Neurology Society of Chinese Medical Association. Chinese expert consensus on diagnosis and treatment of vascular parkinsonism[J]. Chin J Neurol, 2017, 50 (5): 326-330. doi: 10.3760/cma.j.issn.1006-7876.2017.05.003 [6] 中华医学会神经病学分会帕金森病及运动障碍学组, 中国医师协会神经内科医师分会帕金森病及运动障碍学组. 中国帕金森病轻度认知障碍的诊断和治疗指南(2020版)[J]. 中国神经精神疾病杂志, 2021, 47(1): 1-12. doi: 10.3969/j.issn.1002-0152.2021.01.001Parkinson's Disease and Motor Disorders Group, Neurological Branch, Chinese Medical Association. Guidelines for diagnosis and treatment of mild cognitive impairment of China's Parkinson disease (2020 edition)[J]. Chin J Nerv Ment Dis, 2021, 47(1): 1-12. doi: 10.3969/j.issn.1002-0152.2021.01.001 [7] ZADIKOFF C, FOX SH, TANG-WAI DF, et al. A comparison of the mini mental state exam to the Montreal cognitive assessment in identifying cognitive deficits in Parkinson's disease[J]. Mov Disord, 2008, 23(2): 297-299. doi: 10.1002/mds.21837 [8] NASREDDINE ZS, PHILLIPS NA, BE DIRIAN V, et al. The Montreal Cognitive Assessment, MoCA: A brief screening tool for mild cognitive impairment[J]. J Am Geriatr Soc, 2005, 53(4): 695-699. doi: 10.1111/j.1532-5415.2005.53221.x [9] MARTINEZ-MARTIN P, RODRIGUEZ-BLAZQUEZ C, ALVAREZ-SANCHEZ M, et al. Expanded and independent validation of the Movement Disorder Society-Unified Parkinson's Disease Rating Scale (MDS-UPDRS)[J]. J Neurol, 2013, 260(1): 228-236. doi: 10.1007/s00415-012-6624-1 [10] 田金州, 韩明向, 涂晋文, 等. 血管性痴呆诊断、辨证及疗效评定标准(研究用)[J]. 中国老年学杂志, 2002, 22(5): 329-331. doi: 10.3969/j.issn.1005-9202.2002.05.001TIAN JZ, HAN MX, TU JW, et al. Criteria for the diagnosis, the differentiation of syndrome and the evaluation of efficacy of vascular dementia for research studies[J]. Chin J Gerontol, 2002, 22(5): 329-331. doi: 10.3969/j.issn.1005-9202.2002.05.001 [11] 石松鑫, 王大力, 李弘, 等. 血管性帕金森综合征与帕金森病认知功能的比较[J]. 中国卒中杂志, 2022, 17(4): 341-345. https://www.cnki.com.cn/Article/CJFDTOTAL-ZUZH202204003.htmSHI SX, WANG DL, LI H, et al. Comparison of cognitive function between vascular Parkinsonism and parkinson's disease[J]. Chin J Stroke, 2022, 17(4): 341-345. https://www.cnki.com.cn/Article/CJFDTOTAL-ZUZH202204003.htm [12] 孙莉, 马荣莉, 匡春俊, 等. 帕金森病认知障碍的中西医研究进展[J]. 湖北中医药大学学报, 2019, 21(2): 119-122. doi: 10.3969/j.issn.1008-987X.2019.02.034SUN L, MA RL, KUANG CJ, et al. Advances in integrated Chinese-western therapy in cognitive impairment of parkinson's disease[J]. J Hubei Univ Chin Med, 2019, 21(2): 119-122. doi: 10.3969/j.issn.1008-987X.2019.02.034 [13] 方谷. 医林绳墨大全[M]. 北京: 中国中医药出版社, 2015: 25.FANG G. The Complete Compendium of Medical Works[M]. Beijing: China press of traditional Chinese medicine, 2015: 25. [14] 陈士铎. 石室秘录[M]. 北京: 人民军医出版社, 2009: 37.CHEN SD. Secret Records in a Stone Room[M]. Beijing: People's military medical press, 2009: 37. [15] 王肯堂. 证治准绳[M]. 北京: 人民卫生出版社, 2014: 48.WANG KT. Standards for Diagnosis and Treatment[M]. Beijing: People's medical publishing house, 2014: 48. [16] 杨德富, 常诚. 符为民教授运用脑络通颗粒治疗血管性认知障碍新思路[J]. 陕西中医, 2017, 38(4): 509-510. doi: 10.3969/j.issn.1000-7369.2017.04.049YANG DF, CHANG C. Professor fu Weimin's new idea of treating vascular cognitive impairment with Naoluotong Granule[J]. Shaanxi J Tradit Chin Med, 2017, 38(4): 509-510. doi: 10.3969/j.issn.1000-7369.2017.04.049 [17] 刘玮, 卢烁, 刘尊敬. 经颅多普勒超声在脑侧支循环评估中的临床应用[J]. 中国卒中杂志, 2019, 14(8): 786-791. doi: 10.3969/j.issn.1673-5765.2019.08.010LIU W, LU S, LIU ZJ. Assessment of collateral circulation in ischemic stroke using transcranial Doppler ultrasound[J]. Chin J Stroke, 2019, 14(8): 786-791. doi: 10.3969/j.issn.1673-5765.2019.08.010 -
点击查看大图
图(1) / 表(3)
计量
- 文章访问数: 270
- HTML全文浏览量: 17
- PDF下载量: 30
- 被引次数: 0
