益气活血法在脑小血管病认知障碍患者中的临床应用

陈克龙; 宋成城; 陈凌

doi:10.16766/j.cnki.issn.1674-4152.003220

益气活血法在脑小血管病认知障碍患者中的临床应用

doi: 10.16766/j.cnki.issn.1674-4152.003220

浙江中医药大学附属温州市中医院神经内科，浙江温州 325000

基金项目:

浙江省中医药科技计划项目 2022ZB338

温州市基础性科研项目 Y20220219

详细信息

通讯作者:
陈克龙，E-mail: 247360354@qq.com

中图分类号: R743 R242
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- 文章访问数: 162
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- 被引次数: 0
出版历程
- 收稿日期: 2023-06-28
- 网络出版日期: 2023-11-23

Clinical application of supplementing Qi and activating blood in patients with cognitive impairment due to cerebral small vessel disease

Department of Neurology, Wenzhou TCM Hospital of Zhejiang Chinese Medical University, Wenzhou, Zhejiang 325000, China

摘要

摘要: 目的探究利用补阳还五汤进行益气活血法治疗脑小血管病认知障碍患者的临床疗效，观察患者认知功能、注意力、执行能力和炎性因子水平的变化。方法选取2022年2月—2023年5月浙江中医药大学附属温州市中医院收治的脑小血管病认知障碍患者60例，采用随机数表法分为2组，对照组(30例)给予多奈哌齐片治疗，观察组(30例)在对照组治疗方案的基础上给予补阳还五汤进行益气活血法治疗。通过蒙特利尔认知评估量表(MoCA)、数字符号转换测验量表(DSST)和连线测验(TMT)评价患者的认知功能、注意力和执行功能，比较2组患者炎性因子水平[血同型半胱氨酸(Hcy)、超敏C反应蛋白(hs-CRP)]。结果与治疗前比较，治疗后2组患者MoCA、DSST评分显著升高(均P＜0.05)，且观察组的MoCA、DSST评分显著高于对照组(均P＜0.05)；与治疗前比较，治疗后2组患者TMT耗时显著下降(均P＜0.05)，且观察组的TMT耗时[TMT-A：(71.10±10.44)s；TMT-B：(222.63±30.84)s]显著低于对照组[TMT-A：(77.63±12.44)s；TMT-B：(241.53±38.03)s, 均P＜0.05]；与治疗前比较，治疗后2组患者Hcy和hs-CRP水平显著降低(均P＜0.05)，且观察组Hcy和hs-CRP显著低于对照组(均P＜0.05)。结论益气活血法可显著提高脑小血管病认知障碍患者的认知功能、注意力和执行功能，并降低患者的炎性因子水平。
- 益气活血法 /
- 脑小血管病 /
- 认知功能障碍
Abstract: Objective The purpose of this study was to investigate the clinical effect of qi-supplementation and blood-activation therapy with Buyang Huanwu Decoction in the treatment of patients with cognitive impairment due to cerebral small vessel disease, focusing on the effects on cognitive function, attention, executive function and inflammatory factors. Methods A total of 60 patients with cerebral small vessel disease and cognitive impairment admitted to Wenzhou TCM Hospital of Zhejiang Chinese Medical University from February 2022 to May 2023 were selected. The random number table method was used in two groups. The control group (30 cases) was treated with donepezil tablets, and the observation group (30 cases) was treated with Buyang Huanwu decoction for qi-supplementation and blood-activation on the basis of the treatment scheme of the control group. The patients ' cognitive function, attention and executive function were assessed by using Montreal cognitive assessment scale (MoCA), the digit symbol substitution test (DSST) and the trail making test (TMT). Levels of inflammatory factors [blood homocysteine (Hcy), hypersensitive C-reactive protein (hs-CRP)] were compared between the two groups. Results Compared before treatment, the MoCA and DSST scores in both groups were significantly increased after treatment (all P < 0.05), and the MoCA and DSST scores in the observation group were significantly higher than those in the control group (all P < 0.05). Compared with before treatment, the TMT time in both groups decreased significantly after treatment (all P < 0.05), and the TMT time in the observation group [TMT-A: (71.10±10.44) s; TMT-B: (222.63±30.84) s] was significantly lower than that in the control group [TMT-A: (77.63±12.44) s; TMT-B: (241.53±38.03) s, all P < 0.05]. After treatment, the levels of Hcy and hs-CRP in both groups were significantly lower than those before treatment (all P < 0.05), and Hcy and hs-CRP in the observation group were significantly lower than those in the control group (all P < 0.05). Conclusion Supplemening Qi and activating blood circulation can significantly improve the cognitive function and executive function of patients with cognitive impairment due to cerebral small vessel disease, and reduce the level of inflammatory factors in patients.
- Supplementing Qi and activating blood /
- Cerebral small vessel disease /
- Cognitive dysfunction

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表 1 2组CSVD-VCI患者治疗前后MoCA评分比较(x±s，分)

Table 1. Comparison of MoCA scores before and after treatment in 2 groups of CSVD-VCI patients (x±s, points)

组别	例数	治疗前	治疗后	t值	P值
观察组	30	21.13±2.06	26.37±2.17	14.012	< 0.001
对照组	30	21.53±2.08	24.63±2.71	12.143	< 0.001
t值		0.748	2.733
P值		0.458	0.008

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表 2 2组CSVD-VCI患者治疗前后DSST评分比较(x±s，分)

Table 2. Comparison of DSST scores before and after treatment in two groups of CSVD-VCI patients (x±s, points)

组别	例数	治疗前	治疗后	t值	P值
观察组	30	5.43±1.36	8.86±1.05	7.293	< 0.001
对照组	30	5.52±1.17	7.03±1.43	5.126	< 0.001
t值		0.275	5.649
P值		0.785	＜0.001

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表 3 2组CSVD-VCI患者治疗前后TMT耗时比较(x±s，s)

Table 3. Comparison of TMT time before and after treatment in two groups of CSVD-VCI patients (x±s, s)

组别	例数	TMT-A		TMT-B
组别	例数	治疗前	治疗后	治疗前	治疗后
观察组	30	83.40±12.97	71.10±10.44^a	260.67±36.87	222.63±30.84^a
对照组	30	84.77±12.45	77.63±12.44^a	262.13±38.47	241.53±38.03^a
t值		0.416	2.204	0.151	2.114
P值		0.679	0.032	0.881	0.039
注：与同组治疗前比较，^aP < 0.05。

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表 4 2组CSVD-VCI患者治疗前后Hcy及hs-CRP比较(x±s)

Table 4. Comparison of Hcy and hs-CRP before and after treatment in two groups of CSVD-VCI patients (x±s)

组别	例数	Hcy(μmol/L)		t值	P值	hs-CRP(mg/L)		t值	P值
组别	例数	治疗前	治疗后	t值	P值	治疗前	治疗后	t值	P值
观察组	30	17.32±2.42	8.34±3.19	8.271	< 0.001	11.32±1.96	4.28±1.94	9.184	< 0.001
对照组	30	17.63±3.85	14.38±2.28	4.381	< 0.001	11.43±1.84	8.92±1.22	4.024	< 0.001
t值		0.373	8.437			0.224	11.089
P值		0.710	＜0.001			0.823	＜0.001

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参考文献(15)

[1]	苑振云, 李丽博, 智珈鑫, 等. 脑小血管病患者血压变异性与认知和情感障碍的关系[J]. 山东医药, 2022, 62(25): 30-34. https://www.cnki.com.cn/Article/CJFDTOTAL-SDYY202225007.htm YUAN Z Y, LI L B, ZHI J X, et al. Relationships between blood pressure variability and cognitive and affective disorders in patients with cerebral small vessel disease[J]. Shandong Medical Journal, 2022, 62(25): 30-34. https://www.cnki.com.cn/Article/CJFDTOTAL-SDYY202225007.htm
[2]	马春潮, 郭洁, 姜昭, 等. 养血清脑颗粒联合多奈哌齐对脑小血管病认知障碍的疗效观察[J]. 山西中医药大学学报, 2020, 21(3): 196-198. https://www.cnki.com.cn/Article/CJFDTOTAL-SHAN202003012.htm MA C C, GUO J, JIANG Z, et al. Clinical observation on cognitive impairment of cerebral small vessel disease with Yangxueqingnao granule combined with donepezil[J]. Journal of Shanxi College of Traditional Chinese Medicine, 2020, 21(3): 196-198. https://www.cnki.com.cn/Article/CJFDTOTAL-SHAN202003012.htm
[3]	李琳, 曾嵘. 脑小血管病相关认知障碍的中西医研究进展[J]. 中西医结合心脑血管病杂志, 2022, 20(13): 2389-2392. https://www.cnki.com.cn/Article/CJFDTOTAL-ZYYY202213015.htm LI L, ZENG R. Progress of Chinese and Western medicine research on cognitive impairment related to cerebral small vascular disease[J]. Chinese Journal of Integrative Medicine on Cardio-Cerebrovascular Disease, 2022, 20(13): 2389-2392. https://www.cnki.com.cn/Article/CJFDTOTAL-ZYYY202213015.htm
[4]	陈刚, 周海娟, 符文雄, 等. 加味地黄饮子治疗脑小血管病所致认知障碍患者的临床疗效及其对神经功能、炎性反应、氧化应激的影响[J]. 实用心脑肺血管病杂志, 2019, 27(6): 78-81. https://www.cnki.com.cn/Article/CJFDTOTAL-SYXL201906021.htm CHEN G, ZHOU H J, FU W X, et al. Clinical effect of modified rehmanniae cold decoction on cognitive disorder caused by cerebral small vessel disease and its impact on neurological function, inflammatory reaction and oxidative ctress[J]. Practical Journal of Cardiac Cerebral Pneumal and Vascular Disease, 2019, 27(6): 78-81. https://www.cnki.com.cn/Article/CJFDTOTAL-SYXL201906021.htm
[5]	李涛, 刘江枫, 陈塬, 等. 脑小血管病相关认知障碍的中医证候规律探究[J]. 中国民间疗法, 2023, 31(6): 7-11. https://www.cnki.com.cn/Article/CJFDTOTAL-ZMJL202306003.htm LI T, LIU J F, CEHN Y, et al. Research on TCM syndrome rules o￡cognitive impairment related to cerebral small vessel disease[J]. China's Naturopathy, 2023, 31(6): 7-11. https://www.cnki.com.cn/Article/CJFDTOTAL-ZMJL202306003.htm
[6]	陈小容, 王明选, 刘莉, 等. 益气活血法联合茴拉西坦胶囊治疗中风后认知功能障碍及对血清NSE、hs-CRP水平的影响[J]. 辽宁中医药大学学报, 2020, 22(12): 14-17. https://www.cnki.com.cn/Article/CJFDTOTAL-LZXB202012004.htm CHEN X R, WANG M X, LIU L, et al. Analysis of the effects of yiqi huoxue method combined with aniracetam capsule in the treatment of cognitive impairment after stroke and the changes of serum NSE and Hs-CRP levels[J]. Journal of Liaoning University of Traditional Chinese Medicine, 2020, 22(12): 14-17. https://www.cnki.com.cn/Article/CJFDTOTAL-LZXB202012004.htm
[7]	吴睿, 甄娜, 王欣丽, 等. 老年脑小血管病患者认知障碍发生率及影响因素分析[J]. 中国神经免疫学和神经病学杂志, 2022, 29(2): 89-92, 97. https://www.cnki.com.cn/Article/CJFDTOTAL-ZSMB202202003.htm WU R, ZHEN N, WANG X L, et al. Analysis of incidence and influencing factors of cognitive impairment in elderly patients with cerebral small vessel disease[J]. Chinese Journal of Neuroimmunology and Neurology, 2022, 29(2): 89-92, 97. https://www.cnki.com.cn/Article/CJFDTOTAL-ZSMB202202003.htm
[8]	韩晓蕾, 王晓杰, 杜怡峰. 脑小血管病与认知障碍[J]. 中国实用内科杂志, 2021, 41(7): 575-578. https://www.cnki.com.cn/Article/CJFDTOTAL-SYNK202107008.htm HAN X L, WANG X J, DU Y F. Cerebral small vessel disease and cognitive impairment[J]. Chinese Journal of Practical Internal Medicine, 2021, 41(7): 575-578. https://www.cnki.com.cn/Article/CJFDTOTAL-SYNK202107008.htm
[9]	高庆元, 陈晓城, 邹卫兵, 等. 益肾活血中药联合电针穴位刺激治疗脑梗死后记忆功能障碍的疗效[J]. 中华全科医学, 2019, 17(7): 1194-1197. doi: 10.16766/j.cnki.issn.1674-4152.000899 GAO Q Y, CHEN X C, ZOU W B, et al. Efficacy of Yishen Huoxue decoction combined with electroacupuncture on memory dysfunction after cerebral infarction[J]. Chinese Journal of General Practice, 2019, 17(7): 1194-1197. doi: 10.16766/j.cnki.issn.1674-4152.000899
[10]	裴瑜, 张明, 秦瑀, 等. 温阳益气活血法治疗轻度认知功能障碍临床分析[J]. 中外医疗, 2018, 37(7): 4-7. https://www.cnki.com.cn/Article/CJFDTOTAL-HZZZ201807002.htm PEI Y, ZHANG M, QIN Y, et al. Clinical analysis of Warming Yang, Invigorating Qi and Activating Blood Circulation in treating mild cognitive impairment[J]. China & Foreign Medical Treatment, 2018, 37(7): 4-7. https://www.cnki.com.cn/Article/CJFDTOTAL-HZZZ201807002.htm
[11]	高利民, 裴瑜, 李瑞玲, 等. 益气温阳活血法对轻度认知功能障碍患者干预的疗效观察[J]. 山东中医杂志, 2018, 37(1): 18-21. https://www.cnki.com.cn/Article/CJFDTOTAL-SDZY201801007.htm GAO L M, PEI Y, LI R L, et al. Observing effects of the method of Invigorating Qi and Warming Yang and Promoting Blood for treating the mild cognitive impairment[J]. Shandong Journal of Traditional Chinese Medicine, 2018, 37(1): 18-21. https://www.cnki.com.cn/Article/CJFDTOTAL-SDZY201801007.htm
[12]	董刚, 贾洪刚. 补阳还五汤联合重组人组织型纤溶酶原激活物静脉溶栓治疗脑梗死的研究[J]. 中华全科医学, 2018, 16(3): 470-472. doi: 10.16766/j.cnki.issn.1674-4152.000130 DONG G, JIA H G. Research of Buyang Huanwu decoction combined urokinase thrombolysis on acute cerebral infarction[J]. Chinese Journal of General Practice, 2018, 16(3): 470-472. doi: 10.16766/j.cnki.issn.1674-4152.000130
[13]	叶海东, 胡胜利, 徐毅, 等. 益气活血汤联合高压氧治疗老年性下肢动脉硬化闭塞症的疗效观察[J]. 中华全科医学, 2017, 15(2): 358-360. doi: 10.16766/j.cnki.issn.1674-4152.2017.02.053 YE H D, HU S L, XU Y, et al. Yiqi Huoxue Decoction combined with hyperbaric oxygen treatment of senile lower extremity arteriosclerosis Observation on curative effect of occlusive diseasen[J]. Chinese Journal of General Practice, 2017, 15(2): 358-360. doi: 10.16766/j.cnki.issn.1674-4152.2017.02.053
[14]	张薇, 刘会, 张亚岚, 等. 脑小血管病致认知障碍的危险因素研究进展[J]. 解放军医学院学报, 2021, 42(2): 235-238. https://www.cnki.com.cn/Article/CJFDTOTAL-JYJX202102022.htm ZHANG W, LIU H, ZHANG Y L, et al. Research advances in risk factors of cognitive disorder caused by cerebral small vessel disease[J]. Academic Journal of Chinese PLA Medical School, 2021, 42(2): 235-238. https://www.cnki.com.cn/Article/CJFDTOTAL-JYJX202102022.htm
[15]	杨青松, 满春露, 李柯柯, 等. 血清SD-LDL hs-CRP Hcy和Lp-PLA₂水平与脑小血管病患者认知功能障碍的相关性[J]. 中国实用神经疾病杂志, 2022, 25(12): 1507-1511. https://www.cnki.com.cn/Article/CJFDTOTAL-HNSJ202212011.htm YANG Q S, MAN C L, LI K K, et al. Correlation of serum SD-LDL, hs-CRP, Hcy and Lp-PLA2 levels with cognitive impairment in cerebral small vessel disease patients[J]. Chinese Journal of Practical Nervous Diseases, 2022, 25(12): 1507-1511. https://www.cnki.com.cn/Article/CJFDTOTAL-HNSJ202212011.htm