Clinical observation on the combination of butylphthalide and anisodine hydrobromide in the treatment of cerebral small vessel disease with cognitive impairment
Objective To analyze the efficacy and safety of butylphthalide combined with anisodine hydrobromide in the treatment of cerebral small vessel disease with cognitive impairment from different perspectives.Methods Totally 106 pa-tients with acute episode cerebral small vessel disease accompanied by cognitive impairment in Nanyang First People's Hospital from October 1st,2017 to October 31st,2020 were selected and randomly divided into an observation group and a control group,with 53 patients in each group.Both groups received routine treatment.On this basis,the control group was treated with anisodine hydrobromide,while the observation group was treated with butylphthalide combined with ani-sodine hydrobromide for 12 weeks.We compared two groups of clinical efficacy,adverse reactions,pre treatment and 12 week post treatment mini-mental state examination(MMSE),Montreal cognitive assessment(MOCA),hemorheological indicators,cerebral blood flow perfusion parameters[mean transit time(MTT),cerebral blood volume(CBV),blood flow velocity(CBF)],serum matrix metalloproteinase-9(MMP-9),homocysteine(Hcy),and amyloid-beta peptide 42(Aβ42)horizontal.Results The total effective rate of the observation group(90.57％)was higher than that of the control group(75.47％),with a statistically significant difference,x2=4.283,P=0.039.After 12 weeks of treatment,the MMSE score of the observation group was 27.49±2.25,which was higher than the control group's 24.86±3.04,F=6.325,P＜0.001.The MOCA score was 27.86±1.93,higher than the control group's 25.42±2.38,F=5.928,P＜0.001.After 12 weeks of treatment,the whole blood low shear viscosity in the observation group was(6.72±1.03)mPa·s,lower than that in the control group(8.04±1.39)mPa·s,F=9.247,P＜0.001.The high shear viscosity was(3.09±0.64)mPa·s,lower than the control group's(4.13±0.85)mPa·s,F=7.951,P＜0.001.The plasma viscosity was(1.19±0.18)mPa·s,lower than the control group's(1.47±0.22)mPa·s,F=8.122,P＜0.001.After 12 weeks of treatment,the MTT of the observation group was(4.03±0.32)s,lower than that of the control group(5.47±0.45)s,F=10.824,P＜0.001.The CBV was(2.59±0.47)ml/100 g,which was higher than the control group's(2.14±0.39)ml/100 g,F=7.39 4,P＜0.001.The CBF was(22.86±1.58)g·min,which was higher than the control group's(19.94±2.02)g·min,F=9.081,P＜0.001.After 12 weeks of treatment,the serum MMP-9 level in the observation group was(572.32±104.26)μg/L,lower than the control group's(669.76±149.34)μg/L,F=10.808,P＜0.001.The Hcy level was(16.05±1.49)μmol/L,lower than the control group's(18.58±1.83)μmol/L,F=9.986,P＜0.001.Aβ42 horizontal was(1.82±0.25)μg/L,lower than the control group's(2.06±0.28)μg/L,F=6.532,P＜0.001.There was no statistically significant difference in the total incidence of adverse reactions between the observation group(13.21％)and the control group(9.43％),x2=0.376,P=0.540.Conclusion The combination of butylphthalide and anisodine hydrobromide has a significant therapeutic effect on patients with cognitive impairment re-lated to cerebrovascular disease,and can significantly improve cognitive function.The mechanism of action may be related to improving cerebral hemorheology,cerebral blood flow perfusion,and serum MMP-9,Hcy,Aβ42 levels.
cerebral small vessel diseasecognitive impairmentanisodine hydrobromidebutylphthalidehomocysteinematrix metalloproteinase-9amyloid-beta peptide 42
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