目的 观察涤痰汤加味方对血管性痴呆(vascular dementia，VaD或VD)患者认知功能、相关炎性指标的改善及影响作用。方法 选择2020年11月—2022年11月于医院脑科住院治疗的符合纳排标准100例VD患者为研究对象，随机分为常规治疗组和联合组，各组50例，常规治疗组予以基础治疗的同时口服尼莫地平片，联合组在此基础上口服涤痰汤加味方治疗。比较两组患者的临床疗效和不良反应，以及治疗前后认知功能、血脂水平、炎症水平变化，评价涤痰汤加味方治疗VD临床疗效和作用机制。结果 常规治疗组的总有效率为80。00％(40/50)，联合组的总有效率为94。00％(47/50)，联合组的总有效率明显优于常规治疗组(P＜0。05)。干预前两组患者的认知功能和日常生活能力差异无统计学意义(P＞0。05)。干预3个疗程后，联合组患者的简易精神状态检查量表(mini-mental state examinatio，MMSE)评分、痴呆简易筛查量表(brief screening scale for dementia，BSSD)评分以及日常生活能力评定量表(activities of daily living，ADL)评分水平相较于常规治疗组均明显升高;且联合组患者的血清脑源性神经营养因子(brain-derived neurotrophic factor，BDNF)、神经生长因子(nerve growth factor，NGF)水平相较于常规治疗组明显升高，而同型半胱氨酸(homocysteine，Hcy)水平则明显下降(P＜0。01)。干预前两组患者的血脂水平差异无统计学意义(P＞0。05)。干预3个疗程后，与常规治疗组比较，联合组患者的甘油三酯(triglycerides，TG)、总胆固醇(total cholesterol，TC)以及低密度脂蛋白胆固醇(low-density lipoprotein cholesterol，LDL-C)水平均明显降低，而高密度脂蛋白胆固醇(high-density lipoprotein choles-terol，HDL-C)水平明显升高(P＜0。01，P＜0。05);联合组患者血清C反应蛋白(C-reactive protein，CRP)、白细胞介素-6(interleukin-6，IL-6)以及肿瘤坏死因子(tumor necrosis factor，TNF)-α 水平均明显降低(P＜0。01，P＜0。05)o结论 涤痰汤加味方联合西医常规治疗能够改善VD患者认知功能，降低血脂水平，提高治疗效果，分析其机制与保护神经营养因子及抑制机体炎症反应有关，患者不良反应无明显增加，适宜推广。
Improvement and Influence of Modified Diitan Decoction(涤痰汤加味)on Cognitive Function and Related Inflammatory Indexes in Vascular Dementia Patients
Objective To observe the improvement and effect of Modified Diitan Decoction(涤痰汤加味)on cognitive function and related inflammatory indexes in patients with vascular dementia(VD).Methods A total of 100 cases of VD patients who were hospitalized in the brain department of the hospital from November 2020 to November 2022 were selected as the study objects,and were randomly divided into the conventional treatment group and the combined group,with 50 cases in each group.The conven-tional treatment group was given basic treatment and oral nimodipine tablets,and the combined group was given Modified Diitan Decoction orally on the basis.The clinical efficacy and adverse reactions of the two groups were compared as well as the changes of cognitive function,lipid and inflammation before and after treatment,and the clinical efficacy and mechanism of the treatment of VD with Modified Ditan Decoction were evaluated.Results The total effective rate of the conventional treatment group was 80.00％(40/50),and that of the combined group was 94.00％(47/50),which was significantly better than that of the conven-tional treatment group(P＜0.05).There were no significant differences in cognitive function or daily living ability between the two groups before intervention(P＞0.05).After each course of intervention 3,the mini-mental state examination(MMSE)score,brief screening scale for dementia(BSSD)score and activities of daily living(ADL)score of patients in the combination group were significantly increased compared with those in the conventional treatment group.Compared with those of the conven-tional treatment group,the serum levels of brain-derived neurotrophic factor(BDNF)and nerve growth factor(NGF)in the com-bination group were significantly increased,while homocysteine(Hcy)levels were significantly decreased(P＜0.01).Before in-tervention,there was no significant difference in blood lipid levels between the two groups(P＞0.05).After 3 courses of inter-vention,compared with those of the conventional treatment group,the levels of triglycerides(TG),total cholesterol(TC)and low-density lipoprotein cholesterol(LDL-C)in the combination group were significantly decreased,while the level of high-densi-ty lipoprotein cholesterol(HDL-C)was significantly increased(P＜0.01,P＜0.05).The serum levels of C-reactive protein(CRP),interleukin-6(IL-6)and tumor necrosis factor(TNF)-α in tje combination group were significantly decreased(P＜0.01,P＜0.05).Conclusion Modified Diitan Decoction combined with conventional Western medicine treatment can improve the cognitive function of VD patients,reduce the level of blood fat and improve the therapeutic effect.The analysis of its mechanism is related to the protection of neurotrophic factors and inhibition of inflammatory response and the adverse reactions in patients did not increase significantly.The treatment is suitable for promotion.
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