益肾聪明汤治疗小血管闭塞性卒中后认知功能障碍（肾虚痰瘀证）的临床研究

Clinical study on the treatment of cognitive dysfunction (kidney deficiency,phlegm and blood stasis syndrome) after small vascular occlusion stroke by Yishen Congming Decoction

关键词:  益肾聪明汤  小血管闭塞性卒中  认知功能障碍  同型半胱氨酸

Key words:  Yishen Congming Decoction  small vessel occlusive stroke  cognitive dysfunction  homocysteine

摘要:

[目的] 探讨益肾聪明汤治疗小血管闭塞性卒中后认知功能障碍（肾虚痰瘀证）的临床疗效及安全性，同时对患者生活质量及血清同型半胱氨酸（Hcy）的影响。[方法] 选取上海市嘉定区中医医院脑病科脑小血管闭塞性卒中（SAO）合并认知障碍患者80例，按照1：1随机分为治疗组和对照组，在缺血性卒中的基础治疗上，治疗组予以中药益肾聪明汤治疗，对照组予以尼莫地平片治疗，治疗疗程8周。在治疗前和治疗后分别应用蒙特利尔认知评估量表（MoCA）、巴氏量表（MBI）、中医症状评分量表评价患者的认知功能、生活质量及中医症状评分，同时检测患者血清Hcy的水平，并进行安全性评价。[结果] 治疗组MoCA和MBI评分治疗8周后显著高于治疗前和相同时间节点对照组（P<0.01）；日常生活能力量表（ADL）和中医症状评分在治疗8周后显著低于治疗前和相同时间节点对照组（P<0.01）；血清中Hcy含量治疗8周后较治疗前有显著降低（P<0.01），较对照组明显降低（P<0.05）。[结论] 益肾聪明汤可以有效改善小血管闭塞性卒中后认知功能障碍（肾虚痰瘀证），降低血清Hcy水平，提高患者生活质量，且无明显不良反应。

Abstract:

[Objective] To investigate the clinical efficacy and safety of Yishen Congming Decoction in the treatment of cognitive dysfunction (kidney deficiency,phlegm and blood stasis syndrome) after small vascular occlusion stroke,and explore the effect of quality of life and serum homocysteine.[Methods] The 80 patients with brain disease small vascular occlusion stroke(SAO) with cognitive dysfunction were selected,and they were randomly divided into treatment group and control group according to 1:1. While giving the basic treatment of ischemic stroke,the treatment group was treated with traditional Chinese medicine Yishen Congming Decoction,and the control group was treated with nemodipine tablets. The course of treatment was 8 weeks. The Montreal Cognitive Assessment Scale (MoCA),Bartel index (Bartel index),and Chinese medicine symptom score scale were used before and after treatment to evaluate the patient's cognitive function,quality of life,and Chinese medicine symptom score. At the same time,the serum homocysteine (Hcy) level of the patients was measured and the safety was evaluated.[Results] The scores of MoCA and MBI in the treatment group were significantly higher than those in the control group after 8 weeks of treatment (P<0.01);the scores of ADL and TCM syndrome were significantly lower than those in the control group (P<0.01);the content of Hcy in serum was significantly lower than that before treatment (P<0.01),and significantly lower than that in the control group (P<0.05).[Conclusion] Yishen Congming Decoction could improve the clinical effect of cognitive dysfunction (kidney deficiency,phlegm and blood stasis syndrome) after small vascular occlusion stroke,reduce the level of serum Hcy,and improve patients' quality of life without obvious side effects.