黄芪续命汤对缺血性脑卒中致血管性痴呆患者的临床疗效观察

The clinical effect of Astragalus Life-sustaining Decoction on patients with vascular dementia caused by ischemic stroke

关键词:  缺血性脑卒中  血管性痴呆  黄芪续命汤  可溶性髓样细胞触发受体2  脂蛋白相关磷酸酶A2  β淀粉样蛋白 1-42

Key words:  ischemic stroke  vascular dementia  Astragalus Life-sustaining Decoction  soluble myeloid cell trigger receptor 2  lipoprotein-associated phosphatase A2  beta amyloid 1-42

摘要:

[目的] 探讨黄芪续命汤对缺血性脑卒中致血管性痴呆（VD）患者认知功能及血清可溶性髓样细胞触发受体2（sTREM2）、脂蛋白相关磷酸酶A2（Lp-PLA2）和β淀粉样蛋白1-42（Aβ1-42）的影响。[方法] 选取南阳市第二人民医院于2020年1月—2022年8月收治的缺血性脑卒中致血管性痴呆患者110例，采用随机数字表法分为对照组与观察组，观察组54例，对照组53例。对照组均接受单纯常规西医治疗，观察组在对照组的基础上加用黄芪续命汤治疗，两组均持续治疗1个月。对比两组患者临床疗效及治疗前后中医证候积分、蒙特利尔认知评价量表（MoCA）各项评分、简易智力状态检查量表（MMSE）评分、美国国立卫生院卒中量表（NIHSS）评分、长谷川痴呆量表（HDS）评分、血清sTREM2、Lp-PLA2和Aβ1-42水平变化情况，比较两组患者治疗期间不良反应发生情况。[结果] 两组患者临床疗效对比结果显示，观察组治疗总有效率为92.59%，明显高于对照组的77.36%（P<0.05）。治疗后两组患者主症状积分、次症状积分及总积分均明显下降（P<0.05），且观察组上述指标均明显小于对照组（P<0.05）。治疗后两组患者MoCA各项评分均有明显提升（P<0.05），且观察组MoCA各项评分均明显高于对照组（P<0.05）。治疗后两组患者MMSE、NIHSS、HDS评分均有明显改善（P<0.05），且观察组上述评分的改善程度均明显优于对照组（P<0.05）。治疗后两组患者血清sTREM2、Lp-PLA2和Aβ1-42水平均有明显下降（P<0.05），且观察组上述血清指标均明显低于对照组（P<0.05）。观察组与对照组治疗期间不良反应的总发生率分别为5.56%（3/54）、9.43%（5/53），组间比较差异无统计学意义（P>0.05）。[结论] 黄芪续命汤对缺血性脑卒中致血管性痴呆患者的临床疗效确切，可使患者认知功能及血清sTREM2、Lp-PLA2和Aβ1-42水平得到明显改善，且不会增加用药风险，值得临床推广应用。

Abstract:

[Objective] To investigate the effects of Astragalus Life-sustaining Decoction on cognitive function，serum soluble myeloid cell triggering receptor 2（sTREM2），lipoprotein-associated phosphatase A2（Lp-PLA2） and β-amyloid 1-42（Aβ1-42） in patients with vascular dementia（VD） caused by ischemic stroke. [Methods] A total of 110 patients with VD caused by ischemic stroke admitted to our hospital from January 2020 to August 2022 were selected and divided into the control group and observation group by random number table method，with 54 cases in the observation group and 53 cases in the control group. The control group received simple conventional Western medicine treatment，and the observation group was treated with Astragalus life-sustaining Decoction based on the control group. Both groups received continuous treatment for 1 month. The clinical efficacy，TCM syndrome scores，Montreal Cognitive Assessment Scale（MoCA） scores，Simple Mental State Examination Scale（MMSE） scores，National Institutes of Health Stroke Scale（NIHSS） scores，Nagagawa Dementia Scale（HDS） scores，serum sTREM2，Lp-PLA2 and Aβ1 were compared between the two groups. The adverse reactions of patients were compared between the two groups during treatment. [Results] The comparison of clinical efficacy of VD patients between the two groups showed that the total effective rate of the observation group was 92.59%，which was significantly higher than that of the control group（77.36%）（P<0.05）. After treatment，the principal symptom score，secondary symptom score，and total score of VD patients in both groups were significantly decreased（P<0.05），and the above indexes in the observation group were significantly lower than those in the control group（P<0.05）. After treatment，MoCA scores of VD patients in both groups were significantly improved（P<0.05），and MoCA scores in the observation group were significantly higher than those in the control group（P<0.05）. After treatment，MMSE，NIHSS and HDS scores of VD patients in 2 groups were significantly improved（P<0.05），and the improvement degree of the above scores in the observation group was significantly better than that in the control group（P<0.05）. After treatment，serum sTREM2，Lp-PLA2，and Aβ1-42 levels of VD patients in 2 groups were significantly decreased（P<0.05），and the above serum indexes in the observation group were significantly lower than those in the control group（P<0.05）. The total incidence of adverse reactions in the observation group and the control group was 5.56%（3/54） and 9.43%（5/53），respectively，and there was no statistical significance between the two groups（χP>2P>=0.156，P=0.693）. [Conclusion] The clinical efficacy of Astragalus Life-sustaining Decoction in patients with VD due to ischemic stroke is precise，which can lead to significant improvement in cognitive function and serum sTREM2，Lp-PLA2，and Aβ1-42 levels without increasing the risk of medication，and it is worthwhile to popularize the use of the drug in the clinic.