作者单位：510170 广州，广州医学院荔湾医院神经内科(蔡鸣凡)；510170 广州，南方医科大学南方医院神经内科(周亮)

艾地苯醌联合尼莫地平治疗血管性痴呆的疗效观察

蔡鸣凡周亮

【摘要】目的探讨艾地苯醌联合尼莫地平治疗血管性痴呆的临床疗效。方法收集153例血管性痴呆患者，随机分为3组各51例，3组患者在降糖、调脂、降压治疗的基础上，分别应用艾地苯醌、尼莫地平和两药联合治疗，疗程3个月，应用简易精神状态检查量表(MMSE)、蒙特利尔认知评价量表(MoCA)、日常生活活动量表(ADL)评价3组疗效。结果疗程结束后，3组MMSE、MoCA评分均明显高于治疗前(P<0.05)，ADL评分则明显低于治疗前(P<0.05)。治疗后艾地苯醌组和尼莫地平组MMSE、MoCA、ADL评分比较差异无统计学意义(P>0.05)。联合用药组MMSE、MoCA评分均明显高于其他2组(P均<0.05)，ADL评分则明显低于其他2组(P<0.05)。联合用药组、尼莫地平组分别有2、1例患者应用尼莫地平后出现面部红热、血压下降，调整降压药后好转。结论艾地苯醌和尼莫地平改善血管性痴呆患者的疗效相近，两药联合应用效果更佳。

【关键词】血管性痴呆；艾地苯醌；尼莫地平；认知能力

DOI：10.3969/g.issn.0253-9802.2015.07.012

Abstract【】ObjectiveTo explore the clinical efficacy of idebenone combined with nimodipine in the treatment of vascular dementia. MethodsA total of 153 patients with vascular dementia were randomized into three groups with 51 patients in each group. In addition to conventional therapies for the control of blood glucose, lipid levels, and blood pressure, the patients in the three groups were treated with idebenone, nimodipine, or a combination therapy of idebenone and nimodipine for three months. The efficacy in patients of the three groups was evaluated using the Mini Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA), and the Activity of Daily Living Scale (ADL). ResultsAfter three months of treatment, the MMSE and MoCA scores of the patients in the three groups were all significantly higher than the corresponding pre-treatment scores(P<0.05), while the ADL scores were markedly lower than the scores before treatment (P<0.05). No statistically significant differences in the MMSE, MoCA, and ADL scores were observed between the idebenone group and the nimodipine group after treatment(P<0.05). The MMSE and MoCA scores of the combination therapy group were significantly higher than the scores of the other two groups (P<0.05), while the ADL score of the combination therapy group was significantly lower than that of the other two groups (P<0.05). Two patients in the combination therapy group and one patient in the nimodipine group exhibited facial flushing and a blood pressure drop after taking nimodipine, which was relieved after adjustment of the antihypertensive medication. ConclusionIdebenone and Nimodipine show comparable efficacy in the treatment of patients with vascular dementia, while a combination therapy of these two drugs exhibit better efficacy.

收稿日期：(2015-05-12)

Clinical efficacy of idebenone combined with nimodipine in the treatment of vascular dementiaCaiMingfan,ZhouLiang.LiwanHospitalofGuangzhouMedicalCollege，Guangzhou510170,China

【Key words】Vascular dementia; Idebenone; Nimodipine; Cognition

血管性痴呆是因脑缺血性卒中、出血性卒中及缺血、缺氧等脑血管疾病导致的严重认知功能障碍综合征，是继阿尔茨海默病后的又一常见痴呆类型。近年来，随着脑血管病发病率的上升，血管性痴呆的发病率也不断上升，严重影响患者的生存质量。该病如能在早期有效治疗可获治愈，是目前唯一可防、可治的痴呆[1]。艾地苯醌是一种辅酶Q10类似物，有较好的抗氧化作用，对大脑缺氧、缺血时的能量代谢具有良好的改善作用[2]。尼莫地平是二氢吡啶类钙通道拮抗剂，不仅具有改善脑供血及脑代谢的功效，还作用于神经元，对脑神经具有保护作用[3]。本研究通过随机对照方法，评价单独应用艾地苯醌或尼莫地平以及联合应用两药治疗血管性痴呆的疗效及安全性，旨在为日后合理用药提供参考，现报告如下。……