贺丹 谭军 张杰文

中圖分类号 R743 文献标志码 A 文章编号 1001-0408（2018）04-0534-04

DOI 10.6039/j.issn.1001-0408.2018.04.25

摘 要 目的：探讨盐酸美金刚对血管性痴呆（VD）患者认知功能、脑血流动力学及氧化应激水平的影响。方法：选取2013年2月-2015年2月新乡医学院第三附属医院收治的VD患者70例，采用随机数字表法分为对照组（36例）和观察组（34例）。观察组患者给予盐酸美金刚片口服，起始剂量为5 mg/d，qd，随后以5 mg/周递增，第4周至维持剂量20 mg/d，qd；对照组患者给予吡拉西坦片0.8 g，口服，tid。两组患者均以4周为1个疗程，共治疗6个疗程。观察两组患者临床疗效，治疗前后蒙特利尔认知评估量表（MoCA）评分、日常生活活动量表（ADL）评分，大脑中动脉收缩期峰值速度（Vmax）、舒张期峰值速度（Vmin）、搏动指数（PI）、阻力指数（RI）、屏气指数（BHI），血浆丙二醛（MDA）、超氧化物歧化酶（SOD）及血清同型半胱氨酸（Hcy）水平，并记录不良反应发生情况。结果：对照组脱落4例，观察组脱落2例，两组各有32例患者完成本研究。观察组患者的总有效率为87.50%，显著高于对照组的65.63%，差异有统计学意义（P<0.05）。治疗前，两组患者上述指标比较，差异均无统计学意义（P>0.05）。治疗后，两组MoCA、ADL评分及SOD水平均显著升高，MDA、Hcy水平均显著降低，观察组患者Vmax、BHI显著升高，且观察组上述指标均显著优于对照组，差异均有统计学意义（P<0.05）；但两组患者治疗前后Vmin、PI、RI比较，对照组患者治疗前后Vmax、BHI比较，差异均无统计学意义（P>0.05）。两组患者不良反应均较轻微，其发生率比较差异无统计学意义（P>0.05）。结论：盐酸美金刚治疗VD可改善患者脑血流动力学，减轻氧化应激反应，提高其认知功能，且安全性高。

关键词 血管性痴呆；盐酸美金刚；疗效；脑血流动力学；认知功能；氧化应激

ABSTRACT OBJECTIVE： To investigate the effects of memantine hydrochloride on cognitive function， cerebral hemodynamics and oxidative stress level in patients with vascular dementia （VD）. METHODS： A total of 70 VD patients in the Third Affiliated Hospital of Xinxiang Medical College from Feb. 2013 to Feb. 2015 were divided into control group （36 cases） and observation group （34 cases） aoccording to random number table. Observation group was given Memantine hydrochloride tablets orally with initial dose of 5 mg/d， qd， increasing by 5 mg/week gradually， maintaining at 20 mg/d， qd， at 4th week. Control group was given Piracetam tablets 0.8 g orally， tid. A treatment course of 2 groups lasted for 4 weeks， and both were treated for 6 courses. Clinical efficacies as well as MoCA scores， ADL scores， systolic peak velocity （Vmax）， diastolic peak velocity （Vmin）， pulsatility index （PI）， resistance index （RI） and breath holding index （BHI） of middle cerebral artery， the levels of MDA， SOD and Hcy were observed in 2 groups. The occurrence of ADR was recorded. RESULTS： Four， two patients withdrew from the study in control and observation group， respectively， and 32 patients in each group completed the study. The total response rate of observation group was 87.50%， which was significantly higher than 65.63% of control group， with statistical significance （P<0.05）. Before treatment， there was no statistical significance in above indexes between 2 groups （P>0.05）. After treatment， MoCA， ADL scores and SOD levels of 2 groups were increased significantly， while MDA and Hcy levels were decreased significantly； Vmax and BHI of observation group were increased significantly， and above indexes of observation group was significantly better than those of control group， with statistical significance （P<0.05）. There was no statistical significance in Vmin， PI or RI between 2 groups before and after treatment， and Vmax or BHI of control group before and after treatment （P>0.05）. ADRs of 2 groups were mild， and there was no statistical significance in the incidence of ADR between 2 groups （P>0.05）. CONCLUSIONS： Memantine hydrochloride in the treatment of VD patients can improve the cerebral hemodynamics， reduce oxidative stress and improve cognitive function with good safety.

KEYWORDS Vascular dementia； Memantine hydrochloride； Therapeutic efficacy； Cerebral hemodynamics； Cognitive function； Oxidative stress

血管性癡呆（VD）指由脑血管疾病引起的脑功能障碍，占老年期痴呆的49%，发病率仅次于阿尔茨海默病。VD……