【作者】 王辞晓；

【导师】 张英强；

【作者基本信息】 成都中医药大学 ， 中医内科学， 2010， 硕士

【摘要】 目的：通过运用补肾活血化痰法对缺血再灌注小鼠血管性痴呆模型的实验研究及血管性痴呆临床病例治疗的观察,探讨补肾活血化痰法防治血管性痴呆的作用机理及其临床疗效。方法：实验部分：采用双侧颈总动脉结扎反复脑缺血再灌注的方法制备VD小鼠模型。模型成功建立后随机分为假手术组,模型组,喜得镇组,脑力苏胶囊(补肾活血化痰药方配制)高剂量组,脑力苏胶囊低剂量组,其中后三组为治疗组。实验过程中观察各组小鼠的体重变化；术后15天检测小鼠跳台试验得分、脑组织脑源性神经生长因子(BDNF)、血清总超氧化物岐化酶(T-SOD)及血清丙二醛(MDA)含量。临床观察：收集40例符合研究标准的血管性痴呆患者,随机分为治疗组和对照组各20例进行病例研究。两组均以西医常规治疗：对照组口服喜得镇(1mg/次,3次/日)；治疗组在服用喜得镇的基础上加服脑力苏胶囊(脑力苏胶囊方汤剂,口服,200ml／次,3次/日),两组每个疗程均4周,共3个疗程。主要观察患者的安全性及有效性指标、中医证候疗效、认知功能疗效(MMSE)、日常生活活动能力改善情况(ADL)等。结果：实验部分：实验过程中小鼠体重有一过性的降低,一周后体重开始回升,其中以脑力苏胶囊低剂量组最为明显。治疗组小鼠学习反应时间缩短、记忆潜伏时间延长、错误次数减少(p<0.05)；脑内BDNF、血清T-SOD增高(p<0.05),血清MDA降低(p<0.05),其中以脑力苏胶囊低剂量组最为明显。临床观察：治疗组中医证候辨证量表、简易智能状态检查量表、日常生活能力量表等的评分结果及疗效判定均优于对照组。随着治疗时间的延长,治疗组疗效更加显著,优于对照组,(p<0.05)。结论：根据补肾活血化痰法研制的脑力苏胶囊可改善VD小鼠的生长及行为学状况,提高其神经自我保护和抗氧化能力。这可能是该法防治VD作用机制之一。临床观察证实脑力苏胶囊不仅具有改善患者智能障碍,减轻症状,增强患者日常生活能力,提高生活质量的作用,而且有改善血压,降低血清总胆固醇,升高高密度脂蛋白的作用。更多还原

【Abstract】 Objective:Experimental and clinical observation of Kidney-invigorating, Blood-promoting and Phlegm-dissipating in vascular dementia (VD) mice, to explore the mechanism of prevention and treatment VD.Methods:Experimental study The models of VD mice were established by cerebral ischemia reperfusion, All the mice were divided randomly into five groups:sham-operated group, model group, Hydergine group, high-dose of Naolisu capsule group, low-dose of Naolisu capsule group. To observe body weight change in mice, after 15 days later, The influence of cerebral ischemia reperfusion on behaviors of mice was studied by step down test. The levels of brain-derived neurotrophic factor(BDNF), superoxide dismutase(SOD) and malondialdehyde(MDA) were analyzed with biochemistrical analysis method.Clinical observation Study 40 patients who suffered from vascular dementia, all the people were divided randomly into treatment group and control group, and case-control study on them. Two groups have conventional treatment:The control group was treated with Hydergine (Po, 1mg/time, Tid), The treatment group was treated with Hydergine and Naolisu capsule (Po, 200ml/time, Tid). The total course of treatment was 12 weeks, each treatment group were 4 weeks. We observed the safety and efficacy in patients. we used syndrome differentiation scale of vascular dementia(SDSVD), mini-mental state examination(MMSE) and activity of daily living scale(ADL) to evaluate the state of patient.Results:Experimental study There is a transient lowering of body weight, after one week it begin to rise. Repeated cerebral ischemia reperfusion showed more severe impairment of learning and memory than that of treatment groups(p<0.05), the activity of SOD and BDNF obviously increased in treatment groups, the content of MDA reduced in treatment groups(p<0.05), The most obvious is low-dose of capsule group.Clinical observation The treatment group was better than the control group in scores and clinical effectiveness. With the time increasing, The treatment group was more effective than the control group, (p<0.05).Conclusions:The Kidney-invigorating, Blood-promoting and Phlegm-dissipating could improve the growth status, and their nervous self-protection and anti-oxidation ability in mice. It may be one of the mechanisms to treatment VD. Clinical observations confirm Naolisu capsule not only improve patient with intellectual disabilities, reduce bad symptoms, enhance the patient activities of daily living and the role of quality of life. It also reduce the blood pressure, lowering serum total cholesterol, and increase the role of high density lipoprotein.更多还原