【作者】 韦云；

【导师】 周文泉；

【作者基本信息】 中国中医科学院 ， 中西医结合临床， 2011， 博士

【摘要】 血管性痴呆是发生在脑血管病基础上的以记忆、认知功能缺损为主,或伴有语言、视空间技能及情感或人格障碍等的获得性智能的持续性损害。在老年人所患的痴呆中,其发病率仅次于阿尔茨海默氏病,越来越影响老年人的健康和生活质量,并且随着我国人口的逐渐老龄化,将给社会和家庭带来越来越沉重的负担。对于血管性痴呆的治疗,目前国内外尚无特效方法和药物,发挥中医药优势,治疗血管性痴呆具有重要的意义。导师周文泉教授在络病理论的指导下,结合自己多年的临床实践经验,以及现代医学对血管性痴呆发病机制的认识和近年的中医文献研究,提出了轻度血管性痴呆是以肾虚为本,痰浊或瘀血阻络为标的病机学说。目的：本课题通过临床试验研究,观察补肾化痰颗粒、补肾活血颗粒治疗轻度血管性痴呆的临床疗效及安全性,并通过分析其对胆碱能系统的影响并结合现代中药药理研究,探讨其可能作用机制。方法：采用完全随机、对照的原则,将81例患者按照2：1的比例,随机分为中药治疗组55例和对照组26例,中药治疗组在中医辨证论治的基础上又分为肾虚血瘀阻络和肾虚痰浊阻络两型,分别予以补肾化痰颗粒和补肾活血颗粒治疗,对照组给予茴拉西坦胶囊治疗。从临床症状、简易智能量表、日常生活能力评定量表、血清中枢胆碱能系统等方面进行研究,观察中药复方治疗轻度血管性痴呆患者的临床疗效。结果：与治疗前比较,三组均可明显改善轻度血管性痴呆患者的ADL、MMSE积分(P<0.01)；对于NFDS积分的改善,中药治疗组明显优于茴拉西坦组。治疗后,补肾化痰组和补肾活血组对相应的中医躯体症状有较好的治疗作用(P<0.01)。中医治疗组对中医症候的改善作用明显优于对照组(P<0.01或P<0.05)。三组药物均可以增加ACh、ChAT的分泌,对于ACh,中药治疗组疗效明显优于对照组；三组均可以抑制AchE的活性,但三组比较无明显统计学差异。中药治疗组患者用药后未出现明显不良反应。结论：1本中药颗粒剂对轻度血管性痴呆具有与茴拉西坦相似的治疗效果,但是在改善中医症候、调节中枢胆碱能功能方面疗效略优于茴拉西坦；2肾虚为本,痰浊或瘀血阻络是轻度血管性痴呆的主要病机；3运用中医络病理论指导轻度血管性痴呆的治疗是可行的；4调整中枢胆碱能系统的功能可能是本中药颗粒剂发挥益智作用的一条途径。更多还原

【Abstract】 Vascular dementia(VaD),occurring on the basis of cerebrovascular disease,is an acquired durative mental impairment disease characterized by functional impairment of memory and cognition,or accompanied by disorder of language,vision to space,emotion and personality.The incidence of VaD is only second to Alzheimer’s Disease(AD) among the old dementia-stricken people,more and more becoming common disease and frequently-occurring disease of influencing middle-aged and aged people’s health and quality of life.And with the development of Chinese aged population,it will bring heavy burden to society and family.For the treatment of VaD,there is not effective methods and medicine now.It is significant for adopting Chinese medicine to treat VaD.This study combined the collateral disease theory with my tutor’s clinical experiences,the pathogenesis of modern medical knowledge and the TCM literature research in recent years about VaD.My tutor professor zhouwenquan put forward that the basic pathogenesis of early mild vascular dementia was result from kidney deficiency in the root, and the blockage of collaterals by blood stasis or phlegm on the basis of the TCM theory of syndrome differentiation.Objective:First, to observe the efficacy and security of Chinese Herb composition in treating the VaD through scientific clinical trial. Second, through analysing the influence of Chinese Herb composition on the activity of the central cholinergic system and modern pharmacological study to explore the probable mechanism.Method:Completely randomized controlled block trial was used.81 cases of VaD patients were divided into treatment group and control group with the ratio of 2:1 design. Then the treatment group was devided into deficiency of kidney and blood stasis syndrome, deficiency of kidney and phlegm obstruction in collaterals on the basis of TDS,which were then given Bushen and huoxue Granule,Bushen and huatan Granule. The control group was given aniracetam capsules. From the variation of clinical symptoms, simple Intelligence Scale, Clinical Dementia Scale, Daily life ability Scale,central cholinergic system of two group before and after treatment,to analyze clinical efficacy of Mild VaD patients,and to prove the feasibility of the collateral disease theory in guiding the treatment of Mild VaD patients.Result: The result showed that after treatment, the three groups could increase the scores of MMSE and ADL of early Mild VaD patients (P<0.01); as for the scores of NFDS, the effect of the therapentic group was superior to the control group. At the same time, the TCM treatment group had good effect in treating the symptoms, having a very prominent meaning to contrast before and after treating(P<0.01).The TCM syndrome scores was improved in TCM treatment group as compared with that in control group (P<0.01), except the facial expression. As to the impact on the central cholinergic system,the three groups also can stimulate the production of ACh、ChAT and inhibit the activity of AchE.The treatment group and the control group showed a similar efficacy in improving the function of ACh.For Ach,the comparison of the curative effect in the treatment group was better than the control group (P<0.05). After being observed, theTCM treatment groups had no adverse events.Conclusion:1 Aniracetam capsules does not show more effectiveness in treating VaD than Chinese Herb composition in my recearch. In improving the TCM syndrome and injusting the function of the central cholinergic system, Chinese Herb composition has more effective than aniracetam capsules.2 Kidney deficiency in the root, and the blockage of collaterals by blood stasis or phlegm is the basic pathogenesis of early mild vascular dementia.3 It is feasible to treat the VaD according to the collateral disease theory.4 Adjusting the central cholinergic system is the probable mechanism that the Chinese Herb composition works.更多还原