【doc】 石杉碱甲治疗改善脑器质性疾病患者的记忆和认知功能

【doc】 石杉碱甲治疗改善脑器质性疾病患者的记忆和认知功能 石杉碱甲治疗改善脑器质性疾病患者的记 忆和认知功能 128 中国临床康复第9卷第j6期2005—09—28出版 ChineseJournalofClinicalRehabilitation,September282005Vol9No36 ? CLINICALRESEARCH? HuperzineAforimprovingthememoryandcognitivefunctionin patientswithorganicbraindiseases YeQin,WuRui—zhi,LiHal—lin DepartmentofGeriatricPsychiatry,BrainHospitalofNanjingMedicalU— niversity,Nanjing210029,JiangsuProvince,China YeQin,DepartmentofGeriatricPsychiatry,BrainHospitalofNanjing MedicalUniversity.Nanjing2l0029,JiangsuProvince,China . njmu.edu.cn Received:2004—05,O7Accepted:2005一O8—26f04/XM1 Abstract BACKGR0LPND~HuperzineA.acholinesteraseinhibitorextractedfrom qiancengtaherb,canpromotetherecoveryofmemoryandstrengthenmem— pryretention. OBJECTIVE:ToprobeintotheamelioratingeffectofhuperzineAon memoryandcognitivefunotioninpatientswithvasculardementia(VD)and Alzheimer’sdiseasefAD). DESIGN:Caseanalysis. SETTING:DepartmentofGeriatricPsychiatry.BrainHospitalofNanj’ing MedicalUniversity. PARTIC?’ANTS:Totally64patients.30malesand34femalestreatedin theDepartmentofGeriatricPsychiatry,BrainHospitalofNanjingMedical University,betweenMarch2000andMarch2002wererecruited.Among them,therewere4lca~esofVD(VDgroup)and23casesofAD(ADgroup). M_ETH0DS:PatientsinthetwogroupsalltookhuperzineAtabletsoral— ly,atatotaldoseof200gaday,twiceadayfor8weeks.Memoryquo— tient(M0)valueandMiniMentalStatusExamination(MMSE)scorewere usedbeforeandaftertreatmenttoevaluatethecurativeeffects.Evaluate criteria:(1jMarkedlyeffective:MQvalueandMMSEscoreaftertreatment wereenhancedhy25%comparedtothosebeforetreatmentandtheclinical symptomswereimprovedobviously.?Effective:MQvalueandMMSE scorewereenhancedbyl5%separately.andtheclinicalsymptomswere improved.?Otherswereregardedasnon—effectivecases. MAIN0UTC0MEM_EASURES:(Curativeeffectonpatientsinthe twogroups8weeksaftertreatment;?MQvalue,MMSEscore,anddaily activityabilityscoreinpatientsbeforeand”aftertreatment. RESULTS:A1lthe64patientsenteredtheresultanalysis.(Curativeef- ctonpatientsinthetwogroups8weeksaftertreatment:Thetotaleffec. tiverateinVDgroupwas7l%.whichwassignificantlyhigherthanthatin ADgroup(48%)(P<0.01).Thesevererdementiawas,thelesscurative effectwas,.?ScoresofMQ,MMNSEanddailyactivityability:MQvalue andMMSESCOreofpatientsinthetwogroupsweresignificantlyhigheraf- tertreatmentthanbeforetreatmentfP<0.05—0.01).However,scoreofdai. 1yactivityabilitydidnotobviouslydifferfP>0.05). C0NCLUS10N:HuperzineAcaneffectivelyimprovememoryandcognitive functioninpatientswithorganicbraindiseasesandhasgoodcurativeeffects. YeQWuP.ZLiHEEffectsofhupe~ineAonmemoryondcognitivefunction inpatientswilhorganicbroindiseasesZhongguoLinchuangKantfu2005;9(361: 128—9(Chino)1wwwzglckfcom] INTRoDUCTIoN HuperzineA,acholinesteraseinhibitorextractedfromqiancengta herb,canpromotetherecoveryofmemoryandstrengthenthereten— tionofmemory.ResearchinmanyyearsindicatesthathuperzineA hascertaincurativeeffectsll1.ThispaperwastoapplyhuperzineAin treatingmemoryandcognitivefunctiondisordersinpatientswithor- ganicbraindi~asesandprobeintoitscurativeeffects. SUBJECTSANDMETHODS Subjects Totally64patientstreatedintheDepartmentofGeriatricPsychia— try,BrainHospitalofNanjingMedicalUniversity,betweenMarch 2000andMarch2002wererecruited.Amongthem,therewere40 outpatientsand24inpatients.30malesand34femalesagedfrom 60to88yearswiththemeanageoff68+71years.Theyallmetthe diagnosticcriteriafororganicmentaldisordersofthebrain.Among them.therewere4lcasesofvasculardementiafVD1and23cases ofAlzheimer’sdiseasefAD).Inclusioncriteria:Thosewithgeneral— izedinfarction/orbrainatrophyconfirmedbyradiologicalexamina— tion.Exclusioncriteria:Severeheart,1iverandkidneydiscrders. ?Thosewithdementiaduetoothercauses.?Memoryquotient (MQ)?90,MiniMentalStatusExamination(MMsE)?24points. Methods PatientsinthetwogroupsalltookhuperzineAtablets(provided byHenanZhongmeiZhulinZhongshengPharmaceuticalCo.Ltd), atatotaldoseof200gaday,twiceadayfor8weeksasone courseofdisease.Administrationofanydrugsthatwouldpromote intelligenceandaffectbrainmetabolismwasstoppedbeforetreat— ment.Asforpatientswithinsomnia,benzodiazepinedrugsofsmall doseswereusedincombinationwithhuperzineA.Forpatients withpsychiatricsymptoms,asmalldoseoftranquilizerwasadded. MQvalueandMMSEscoreweremeasuredbeforeandaftertreat— ment.Blood,urineroutine.liverandkidneyfunotions.andelec— trocardiogramweredetected. Evaluativecriteriaforcurativeeffects:Markedlyeffective:MQ valueandMMSEscorewereenhancedby25%aftertreatment comparedwiththosebeforetreatment.andtheclinicalsymptoms wereobviouslyimprovedEffective:MQvalueandMMSEscore wereenhancedbyl5%respectivelycomparedwiththosebefore treatment.andtheclinicalsymptomswereimproved.?Others wereregardedasnon—effectivecases. Statisticalanalysis:Theanalysisofvarianceandttestwereper— formedwithSPSSl0.0softwarebytheauthors RESUL’I’S Descriptivestatistics Quantitativeanalysisoftheparticipants Totally64patientswereincludedinthisexperimentandallof thementeredtheresultanalysiswithnolOSSnthemidway. Comparisonofbaselinedatabetweenthetwogroups@able1) Thetwogroupsdidnotsignificantlydifferingender,age,courseof disease,anddeeofdementia(尸>0O5). TahlelCompasonofbaselinedatabetweenthetw.gr【)ups Gmup满 (yr)Course0fDgree0fden1entia(miId/diseasP(yr1moderate/severe1 Statis廿calinfbrence sonofcuI_ativeeffcts8weeksaftertIatmentinpatients Compa— ofthetwogroupsfrable2) 1’able2C0mps0n0fcuraVeec[s8weeksanerfrea[men,jpan,s ofthetw.gmups(n/%) <O.O1,svasculardementi0up lSSN1671—5926CN21—1470/R Mckf.CODI723385083@sina.com叶勤’等l磊盖脑器质性疾病患者的 Table2showsthatthetotaleffectiverateinVDgroupandAD groupwas71%and48%,respectively,withsignificantdifference fP<0.011. Relationshipbetweendementiadeg~eandcurativeeffectsinpa— tientsofthetwogroups(Table3) Table3Comparisonofthecurativeeffectsondifferentdementiadegrees inpatientsofthetwogroups 129 ThepathogenesisofADisstillunclear.Accordingtobiochemical studies.itisrelatedtotheinfluencebyneuralcholinergicsystem iniuryonthelevelofcerebralfreeradicals141.Withtheprogressof AD,thedegenerationofneuralcholinergicsystemworsensgradual— lv:themetabolismoffreeradicalsisobviousdisturbed,whichis closelyrelatedtothelevelofsuperoxidedismutaseandperoxidase inthehippoeampuscloselyconnectedwithcholinergicsystem.In retum.thedisturbanteoffreeradicalswo~ensthedisorderof neurotransmittermetabolism.injurescerebraltissuesincessantly, andworsensthesymptomsofAD.Recentstudieshavefoundthat huperzineAnotonlyhasinhibitoryeffectsoncholinesterase,but alsocanenhancetheabilityofsuperoxidedismutaseandlowerthe concentrationofprperoxidasesoastocureAD. Table3showsthatthesevererdementiawas,thepoorerthecura— tiveeffectwas.REFERENCES Memoryandcognitivefunctionbeforeandaftertreatmentinpa— tientsofthetwogroups(Table4) Table4Memoryandcognitivefunctionbeforeandaftertreatmentinjm— tientsofthetwogroups1 Memol~”quotient61.4?16.1274-2?12.836.388<00l MiniMentalStatusExamination20.7-+6.9026.2-+1.6421.474<0.05 Abilityofdailyliaeti~rities30.6-+2.8426.8-+5601.345>005 Memoryquotient436?126O58.6-+8.958.038<00l MiniMentalStatusExaminationl67?6.82207-+6.5l2.947<0.05 Abilityofdailylifeactivities22.2-+4.3318.9-+5.771.743>0.05 Table4showsthatMOandMMSEscoresandcurativeeffectsin thetwogroupswereremarkablyimprovedaftertreatmentcompared 0.011.Itsuggeststhathu— withthosebeforetreatmentfP<0.05— perzineAhasgoodcurativeeffectsintreatingmemoryandcogni— tivefunctiondisorderinorganicbraindiseases. Adverseeventsandsideeffects Adversereactionscalewasusedtoperformevaluationonthe2. 4.6and8weeks’afteradministration.Onweek2’aftertreat— ment.mildenterogastricreactionoccurredin2casesandmild dizzinessoccurredin4cases.Onweek4aftertreatment.bradycar— diaf54—60times/min1occurredin5cases.Sideeffectsdeveloped in11cases.andtheclinicalsymptomsdisappearedwithoutspecial treatment.Therewerenootherobviouschangesaftertherapy. DISCUSSIoN Manyscholarsbelievethatlearningandmemoryfunotionsare closelvrelatedtotheneuralcholinergicsystem~.Thelevelofneu— rotransmitteracetylcholineinthebrainispositivelyrelatedto learningandmemoryfunction.Itisthusevidentthatacetylcholine hasanimportantroleincognitivememoryfunotionofthebrain. ThepresentstudyusedhuperzineA,acholinesteraseinhibitor,to treatorganicbraindiseasesin64cases.The8一weekobservation showedthathuperzineAhadgoodcurativeeffectsonorganic memoryandcognitivefunctionofthebrain.Thetotaleffectiverate was63%.andtheeffectiveratewas70%inVDgroup.whichwas obviouslyimprovedcomparedtothatinADgroupf48%1.There— suitswereconsistentwiththoseintheliterature.Insomeexperi— ments.huperzineAwasusedtotratmemorvandcognitivefunc— tioninADandVDpatients,andachievedamelioratingeffects.It isalsorevealedinthelateststudiesthatthecombinationofestro— genandhuperzineAcaneffectivelytreatmildandmoderateAD infemalepatientsandimprovecognitivefunctionanddailylife seIf-careabilitywithbettertoleranceandgreatsafety[31. 石杉碱甲治疗改善脑器质性疾病患者的记忆和 认知功能 叶勤,吴瑞枝,李海林(南京医科大学附属脑科医院老年精神科,江苏 省南京市2l0HD29) 叶勤,女,1960年生,江苏省南京市人,汉族,1982年南京医科大学毕 业,主要从事老年精神病治疗及老年心理卫生的研究. 摘要 背景:石杉碱甲是从千层塔草药中提炼的胆碱酯酶抑制剂,具有促进 记 忆再现和增强记忆保持的作用. 目的:应用石杉碱甲治疗血管性痴呆和阿尔茨海默病患者,探讨其对 记 忆和认知功能的改善作用. :病例分析: 单位:南京医科大学附属脑科医院老年精神科 对象:选择20oO一03/2002—03南京医科大学附属脑科医院老年精神科 患者64例.男30例,女34例;其中血管性痴呆4l例(血管性痴呆组), 阿尔茨海默病23例(阿尔茨海默病组). 方法:两组患者均服用石杉碱甲片剂,每日总剂量为200Ixg,2次/d共 治疗8周.治疗前后采用记忆商值,简易智能状态量表评分评定疗效 疗效评定:?显效:治疗后记忆商值,简易智能状态量表评分比治 疗前提高25%以上,以及l临床症状明显改善?有效:记忆商值,简易智 能状态量表评分分别提高15%以上,以及临床症状有改善.?其他视为 无效病例: 主要观察指标:?两组患者治疗8周后疗效?两组患者治疗前后记忆 商值,简易智能状态量表,El常生活活动能力评分 结果:64例患者全部进入结果分析.?两组患者治疗8周后疗效:血管性 痴呆组总有效率为7l%,明显高于阿尔茨海默病组(48%)(P<0.01): 其中痴呆程度越重,疗效越差.?记忆商值,简易智能状态量表,日常 生 活活动能力评分:两组患者治疗后记忆商值,简易智能状态量表评分均 明显高于治疗前(P<0.05,0.01).而日常生活活动能力评分无明显改善 (P>0.05). 结论:石杉碱甲能有效改善脑器质性疾病患耆记忆和认知能力,具有较 好的疗效 主词:阿尔茨海默病/药物疗法;倍半萜类/治疗应用;痴呆,血管性/ 药物疗法;精神状态,检查表 中图分类号:R742文献标识码:A文章编号:1671—5962一(2005)36—0128—02 叶勤,吴瑞枝,李海林石杉碱甲治疗脑器质性疾病患者记忆和认知功能的疗效 中国临床康复,2005,9(36):128—91wwwzglckfcom] (EditedbyFanXH/SongLP/XiaoXL)