【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.
设计: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
评分评定疗效
疗效评定标准:?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
主题词: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)