作者：丁彩霞，盛蕾，张兰坤，胡丹，肖婧，李传游

单位：

南京中医药大学第二附属医院神经内科

单位（英文）：

Department of Neurology, the Second Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing 210017, China

关键词：

卒中; 卒中后认知障碍; 桃核承气汤; 治疗结果; 认知功能; 脂联素;

关键词（英文）：

Stroke; Post-stroke cognitive impairment; Taohe Chengqi decoction; Treatment outcome; Cognitive function; Adiponectin

中图分类号：

DOI：

10.12114/j.issn.1008-5971.2023.00.157

基金项目：

江苏省中医药科技发展计划项目（MS2022038）

摘要：

目的 探讨桃核承气汤治疗卒中后认知障碍（PSCI）的疗效及其对患者认知功能和血清脂联素水平的影响。方法 选取2018—2019年于南京中医药大学第二附属医院神经内科门诊就诊的PSCI患者100例。采用随机数字表法将患者分为常规组和桃核承气汤组，每组50例。常规组中因失访脱落1例，最终纳入49例；桃核承气汤组中因依从性差及失访脱落3例，最终纳入47例。常规组患者采用抗血小板聚集、调脂稳定斑块、控制血压及血糖等基础治疗联合多奈哌齐片进行治疗；桃核承气汤组患者在常规组基础上加用桃核承气汤进行治疗，两组均以4周为1个疗程，共治疗3个疗程。治疗后评定两组患者中医证候疗效，治疗前后采用简易精神状态检查量表（MMSE）、蒙特利尔认知评估量表（MoCA）评估患者认知功能，采用血管性痴呆中医辨证量表（SDSVD）评估患者中医症状改善情况，采用放射免疫法检测血清脂联素水平，记录两组患者治疗期间不良反应发生情况。结果 桃核承气汤组中医证候疗效优于常规组（u=2.418,P=0.016）。治疗后，两组MMSE、MoCA评分分别高于本组治疗前，SDSVD评分分别低于本组治疗前（P<0.05）；治疗后，桃核承气汤组MMSE、MoCA评分高于常规组，SDSVD评分低于常规组（P<0.05）。治疗后，两组血清脂联素水平分别高于本组治疗前，且桃核承气汤组血清脂联素水平高于常规组（P<0.05）。两组患者治疗期间均未出现明显不良反应。结论 桃核承气汤可有效提高PSCI患者的中医证候疗效，改善认知功能，上调血清脂联素水平，且未见明显不良反应。

英文摘要：

Objective To investigate the efficacy of Taohe Chengqi decoction in the treatment of post-stroke cognitive impairment (PSCI) and its influence on patients cognitive function and serum adiponectin level. Methods A total of 100 patients with PSCI who visited the Department of Neurology in the Second Affiliated Hospital of Nanjing University of Chinese Medicine from 2018 to 2019 were selected. The patients were divided into the regular group and the Taohe Chengqi decoction group by random number table method, with 50 cases in each group. In the regular group, 1 case was dropped out due to lost follow-up, and 49 cases were ultimately included; in the Taohe Chengqi decoction group, 3 cases were dropped out due to poor compliance and loss of follow-up, and 47 cases were ultimately included. The regular group was given basic treatment such as antiplatelet aggregation, lipid regulation, plaque stabilization, control blood pressure and blood glucose combination with donepezil tablets; the Taohe Chengqi decoction group was given Taohe Chengqi decoction on the basis of the regular group, 4 weeks was a course, both groups were treated for 3 courses. The therapeutic effect of traditional Chinese medicine (TCM) syndromes of the two groups was evaluated after treatment. Before and after treatment, Mini-mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) were used to evaluate the cognitive function, Scale for the Differentiation of Syndromes of Vascular Dementia (SDSVD) was used to evaluate the improvement of TCM symptoms, and radioimmunoassay was used to detect the serum adiponectin level of the two groups, and the incidence of adverse reactions during the treatment of the two groups was recorded. Results The therapeutic effect of TCM syndromes of the Taohe Chengqi decoction group was better than that of the regular group (u=2.418, P=0.016) . After treatment, MMSE score and MoCA score in the two groups were higher than those before treatment, SDSVD score was lower than that before treatment, respectively (P < 0.05) ; after treatment, MMSE score and MoCA score in the Taohe Chengqi decoction group were higher than those in the regular group, SDSVD score was lower than that in the regular group (P < 0.05) . After treatment, serum adiponectin level in the two groups was higher than that before treatment, respectively, and serum adiponectin level in the Taohe Chengqi decoction group was higher than that in the regular group (P < 0.05) . There was no serious adverse reactions during the treatment of the two groups. Conclusion Taohe Chengqi decoction can effectively improue the therapeutic effects of TCM syndromes of PSCI patients, and improve cognitive function, upregulate serum adiponectin level, and has no significant adverse reactions.

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