静脉注射和口服丁苯酞转换治疗对血管性认知障碍伴高同型半胱氨酸血症的疗效研究

Efficacy of Sequential Intravenous-to-Oral Butylphthalide Therapy in Vascular Cognitive Impairment with Hyperhomocysteinemia

摘要

目的 研究丁苯酞静脉注射-口服转换治疗对血管性认知障碍（vascular cognitive impairment，VCI）伴高同型半胱氨酸血症（hyperhomocysteinemia，HHcy）的治疗效果。方法 选取无锡市锡山人民医院收治的 VCI 伴 HHcy 患者，共计 154 例，采用随机数字表法按照 1∶1 比例，分为观察组（n = 77）、对照组（n = 77）。2 组患者均接受常规药物治疗，观察组加用丁苯酞静脉注射-口服转换治疗。对比 2 组患者治疗前后的智力状态、认知功能、日常生活能力及同型半胱氨酸（homocysteine，Hcy）、炎症因子水平变化，并评估 2 组的治疗效果和安全性。结果 2 组治疗 3、6 个月后的简易智力状态检查（mini-mental state examination，MMSE）评分、蒙特利尔认知量表（Montreal cognitive assessment，MoCA）评分、日常生活能力（activities of daily living，ADL）评分均相较于治疗前显著升高（P ＜ 0.05）；观察组治疗 3、6 个月后的 MMSE、MoCA、ADL 评分较对照组高（P ＜ 0.05）。2 组治疗 6 个月后的 Hcy、白细胞介素-6（interleukin-6，IL-6）、肿瘤坏死因子-α（tumor necrosis factor-α，TNF-α）水平相较于治疗前显著下降（P ＜ 0.05）；观察组治疗 6 个月后的 Hcy、IL-6、TNF-α 水平低于对照组（P ＜ 0.05）。观察组治疗 6 个月后的总有效率为 94.81%，与对照组（80.52%）相比，观察组更高（P ＜ 0.05）。2 组患者组间不良反应发生情况相比较，未见明显统计学差异（P ＞ 0.05）。结论 丁苯酞静脉注射和口服转换治疗 VCI 伴 HHcy 的疗效确切、安全性良好，且能有效改善患者的智力状态、认知功能、日常生活能力，并下调 Hcy、炎症因子水平。

Abstract

Objective To investigate the efficacy of sequential intravenous-to-oral butylphthalide therapy in vascular cognitive impairment (VCI) with hyperhomocysteinemia (HHcy). Methods A total of 154 patients with VCI and HHcy admitted to Xishan Peopleʼs Hospital of Wuxi City were randomly divided into an intervention group (n= 77) and a control group (n= 77) in a 1∶1 ratio by a random number table. Both groups received conventional pharmacological treatment, while the intervention group was additionally treated with sequential intravenous-to-oral butylphthalide. Changes in mental status, cognitive function, activities of daily living (ADL), as well as homocysteine (Hcy) and inflammatory factor levels were compared between groups before and after treatment. Therapeutic efficacy and safety were also evaluated. Results After 3 and 6 months of treatment, both groups demonstrated significantly higher mini-mental state examination (MMSE), Montreal cognitive assessment (MoCA), and ADL scores compared to baseline (P＜ 0.05). The intervention group exhibited significantly higher MMSE, MoCA, and ADL scores than the control group at both time points (P＜ 0.05). After 6 months of treatment, levels of Hcy, interleukin-6 (IL-6), and tumor necrosis factor-α (TNF-α) were significantly decreased in both groups compared to baseline (P＜ 0.05). Meanwhile, the levels of Hcy, IL-6, and TNF-α in the intervention group were lower than those in the control group (P＜ 0.05). After 6 months of treatment, the total effective rate in the intervention group was 94.81%, which was higher than that in the control group (80.52%, P＜ 0.05). No statistically significant difference was found in the occurrence of adverse reactions between the two groups (P＞ 0.05). Conclusion Sequential intravenous-to-oral butylphthalide therapy demonstrates robust efficacy and favorable safety in treating VCI with HHcy. It effectively improves mental status, cognitive function, ADL, and reduces Hcy and inflammatory factor levels.

关键词

丁苯酞 / 血管性认知障碍 / 高同型半胱氨酸血症 / 药效研究

Key words

butylphthalide / vascular cognitive impairment / hyperhomocysteinemia / efficacy study

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