目的 探讨培元通脑胶囊联合奥拉西坦胶囊治疗卒中后血管性痴呆的临床疗效。方法 选取2017年4月—2019年5月天津市宁河区医院收治的84例卒中后血管性痴呆患者，根据随机数字表法将患者分为对照组和治疗组，每组各42例。对照组口服奥拉西坦胶囊，0.8 g/次，3次/d。治疗组在对照组的基础上口服培元通脑胶囊，3粒/次，3次/d。两组疗程均为12周。观察两组患者疗效，比较简易精神状态量表（MMSE）评分、日常生活活动能力（ADL）评分、美国国立卫生院卒中量表（NIHSS）评分、长谷川痴呆量表（HDS）评分、血清同型半胱氨酸（Hcy）、脂蛋白磷脂酶A2（Lp-PLA2）、脑源性神经营养因子（BDNF）以及胰岛素样生长因子-1（IGF-1）水平。结果 治疗后，治疗组的临床总有效率为92.86%，明显高于对照组的73.81%（P<0.05）。治疗后，两组MMSE、HDS评分升高，ADL、NIHSS评分下降（P<0.05）；且治疗后治疗组MMSE、HDS评分高于对照组，ADL、NIHSS评分低于对照组（P<0.05）。治疗后，两组BDNF水平升高，Hcy、Lp-PLA2、IGF-1水平均下降（P<0.05）；治疗后治疗组BDNF水平高于对照组，Hcy、Lp-PLA2、IGF-1水平则低于对照组（P<0.05）。结论 培元通脑胶囊联合奥拉西坦胶囊治疗卒中后血管性痴呆的疗效显著，可有效改善患者症状、生活质量，调节Hcy、Lp-PLA2、IGF-1、BDNF水平，具有一定临床推广价值。

Objective To investigate the clinical effect of Peiyuan Tongnao Capsules combined with Oxiracetam Capsules in treatment of vascular dementia after stroke. Methods Patients (84 cases) with vascular dementia after stroke in Tianjin Ninghe Hospital from April 2017 to May 2019 were randomly divided into control and treatment groups, and each group had 42 cases. Patients in the control group were po administered with Oxiracetam Capsules, 0.8 g/time, three times daily. Patients in the treatment group were po administered with Peiyuan Tongnao Capsules on the basis of the control group, 3 grains/time, three times daily. Patients in two groups were treated for 12 weeks. After treatment, the clinical efficacies were evaluated, and Mini Mental State Scale (MMSE) scores, Activity of Daily Living (ADL) scores, National Institutes of Health Stroke Scale (NIHSS) scores, Hasegawa Dementia Scale (HDS) scores, and the levels of serum homocysteine (Hcy), lipoprotein phospholipase A2 (Lp-PLA2), brain derived neurotrophic factor (BDNF), and insulin like growth factor-1 (IGF-1) in two groups were compared. Results After treatment, the total clinical effective rate of the treatment group was 92.86%, which was higher than 73.81% of the control group (P<0.05). After treatment, MMSE scores and HDS scores in two groups were increased, but ADL scores and NIHSS scores in two groups were decreased (P<0.05). And MMSE scores and HDS scores in the treatment group were higher than those in the control group, but ADL scores and NIHSS scores in the treatment group were lower than those in the control group (P<0.05). After treatment, the levels of BDNF in two groups were increased, but the levels of Hcy, Lp-PLA2, and IGF-1 in two groups were decreased (P<0.05). And the levels of BDNF in the treatment group was higher than that in the control group, the levels of Hcy, Lp-PLA2, and IGF-1 in the treatment group were lower than that in the control group (P<0.05). Conclusion Peiyuan Tongnao Capsules combined with Oxiracetam Capsules has clinical curative effect in treatment of vascular dementia after stroke, can effectively improve the symptoms and quality of life of patients, and regulate the levels of Hcy,Lp-PLA2, IGF-1 and BDNF.

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