目的 探讨丁苯酞软胶囊联合多奈哌齐片治疗阿尔茨海默病的临床疗效。方法 选取2014年3月-2018年3月于武汉市第三医院光谷院区治疗的150例阿尔茨海默病患者为研究对象，将患者按随机数表法分为对照组和治疗组，每组各75例。对照组于睡前口服多奈哌齐片，2次/d，起始剂量为1片/次，2周后调整剂量为2片/次。治疗组在对照组基础上口服丁苯酞软胶囊，3次/d，起始剂量为1粒/次，逐渐增加剂量，4周后调整剂量为2粒/次。两组均连续治疗6个月。观察两组的临床疗效，比较两组的简易精神状态量表（MMSE）评分、认知功能评定量表（ADAS-cog）评分、日常生活能力量表（ADL）评分、大脑后动脉血流速度、血清因子水平。结果 治疗后，对照组和治疗组的总有效率分别为77.33%、90.67%，两组比较差异有统计学意义（P<0.05）。治疗后，两组MMSE评分均显著提高，ADAS-cog评分和ADL评分均显著降低，同组治疗前后比较差异有统计学意义（P<0.05）；且治疗组的MMSE评分、ADAS-cog评分和ADL评分明显优于对照组，差异有统计学意义（P<0.05）。治疗后，治疗组患者左右侧大脑后动脉刺激期血流速度、静息期血流速度和平均血流速度均显著高于对照组，差异具有比较意义（P<0.05）。治疗后，两组患者同型半胱氨酸（Hcy）、尿酸（UA）水平均显著下降，人β淀粉样蛋白1-42（Aβ1-42蛋白）水平显著升高，同组治疗前后比较差异有统计学意义（P<0.05）；且治疗组血清因子水平显著优于对照组，差异具有比较意义（P<0.05）。结论 丁苯酞软胶囊联合多奈哌齐片治疗阿尔茨海默病具有较好的临床疗效，能改善患者认知功能，促进大脑后动脉血流速度，调节血清因子水平，安全性较好，具有一定的临床推广应用价值。

Objective To investigate the effect of Butylphthalide Soft Capsules combined with Donepezil Tablets in treatment of Alzheimer's disease. Methods Patients (150 cases) with Alzheimer's disease in Guanggu Hospital District of Wuhan Third Hospital from March 2014 to March 2018 were randomly divided into control and treatment groups, and each group had 75 cases. Patients in the control group were po administered with Donepezil Tablets, twice daily, starting dosage 1 tablet/time, and the dosage was adjusted to 2 tablets/time after 2 weeks. Patients in the treatment group were po administered with Butylphthalide Soft Capsules on the basis of the control group, three times daily, starting dosage 1 grain/time, increased the dose gradually and adjust the dose to 2 grain/time after 4 weeks. Patients in two groups were treated for 6 months. After treatment, the clinical efficacies were evaluated, and MMSE scores, ADAS-cog scores, ADL scores, the blood flow velocity of posterior cerebral artery, and the serum factor levels in two groups were compared. Results After treatment, the clinical efficacies in the control and treatment groups were 77.33% and 90.67%, respectively, and there was difference between two groups (P<0.05). After treatment, MMSE scores in two groups were significantly increased, but ADAS-cog scores and ADL scores in two groups were significantly decreased, and the difference was statistically significant in the same group (P<0.05). And the scores in the treatment group were significantly better than those in the control group, with significant difference between two groups (P<0.05). After treatment, blood flow velocity during stimulation, resting blood flow velocity and average blood flow velocity of left and right posterior cerebral artery in the treatment group were significantly higher than those in the control group, and there was difference between two groups (P<0.05). After treatment, the levels of Hcy and UA in two groups were significantly decreased, but the levels of Aβ1-42 protein in two groups were significantly increased, and the difference was statistically significant in the same group (P<0.05). And the serum factor levels in the treatment group were significantly better than those in the control group, with significant difference between two groups (P<0.05). Conclusion Butylphthalide Soft Capsules combined with Donepezil Tablets has clinical curative effect in treatment of Alzheimer's disease, can improve cognitive function, promote blood flow velocity of posterior cerebral artery, and regulate serum factor level, with good safety, which has a certain clinical application value.

R971

武汉市卫计委公共卫生科研项目（WG13D02）