目的 探究脑心通胶囊联合盐酸美金刚治疗血管性痴呆患者临床效果。方法 选取天津中医药大学第一附属医院2016年4月-2018年1月收治的血管性痴呆患者94例，随机分成对照组和治疗组，每组各47例。对照组口服盐酸美金刚片，第1周剂量5 mg/d，然后每周递增5 mg至第4周达到维持剂量20 mg/d。治疗组在对照组基础上口服脑心通胶囊，3粒/次，3次/d。两组均连续治疗2个月。观察两组患者临床疗效，同时比较治疗前后两组患者认知障碍改善情况、脑血流动力学和血清炎性细胞因子水平。结果 治疗后，对照组和治疗组临床总有效率分别为74.47%和91.49%，两组比较差异具有统计学意义（P<0.05）。治疗后，两组患者日常生活能力量表（ADL）、简易智力状态检查量表（MMSE）和蒙特利尔认知评估量表（MoCA）评分显著升高（P<0.05），且治疗组患者ADL、MMSE和MoCA评分明显高于对照组（P<0.05）。治疗后，两组大脑前动脉（ACA）、大脑后动脉（PCA）、大脑中动脉（MCA）和左右椎动脉（VA）平均血流速度明显升高（P<0.05），且治疗组患者ACA、PCA、MCA、VA平均血流速度明显高于对照组（P<0.05）。治疗后，两组患者血清C反应蛋白（CRP）、白细胞介素-18（IL-18）、IL-6、肿瘤坏死因子-α（TNF-α）水平明显降低（P<0.05），且治疗组CRP、IL-18、IL-6、TNF-α水平明显低于对照组（P<0.05）。结论 脑心通胶囊联合盐酸美金刚治疗血管性痴呆患者对认知障碍改善起积极作用，促使脑部血液循环改善，还可抑制炎症反应，具有较高用药安全性，疗效显著。

Objective To explore the clinical effect of Naoxintong Capsules combined with memantine hydrochloride in treatment of vascular dementia. Methods Patients (94 cases) with vascular dementia in First Teaching Hospital of Tianjin University of TCM from April 2016 to January 2018 were randomly divided into control and treatment groups, and each group had 47 cases. Patients in the control group were po administered with Memantine Hydrochloride Tablets, 5 mg/d for the first week, then weekly increased with 5 mg utill the maintenance dose of 20 mg/d at the forth week. Patients in the treatment group were po administered with Naoxintong Capsules on the basis of the control group, 3 grains/time, three times daily. Patients in two groups were treated for 2 months. After treatment, the clinical efficacy was evaluated, and the improvement of cognitive impairment, the cerebral hemodynamics indexes, the CRP, IL-18, IL-6 and TNF-α levels in two groups before and after treatment were compared. Results After treatment, the clinical efficacy in the control and treatment groups was 74.47% and 91.49% respectively, and there were differences between two groups (P < 0.05). After treatment, the ADL, MMSE and MoCA scores in two groups were significantly increased (P < 0.05), and which in the treatment group were significantly higher than those in the control group (P < 0.05). After treatment, the average blood flow velocity of ACA, PCA, MCA and VA in two groups were significantly increased (P < 0.05), and which in the treatment group was significantly higher than that in the control group (P < 0.05). After treatment, the serum levels of CRP, IL-18, IL-6 and TNF-α in two groups were significantly decreased (P < 0.05), and the CRP, IL-18, IL-6 and TNF-α levels in the treatment group were significantly lower than those in the control group (P < 0.05). Conclusion Naoxintong Capsules combined with memantine hydrochloride in treatment of vascular dementia can positively improve cognitive impairment, promoting the improvement of cerebral blood circulation, and inhibiting and inhibiting inflammatory reaction, which has high safety and significant curative effect.

国家自然科学基金委员会资助项目（81403332）