目的 探究美金剛與多奈哌齊治療老年血管性癡呆的療效對比。方法 選取2015年1月-2017年7月在焦作市第二人民醫(yī)院門診就診的40例老年血管性癡呆患者為研究對象，據(jù)隨機數(shù)表法分為美金剛組和多奈哌齊組，每組各20例。美金剛組患者口服鹽酸美金剛片，第1周5 mg/次，1次/d，后每周以5 mg增量，第4周20 mg/d，10 mg/次。維持第4周劑量至療程結束。多奈哌齊組患者口服鹽酸多奈哌齊片，5 mg/次，1次/d；服用4周后，10 mg/次，1次/d，服用至療程結束。兩組療程均為12周。觀察兩組患者的臨床療效，同時比較兩組患者簡易智能狀態(tài)檢查表（MMSE）評分、臨床癡呆評定量表（CDR）評分、日常生活能力量表（ADL）評分和血清學指標。結果 兩組間臨床療效比較差異無統(tǒng)計學意義。治療后，兩組MMSE評分顯著升高，而CDR和ADL評分顯著降低（P<0.05）；治療4周、12周后，多奈哌齊組MMSE和ADL評分顯著低于同期美金剛組，CDR評分顯著高于同期美金剛組，差異有統(tǒng)計學意義（P<0.05）。治療后，兩組腦源性神經(jīng)營養(yǎng)因子（BDNF）、胰島素樣生長因子-1（IGF-1）水平顯著升高，內(nèi)皮素（ET）水平顯著降低（P<0.05）；治療4周、12周后，多奈哌齊組BDNF、IGF-1和ET水平顯著低于同期美金剛組，差異有統(tǒng)計學意義（P<0.05）。結論 美金剛與多奈哌齊治療老年血管性癡呆患者均具一定臨床效果，且安全性相當，這可能與BDNF、IGF-1水平升高，ET水平降低有關。

Objective To explore the effect of memantine and donepezil in treatment of elderly patients with vascular dementia. Methods A total of 40 elderly patients with vascular in the Second People's Hospital of Jiaozuo from January 2015 to July 2017 were selected as the research objects. According to the random number table method, they were divided into memantine and donepezil group, with 20 patients in each group. Patients in the memantine group were po administered with Memantine Hydrochloride Tablets, 5 mg/time and once daily in the first week, then at 5 mg increments for per week, and 20 mg/d and 10 mg/time in the fourth week. The dose was maintained for 4 weeks until the end of treatment. Patients in the donepezil group were po administered with Donepezil Hydrochloride Tablets, 5 mg/time, once daily, after 4 weeks, 10 mg/time, once daily, until the end of the course of treatment. The course of treatment was 12 weeks in two groups. The clinical efficacy in two groups was observed, and the MMSE score, CDR score, ADL score, and serological indicators were compared between two groups. Results There was no statistically significant difference in clinical efficacy between two groups. After treatment, MMSE scores in two groups were significantly increased, while CDR and ADL scores were significantly decreased (P<0.05). After 4 and 12 weeks of treatment, the MMSE and ADL scores in donepezil group were significantly lower than those in memantine group, and the CDR scores were significantly higher than those of memantine group, with statistically significant differences (P<0.05). After treatment, BDNF and IGF-1 levels were significantly increased in two groups, but ET levels were significantly decreased (P<0.05). After 4 weeks and 12 weeks of treatment, BDNF, IGF-1 and ET levels in donepezil group were significantly lower than those in memantine group, with statistically significant differences (P<0.05). Conclusion Both memantine and donepezil showed certain clinical efficacy and comparable safety in treatment of elderly patients with vascular dementia, which may be related to increased BDNF and IGF-1 levels, and decreased ET levels.

R971

河南省醫(yī)學科技攻關計劃項目（201703115）