目的:脑小血管病(CSVD)常与认知功能障碍并存,导致治疗和管理方面的重大挑战。本研究旨在研究多奈哌齐和尼莫地平联合应用对CSVD合并认知功能障碍患者的疗效以及对患者白蛋白和前白蛋白水平的影响。
方法:回顾性分析2019年1月至2022年12月苏州新区人民医院收治的112例CSVD合并认知功能障碍患者的临床资料。共有50例接受多奈哌齐治疗的患者被分配到对照组,研究组有62例同时接受尼莫地平和多奈哌齐的患者。比较两组患者血清同型半胱氨酸(Hcy)、高敏C反应蛋白(hs-CRP),白蛋白,治疗前后的前白蛋白,功效,和不良反应。此外,采用logistic回归分析影响患者预后的危险因素.
结果:治疗前,两组Hcy和hs-CRP水平无显著差异(p>0.05),而在治疗后,两组水平均显着下降(p<0.01),研究组水平降低更明显(p<0.05)。治疗后,研究组的白蛋白和前白蛋白水平显著高于对照组(p<0.001).与对照组相比,研究组的总体反应率明显更高(p=0.012)。关于不良反应的总发生率,没有发现明显的组间差异(p=0.752)。单变量分析确定的年龄,病程,心率(HR),蒙特利尔认知评估(MoCA)评分,舒张压(DBP),收缩压(SBP),饮酒史,以及药物治疗方案作为影响患者预后的危险因素。多因素logistic回归分析确定了SBP,DBP,用药方案为独立危险因素。
结论:多奈哌齐联合尼莫地平可有效治疗CSVD合并认知功能障碍的患者。可显著降低Hcy和hs-CRP水平,改善营养状况,且不增加不良反应发生频率。此外,对于有认知功能障碍的CSVD患者,年龄,病程,MoCA得分,HR,SBP,DBP,饮酒史,和药物治疗方案是影响患者预后的危险因素,而SBP,DBP,和用药方案是独立的危险因素。
OBJECTIVE: Cerebral small vessel disease (CSVD) often coexists with cognitive dysfunction in patients, leading to significant challenges in treatment and management. This study aimed to examine the efficacy of combined application of
donepezil and nimodipine on patients with comorbid CSVD and cognitive dysfunction and the effects on patients\' albumin and prealbumin levels.
METHODS: The records of 112 patients with comorbid CSVD and cognitive dysfunction treated at the People\'s Hospital of Suzhou New District from January 2019 to December 2022 were analysed retrospectively. A total of 50 patients receiving
donepezil were allocated to the control group, and 62 patients receiving both nimodipine and
donepezil to the study group. Outcomes compared between the two groups included serum homocysteine (Hcy), high sensitivity C-reactive protein (hs-CRP), albumin, and prealbumin before and after therapy, efficacy, and adverse reactions. Additionally, logistic regression was performed to analyze the risk factors impacting patient prognosis.
RESULTS: Prior to therapy, the two groups did not differ significantly in Hcy and hs-CRP levels (p > 0.05), whereas after therapy, the levels in both groups dropped significantly (p < 0.01), with more obvious lower levels in the study group (p < 0.05). After treatment, the study group presented significantly higher albumin and prealbumin levels than the control group (p < 0.001). An obvious higher overall response rate was observed in the study group compared to the control group (p = 0.012). No significant inter-group discrepancy was found regarding the total incidence of adverse reactions (p = 0.752). Univariate analysis identified age, course of disease, heart rate (HR), Montreal Cognitive Assessment (MoCA) score, diastolic blood pressure (DBP), systolic blood pressure (SBP), drinking history, as well as medication regimen as risk factors impacting patient prognosis. Multivariate logistic regression analysis identified SBP, DBP, and medication regimen as the independent risk factors.
CONCLUSIONS: Combined application of
donepezil and nimodipine can effectively treat patients with comorbid CSVD and cognitive dysfunction. It can significantly lower the Hcy and hs-CRP levels and improve the nutritional status without increasing the frequency of adverse reactions. In addition, for CSVD patients with cognitive dysfunction, age, course of disease, MoCA score, HR, SBP, DBP, drinking history, and medication regimen are risk factors impacting patient prognosis, while SBP, DBP, and medication regimen are independent risk factors.