2018 年第 7 期 第 13 卷

丙戊酸镁联合多奈哌齐治疗阿尔茨海默病的效果及对患者尿阿尔茨海默病相关神经丝蛋白与血浆脂蛋白相关磷脂酶A2水平的影响

Effect of magnesium valproate combined with donepezil on Alzheimer disease, urine alzheimer-associated neuronal thread protein and plasma lipoprotein-associated phospholipase A2

作者：丛燕楠孙海荣张金彪赵俊武谭明董礼全耿娜李梦凡刘潇潇

英文作者：

单位：264200山东省威海市立医院神经内科

英文单位：

关键词：阿尔茨海默病；丙戊酸镁；多奈哌齐；阿尔茨海默病相关神经丝蛋白；脂蛋白相关磷脂酶A2

英文关键词：

• 摘要：

• 【摘要】目的    探讨丙戊酸镁联合多奈哌齐治疗阿尔茨海默病（AD）的效果及对患者尿AD相关神经丝蛋白(AD7c-NTP)与血浆脂蛋白相关磷脂酶A2(Lp-PLA2)水平的影响。方法    选取2015年1月至2016年12月收入山东省威海市立医院的AD患者120例为研究对象，按照随机数字表法分为观察组与对照组，各60例。对照组患者给予盐酸多奈哌齐口服治疗，观察组患者在对照组基础上给予丙戊酸镁口服治疗，疗程8周。比较2组患者治疗前后的简易智力状态检查量表（MMSE）评分、日常生活能力（ADL）评分、神经精神问卷（NPI）评分、尿AD7c-NTP、 血浆Lp-PLA2、炎性因子白细胞介素6（IL-6）、肿瘤坏死因子α（TNF-α）、C反应蛋白（CRP）水平以及不良反应情况。结果    治疗后，2组患者的MMSE、NPI评分较治疗前明显升高，且观察组明显高于对照组［（24.0±4.7）分比（20.4±4.3）分、（25±9）分比（19±9）分］；ADL评分较治疗前明显降低，且观察组明显低于对照组［（19±5）分比（26±6）分］，差异均有统计学意义（均P<0.05）。治疗后2组患者的尿AD7c-NTP、血浆Lp-PLA2水平较治疗前明显降低，且观察组明显低于对照组［（1.8±0.6）μg/L比（3.4±0.9）μg/L、（40±9）μg/L比（58±10）μg/L］，差异均有统计学意义（均P<0.05）。治疗后2组患者的炎性因子IL-6、TNF-α、CRP水平较治疗前明显降低，且观察组明显低于对照组［（122±59）pg/L比（175±84）pg/L、（154±14）pg/L比（174±17）pg/L、（3.3±0.8）mg/L比（6.6±1.4）mg/L］，差异均有统计学意义（均P<0.05）。2组患者的不良反应发生率差异无统计学意义（P＞0.05）。结论    丙戊酸镁联合多奈哌齐治疗能够明显提高AD患者的认知功能、日常生活能力及神经精神状态，降低尿AD7c-NTP及血浆Lp-PLA2水平，抑制炎性反应，安全性高。

• 【Abstract】Objective    To investigate the effect of magnesium valproate combined with donepezil on Alzheimer disease（AD）, urine alzheimer-associated neuronal thread protein(AD7c-NTP) and plasma lipoprotein-associated phospholipase(Lp-PLA2). Methods    Totally 120 AD patients admitted from January 2015 to December 2016 in Weihai Municipal Hospital were randomly divided into observation group and control group, with 60 cases in each group. The control group took doneprezil; the observation group took magnesium valproate and donepezil; the course of treatment was 8 weeks. The mini-Mental State Examination(MMSE) score, activity of daily living(ADL) score, Neuropsychiatric Inventory(NPI) score, levels of urine AD7c-NTP, plasma Lp-PLA2, interleukin-6(IL-6), tumor necrosis factor-α(TNF-α), C-reactive protein(CRP) and occurrence of adverse reactions were analyzed. Results    After treatment, MMSE score and NPI score were significantly higher than those before treatment; MMSE score and NPI score in observation group were significantly higher than those in control group［（24.0±4.7） vs （20.4±4.3）, （25±9） vs （19±9）］(P<0.05); ADL score was significantly lower than that before treatment; ADL score in observation group was significantly lower than that in control group［（19±5） vs （26±6）］(P<0.05); levels of urine AD7c-NTP and plasma Lp-PLA2 were significantly lower than those before treatment; levels of urine AD7c-NTP and plasma Lp-PLA2 in observation group were significantly lower than those in control group［（1.8±0.6）μg/L vs （3.4±0.9）μg/L, （40±9）μg/L vs （58±10）μg/L］(P<0.05); levels of IL-6, TNF-α and CRP were significantly lower than those before treatment; levels of IL-6, TNF-α and CRP in observation group were significantly lower than those in control group［（122±59）pg/L vs （175±84）pg/L, （154±14）pg/L vs （174±17）pg/L, （3.3±0.8）mg/L vs （6.6±1.4）mg/L］(P<0.05). There was no significant difference of incidence of adverse reactions between groups(P>0.05). Conclusion    Magnesium valproate combined with donepezil treating Alzheimer disease can significantly improve cognitive function, ADL and neuropsychiatric status, reduce urine AD7c-NTP and plasma Lp-PLA2 level and inhibit inflammatory response.

  【Key words】Alzheimer disease;Magnesium valproate;Donepezil;Alzheimer-associated neuronal thread protein;Lipoprotein-associated phospholipase A2