摘要
目的探寻氢溴酸加兰他敏片对阿尔茨海默病(AD)患者血清乙酰胆碱酯酶(AchE)水平的影响和临床疗效。方法选取2022年3-12月于北京市隆福医院确诊为阿尔茨海默病的患者共100例。利用简单随机分配法,将接受此次研究的100例AD患者分为治疗组(50例)和安慰剂组(50例)。所有患者均接受常规治疗和认知康复训练治疗,治疗组患者服用氢溴酸加兰他敏片(初始剂量为5 mg/次,4次/d,3 d后增加药量至10 mg/次,4次/d),安慰剂组患者给予同等剂量的安慰剂(糖果)进行安慰治疗。比较两组患者治疗前后的认知功能、日常生活能力水平、焦虑抑郁症状的严重程度、血清乙酰胆碱酯酶水平、临床疗效以及用药后的不良反应。结果治疗组总有效率(94%)高于安慰剂组(80%),差异具有统计学意义(P<0.05)。治疗前,安慰剂组和治疗组患者的MoCA评分、MMSE评分、ADL评分分别为(20.18±2.50 vs.20.63±2.37)、(18.20±2.45 vs.18.03±2.11)、(48.37±3.43 vs.48.23±3.15),治疗后,安慰剂组和治疗组的MoCA评分、MMSE评分、ADL评分分别为(23.98±2.16 vs.27.11±2.21)、(22.07±2.10 vs.25.03±2.58)、(56.99±3.31 vs.67.99±3.11),治疗后两组各项评分均较治疗前提高(P<0.05),且治疗组高于安慰剂组(P<0.05);治疗前,安慰剂组和治疗组的HAMA评分、HAMD评分分别为(17.48±3.74 vs.17.60±3.57)、(18.15±2.94 vs.18.46±2.83),治疗后,安慰剂组患者和治疗组患者的HAMA评分、HAMD评分分别为(14.54±3.23 vs.6.74±3.40)、(14.54±3.85 vs.7.44±3.43),两组患者治疗后焦虑及抑郁的严重程度较治疗前降低(P<0.05),且治疗组的评分低于安慰剂组(P<0.05);治疗前,安慰剂组和治疗组患者的血清乙酰胆碱酯酶水平分别为(23.26±3.50)mmol/L、(23.39±3.10)mmol/L,治疗后分别为(19.85±2.29)mmol/L、(17.85±2.30)mmol/L,两组患者治疗后血清AchE水平较治疗前降低(P<0.05),且治疗后治疗组患者的血清AchE水平明显低于安慰剂组患者(P<0.05)。安慰剂组有3例(6%)患者出现了不良反应,1例(2%)失眠,1例(2%)心悸,1例(2%)ST段压低;治疗组有12例(24%)患者出现了不良反应,1例(2%)失眠,1例(2%)头晕,2例(4%)恶心、呕吐,1例(2%)视力模糊,1例(2%)嗜睡,1例(2%)腹泻,3例(6%)心悸,1例(2%)EEG中-轻度异常。治疗组AD患者不良反应发生率高于安慰剂组患者,差异具有统计学意义(P<0.05)。结论氢溴酸加兰他敏片可以有效降低阿尔茨海默病患者的血清AchE水平,并且有效地提高了患者的记忆力、认知功能以及日常生活能力,明显缓解了患者的焦虑、抑郁等症状,显著延缓了患者病情发展速度,并且明显提高了患者的生存质量。
Objective To observe the efficacy of evolocumab in patients with extremely high-risk atherosclerotic cardiovascular disease(ASCVD).Methods From October 2020 to July 2022,54 patients with confirmed extremely high-risk atherosclerotic cardiovascular disease who received treatment in Xianghongqi Outpatient Department of Jingxi Medical District of PLA General Hospital were selected.All of them were treated with moderate-intensity statins combined with ezeimibe lipid-lowering therapy,and their low-density lipoprotein cholesterol(LDL-C)was not up to standard.The enrolled patients were randomly divided into the statin enhanced group(27 cases)and the evolocumab group(27 cases).The treatment regimen of the statin enhanced group was adjusted to atorvastatin calcium 30 mg oral qd or rosuvastatin calcium 15 mg oral qd,while the original regimen of ezetimibe 10 mg oral qd was continued.In the evolocumab group,ezetimibe in the original regimen was changed to evolocumab 140 mg subcutaneous q2w,and the original regimen was continued with atorvastatin calcium 20 mg oral qd or rosuvastatin calcium 10 mg oral qd.Both groups were treated for 3 months.Changes in total cholesterol(TC),triglyceride(TG),high-density lipoprotein cholesterol(HDL-C)and LDL-C levels before and after treatment were observed,and adverse reactions were recorded.Results After treatment,LDL-C was(0.85±0.09)mmol/L in evolocumab group and(1.92±0.19)mmol/L in statin enhanced group.LDL-C was significantly decreased in both groups compared with before treatment,and the effect was more significant in the evolocumab group,the difference being statistically significant(P<0.05),but the effect of lowering TG and increasing HDL-C was better in statin enhanced group(P<0.05).The adverse reactions of the two groups were mild and transient,the treatment being generally safe.Conclusion In this study,the effect of evolocumab on lowering LDL-C in extremely high-risk ASCVD patients with substandard blood lipids is obvious,and all patients reach the standard.
作者
孙金燕
黄大伟
唐新宁
Sun Jinyan;Huang Dawei;Tang Xinning(Department of Clinical Laboratory,the Third Hospital of Chaoyang District,Beijing 100025,China;Department of Clinical Laboratory,Beijing Longfu Hospital,Beijing 100001,China;Department of Clinical Laboratory,Wangjing Hospital,China Academy of Chinese Medical Sciences,Beijing 100102,China)
出处
《实用药物与临床》
CAS
2023年第5期413-417,共5页
Practical Pharmacy and Clinical Remedies
