| Objective:(1)To study the TCM syndrome differentiation of vascular cognitive impairment and the correlation between different syndromes and cognitive function;(2)To study the efficacy and safety of Dihuang Yin combined with donepezil hydrochloride in the treatment of phlegm turbidity obstruction orifice vascular cognitive impairment.Methods: This paper is divided into three sections.The first section systematically evaluates the published literature on TCM symptoms of vascular cognitive disorder Literatures related to TCM symptoms of vascular cognitive impairment in Pubmed,including cnki database,wanfang database,weipu Chinese journal database and Pubmed database from 2000 to 2018 were searched by computer,and meta-analysis was conducted with Rev Man5.3.0.Section 2 on the basis of the cross-sectional study,60 patients with VCI were included for a 12-month follow-up survey.After the baseline,TCM symptom factors score and neuropsychological assessment were conducted every 3 months to analyze the correlation between TCM factors and cognitive function.Section 3:120 patients with vascular cognitive impairment due to phlegm turbidity obstruction were selected and divided into western medicine group,traditional Chinese medicine group and integrated traditional Chinese and western medicine group.All 3 groups were given basic medical treatment,the western medicine group was given oral donepezil hydrochloride,the traditional Chinese medicine group was given rehmannia rehmannia yinzi plus or less,the combined Chinese and western medicine group was given oral donepezil hydrochloride and rehmannia rehmannia yinzi,and the cognitive function and related biological indicators of the three groups were compared.Results:1.Literature study included 12 articles,through the literature study,we found that the frequency of single TCM syndromes: kidney deficiency > phlegm turbidity >blood stasis > qi stagnation > Qi and blood deficiency > Yin deficiency > Yang Hyperactivity = heat toxicity;The frequency of main combined syndromes: kidney deficiency + phlegm turbidity > kidney deficiency + blood stasis > kidney deficiency+ phlegm turbidity + blood stasis = blood stasis + phlegm turbidity > qi stagnation +blood stasis.2.Cross-sectional studies found that:(1)In general data,the difference of education years between VCIND group and healthy control group was only significant(P<0.05),there were significant differences in age and education years between VD group and healthy control group(P<0.01),there were significant differences in age and education years between VD group and VCIND group(P<0.05),there was no significant difference in gender among the three groups(P>0.05).VCIND group,VD group and healthy control group have differences in the integrals of three TCM syndromes,namely kidney essence deficiency,phlegm turbidity and mengqiao,blood stasis and internal obstruction.There are differences between VCIND group and VD group in the integrals of three TCM syndromes,namely kidney essence deficiency,phlegm turbidity and mengqiao,blood stasis and internal obstruction.Cognitive function of VCI patients is correlated with demographic characteristics,especially years of education.Cognitive function of VCI patients is mainly related to deficiency of kidney essence and TCM syndromes of phlegm turbidity and mengqiao.(2)There were significant differences between VCIND group,VD group and NC group in the scores of kidney essence deficiency,phlegm Meng Shenqiao and blood stasis(P<0.01).There was no significant difference between VCIND group and VD group and NC group(P>0.05).In the comparison between VCIND group and VD group,the scores of kidney essence deficiency syndrome and phlegm turbidity Mengqiao syndrome were significantly different(P<0.01),blood stasis syndrome was significantly different(P<0.05),Yin deficiency and Yang hyperactivity,heat toxicity and Qi and blood deficiency syndrome were not significantly different(P>0.05).(3)The total score of MMSE was positively correlated with the length of education(P<0.05);the score of orientation was positively correlated with the length of education(P<0.05);the imitation of language and structure was positively correlated with the length of education(P<0.01);the memory score was negatively correlated with age(P<0.05);and it was correlated with occupational type(P<0.01).No correlation was found between attention,computational ability,recall and other demographic characteristics of VCI patients,nor was there any correlation between gender and the total score of MMSE and each score of VCI patients.3.Clinical study found that: the changes of MMSE score and ADL score in western medicine group were significantly different from those in comprehensive group(P<0.05),SDSVD score was significantly different from those in comprehensive group(P<0.01);the differences of MMSE score and ADL score in traditional Chinese medicine group were significantly different from those in comprehensive group(P<0.01),and there was significant difference between western medicine group and traditional Chinese medicine group(P<0.01).There was no significant difference in SDSVD score between the two groups(P>0.05),and there was significant difference between the two groups(P<0.01).There was significant difference in Hcy change between the western medicine group and the comprehensive group(P<0.01),but there was no significant difference between the traditional Chinese medicine group and the comprehensive group(P>0.05).There was no significant difference in plasma viscosity and erythrocyte aggregation index between the three groups(P>0.05).There was no significant difference in whole blood viscosity and erythrocyte deformability index between the three groups(P>0.05).Conclusion : Literature studies and cross-sectional studies indicate that kidney deficiency syndrome is the most common single syndrome in patients without VCI,kidney deficiency plus phlegm turbidity is the most common complex syndrome;kidney deficiency syndrome and phlegm turbidity syndrome are closely related to the cognitive function of VCI patients;Bushen Huatan Kaiqiao method combined with western medicine is better than single western medicine group and single traditional Chinese medicine group in the treatment of vascular cognitive impairment of phlegm turbidity and Mengqiao type.However,it needs to be further confirmed by large-scale,multi-center clinical trials. |
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