The Characteristic Of TCM Synderome Of Hld With Cognitive Disorder And Clinical And Experimental Study On Eliminating Phlegm And Resolving Stasis Recip

1 Objective The clinical observation showed that cognitive impairment is one of the symptoms of HLD.It is effective to treat the cognitive impairment of HLD with traditional Chinese medicine of removing phlegm and removing stasis.Syndrome is the precondition and basis for the treatment of disease in TCM.However,the characteristics of TCM syndrome of HLD with cognitive disorder are still lack of large sample investigation.To solve this problem,the subject investigates the syndromes of HLD with cognitive disorder,in order to provides evidence-based medical basis for clinical treatment.At the same time,we observe the effect of traditional Chinese medicine on the treatment of HLD with cognitive disorder,and discuss its mechanism.2 Methods2.1 TCM syndrome investigation The patients who visited Neurology of The First Affiliated Hospital of Anhui University of TCM from March 2017 to October 2017.Then,the patients were divided into two groups,one group was HLD without other diseases(156 cases),the other group was HLD with cognitive disorder(102 cases).2.2 Clinical study70 cases of HLD patients with cognitive disorder which randomly choosed from Neurology of The First Affiliated Hospital of Anhui University of TCM from March2017 to October 2017.Treatment group was given the treatment of DMPS.Control group was given the treatment of DMPS and Eliminating phlegm Resolving stasis recipe.To observe the difference of TCM syndromes scores,cognitive function,activity of daily living and neurological deficit in two groups,and the effect of Eliminating phlegm Resolving stasis recipe on long-term clinical effect.2.3 Experimental study100 C57 mice were fed for 1 weeks were randomly divided into 5 groups: blank group,copper load model group,GDL group,DMSA group,GDL+DMSA group,20 rats in each group.The dosage of the mice was changed according to the body surface area,and the ratio was about 1:9 according to the daily dosage of adult.All the animals in each group were gavaged in the morning,and the dosage of 0.2ml solution was 10 g,one times a day.The blank group and the copper load model group were given equal volume of physiological saline.Configuration methods: Gandouling,each tablet(0.3g)dissolved in 4ml solution,DMSA,each capsule(0.25g)dissolved in 20 ml solution.The drug was administered for 7 days or 28 days.HE staining was used to observe the pathological changes of the neurons in the CA1 region of the hippocampus of mice.Immunohistochemistry was used to observe the proliferation and survival of the SGZ.3 Results3.1 TCM syndrome investigation3.1.1 Comparison of TCM syndrome distribution ratio in two groups The distribution rate of phlegm dampness and blood stasis in group CD was significantly higher than that in group WD(P<0.01).The distribution rate of fire-heat and liver-yin deficiency in group WD was significantly higher than that in group CD(P<0.05 or P<0.01).There was no significant difference in the distribution rate of qi depression,qi deficiency,blood deficiency,kidney-yin deficiency,kidney-yang deficiency,yang hyperactivity and spleen-yang deficiency(P>0.05).3.1.2 Comparison of TCM syndrome scores of in two groups TCM syndrome score of phlegm dampness and blood stasis in group CD was significantly higher than that in group WD(P<0.01).TCM syndrome score of fire-heat and liver-yin deficiency in group WD was significantly higher than that in group CD(P<0.05 or P<0.01).There was no significant difference in TCM syndrome score of qi depression,qi deficiency,blood deficiency,kidney-yin deficiency,kidney-yang deficiency,yang hyperactivity and spleen-yang deficiency(P>0.05).3.1.3 Comparison of the distribution of composite syndromes in two groups The proportion of two syndromes in group CD was larger than that in group WD(P<0.05 or P<0.01).The proportion of single syndrome in group WD was larger than that in group CD(P<0.05 or P<0.01),and there was no significant difference in the proportion of multiple syndromes between CD group and WD group(P>0.05).3.1.4 Logistic regression analysis of HLD with cognitive disorder and syndrome Logistic regression analysis was used to study the risk of cognitive impairment in patients with HLD.The regression coefficients of phlegm dampness and blood stasis were 328.882 and 249.074,respectively,and all of them were statistically significant(P<0.01).3.2 Clinical study3.2.1 Comparison of the effect rate of TCM syndrome in the two groups The scores of TCM syndrome in two groups after treatment were all lower than those before treatment(P<0.01 or <0.05),indicating that both the treatment group and the control group could improve the TCM Syndromes of the patients.The TCM syndrome score in the treatment group was significantly lower than that in the control group(P<0.01),and the effective rate in the treatment group was significantly higher than that in the control group(P<0.05),indicating that the treatment group had better curative effect than the control group in improving TCM syndromes3.2.2 Comparison of the improvement of cognitive function in two groups The scores of the MMSE scale in the treatment group and the control group were all higher than that before the treatment(P<0.01),indicating that both the treatment group and the control group were able to improve the cognitive function of the patients.The score of MMSE scale in the treatment group was higher than the control group(P<0.01),and the treatment group was more effective than the control group(P<0.05),indicating that the treatment group had better effect than the control group in improving the cognitive function of the patients.3.2.3 Comparison of the improvement of activity of daily living in two groups The scores of Barthel scale in the two groups were all higher than those before treatment(P<0.01),indicating that both the treatment group and the control group could improve their daily living ability.The score of Barthel scale in the treatment group was higher than the control group(P<0.05),and the treatment group was more effective than the control group(P<0.05),indicating that the treatment group had better curative effect than the control group in improving the daily living ability of patients.3.2.4 Comparison of the improvement of neurological impairment in two groups The scores of the NFDS scale in the treatment group and the control group were all lower than that before the treatment(P<0.01),indicating that both the treatment group and the control group could improve the nerve function defect of the patients.The score of NFDS scale in the treatment group was lower than the control group(P<0.05),and the effective rate in the treatment group was higher than the control group(P<0.05),indicating that the treatment group had better effect than the control group in improving the neurological deficit of patients.3.2.5 The effect of eliminating phlegm and removing stasis recipe on the long-term clinical effect After 3 months of treatment,there were no significant changes in TCM syndromes,cognitive functions,activities of daily living and neurological deficits in the treatment group(P>0.05).In the control group,the TCM syndromes increased,cognitive function decreased and daily living ability were decreased(P<0.05 or <0.01),but there was no significant change in nerve function defect(P>0.05).3.3 Experimental study3.3.1 Effect of copper load on the morphology of neural cells in the CA1 region of the hippocampus of mice and the effect of eliminating phlegm and removing stasis recipe About the degree of nerve cell deformation and necrosis in the CA1 region of the hippocampus of mice,GDL group,DMSA group,GDL+DMSA group were less than model group,GDL+DMSA group were less than GDL group and DMSA group.The pathological change of 28 days is more than 7 days in model group.The pathological change of 28 days is less than that 7 days in GDL+DMSA group.3.3.2 Effect of eliminating phlegm and removing stasis recipe on the proliferation and survival of SGZ in mice with copper load The quantitative analysis showed that the number of Brd U positive cells increased significantly in model group,GDL group,DMSA group and GDL+DMSA group after7 days of treatment,compared with the blank group(P<0.01).Model group,GDL group,DMSA group and GDL+DMSA group compared to each other,the difference was not statistically significant.The number of survival Brd U positive cells decreased significantly in model group,GDL group,DMSA group and GDL+DMSA group after28 days of treatment.But the viable cells in DMSA group and GDL+DMSA group was significantly higher than that in model group(P<0.01).What's more,the number of survival cell in GDL+DMSA group was higher than that in DMSA group.To calculate the survival rate of newborn cells,we can find that the survival rate of newborn nerve cells were significantly decreased in model group,GDL group,DMSA group and GDL+DMSA group when compared with blank group(P<0.01).Among them,the survival rate is the lowest in the model group.The survival rate of newborn nerve cells in DMSA group and GDL+DMSA group were higher than that in the model group.And the survival rate of newborn nerve cells in GDL+DMSA group was higher than that in DMSA group.4 Conclusion4.1 Phlegm dampness and blood stasis are the main components of syndrome for HLD with cognitive disorder.4.2 Eliminating phlegm and removing stasis recipe can make TCM syndrome,cognitive function,daily life ability,neurological impairment,long-term clinical efficacy better for the patients of HLD with cognitive disorder.4.3 Eliminating phlegm and removing stasis recipe can alleviate the damage of copper toxin on the nerve cells in the CA1 region of the hippocampus of mice.4.4 Eliminating phlegm and removing stasis can activate the proliferation and survival rate of nerve cells in SGZ.