Clinical Observation Of Yizhitongmai Decoction In Treating Vascular Dementia And Experimental Study Of The Effects About Its Disassembled Prescriptions On NLRP3 Inflammasome

Objective To observe the effect of Yizhitongmai Decoction in treating mild to moderate vascular dementia(VaD)of Kidney essence deficiency with blood stasis syndrome through clinical research,as well as investigate the effects of Yizhitongmai decoction and its dissembled prescriptions(Kidney-tonifving decoction and Meridian-dredging decoction)on the cognitive function and expression of NLRP3 inflammasome in VaD model rats through experimental study,to elucidate the role and mechanism of the two different methods of tonifying kidney and dredging collaterals in the pathogenesis of VaD from the macro and micro level.Methods This study is divided into clinical and experimental parts.Clinical observation: 80 patients were divided into the control group and the treatment group according to the principle of randomized control,each group has 40 patients.The control group was treated with conventional western medicine,on the basis,the treatment group was additionally treated with Yizhitongmai Decoction,observing the changes of clinical efficacy indicators(MMSE,ADL,SDSVD)both within safety indexes before treatment and after treatment for 6th weeks and 12 th weeks.Experimental study: 72 male Wistar rats were randomized into 6 groups: blank control,sham operation,model,Yizhitongmai,Kidney-tonifving and Meridian-dredging groups.The blank control group received no operation,the sham operation group received operation without ligation,and other groups received 2-VO operation to establish VaD models.After that each experimental group was intragastrically administered the corresponding decoction for 28 days.The learning-memory ability was detected using Morris water maze tests,the expression of NLRP3,caspase-1 and IL-1? was determined using Western blot.Results(1)Clinical observation: In the treatment group,the MMSE score increased,the ADL and SDSVD scores decreased(all P <0.01)at the 6th week and the 12 th week and all these indexs were better than those in the control group.No adverse reactions occurred during the treatment.(2)Experimental study: In comparison with the sham operation group,the average escape latency were prolonged and the times to cross the platform within 120 s were decreased,target quadrant dwell time shortened(all P<0.05),while the expression levels of NLRP3,caspase-1,IL-1? was increased in the hippocampus of the model and experimental groups.Compared with the model group,the cognitive impairment in the treatment groups were significantly relieved,the necrosis neurons in hippocampus decreased and the detection indexes were suppressed in different degree.When Yizhitongmai group compare with the two disassembled prescription groups,these effects were more prominent in Yizhitongmai group.Conclusion(1)Yizhitongmai decoction can significantly improve the cognitive impairment,self-care ability and symptoms of traditional Chinese medicine in patients with vascular dementia,the curative effect is exact,safe and reliable.(2)Yizhitongmai decoction and its two disassembled formulas can significantly improve the learning-memory abilities of VaD rats and effectively inhibit the expression of NLRP3 caspase-1 and IL-1?,while the Yizhitongmai decoction has more prominent effect.