脑内微小病变不同干预模式的临床疗效比较

目的通过比较脑内微小病变的不同干预模式，尝试建立一种能有效控制脑内微小病变进展、预防脑梗死发病的诊疗模式。方法采用非随机对照研究方法，将408例存在多发的脑内微小病变者分为中药干预组（100例）、阿司匹林干预组（104例）、阴性对照组（100例）和非规范干预组（104例）。非规范干预组不予特定干预措施，其他3组均进行社区生活方式干预和血管性危险因子常规治疗；中药干预组加服桂枝茯苓丸加地龙粉剂，阿司匹林干预组加服阿司匹林。定期复查，比较各组脑内微小病变、血管性危险因子变化以及脑梗死发病率。结果中药干预组脑内微小病变总有效率为66.67％，明显高于阿司匹林干预组（52.32％）、阴性对照组（42.86％）和非规范干预组（37.04％）；阿司匹林干预组明显高于非规范干预组，差异均有统计学意义（P<0.01，P<0.05）。治疗后，中药干预组LDL-C、TC和TG均明显低于阿司匹林干预组（P<0.05），LDL-C、TC明显低于阴性对照组（P<0.01），收缩压明显低于非规范干预组（P<0.05）；阴性对照组收缩压和TC明显低于非规范干预组（P<0.05）。中药干预组脑梗死发病率为2.17％（2/92），明显低于阴性对照组（11.36％，10/88）和非规范干预组（14.44％，13/90），差异均有统计学意义（P<0.05），但与阿司匹林干预组（6.74％，6/89）比较，差异无统计学意义（P>0.05）。结论中药桂枝茯苓丸加地龙粉剂可以治疗脑内微小病变，控制血管性危险因素，并最终预防脑梗死发生。规范化的中药干预模式在治疗脑内微小病变预防脑梗死发病的几种模式中疗效最佳，或可在临床推广。

英文摘要:

Objective To tentatively establish a diagnosis and treatment mode for effectively controlling the progress of cerebral microlesions （CM） and preventing the incidence of cerebral infarction （CI） by comparing different intervention modes for treating CM. Methods Using a prospective， nonrandomized， controlled trial， 408 subjects with multiple CM were assigned to the Chinese medical pharmacy intervention group （Group A， 100 case）， the aspirin intervention group （Group B， 104 cases）， the negative control group （Group C， 100 cases）， and the non-intervention group （Group D， 104 cases）. No intervention was given to those in Group D. Patients in the other 3 groups were intervened by life style and routine therapies of vasculogenic risk factors. Those in Group A took Guizhi Fuling Pill （GFP） and earthworm powder additionally. Those in Group B took aspirin additionally. They were routinely followed-up. The CM， the changes of vasculogenic risk factors， and the incidence rate of CI were compared among the 4 groups. Results The total effective rate of CM was 66.67％ in Group A， obviously higher than that of Group B （52.32％）， Group C （42.86％）， and Group D （37.04％）， respectively. It was obviously higher in Group B than in Group D， showing statistical difference （P<0.01， P<0.05）. After treatment， the serum levels of LDL-C， TC， and TG were obviously lower in Group A than in Group B （P<0.05）； the serum levels of LDL-C and TC were obviously lower in Group A than in Group C （P<0.01）； the systolic pressure was obviously lower in Group A than in Group D （P<0.05）. The systolic pressure and the serum TC level were obviously lower in Group C than in Group D （P<0.05）. The incidence rate of CI was 2.17％（2/92 cases） in Group A， obviously lower than that of Group C （11.36％，10/88 cases） and Group D （14.44％， 13/90 cases）， showing statistical difference （P<0.05）. But there was no statistical difference between Group A and Group B （6.74％，6/89 cases）（P>0.05）. Conclusions GFP combined earthworm powder could treat CM， control vasculogenic risk factors， and finally prevent the incidence of CI. Standard Chinese medical intervention mode showed the optimal effects in treating CM and preventing the incidence of CI， and perhaps it could be spread clinically.

关闭