新疆医科大学学报

目的 探讨复方脑蛋白水解物片联合丁苯酞治疗急性脑梗死(Acute cerebral infarct, ACI)后认知功能障碍的效果。方法 选取2023年1月至2024年1月大兴区人民医院ACI后认知功能障碍患者82例，按随机数字表法分组，对照组41例给予丁苯酞治疗，研究组41例联合复方脑蛋白水解物片治疗。比较两组治疗前和治疗8周后认知功能、神经功能缺损程度、脑血流灌注、血清学指标[脂蛋白相关磷脂酶A2(Lipoprotein-associated phospholipase A2,LP-PLA2)、基质金属蛋白酶-9(Matrix metalloprotein-9,MMP-9)、胶质细胞源性神经营养因子(Glialcellline-derivedneurotrophicfactor, GDNF)]。统计两组疗效及不良反应发生率。结果 研究组治疗总有效率(92.68%)高于对照组(75.61%),差异有统计学意义(P<0.05);治疗8周后研究组美国国立卫生研究院卒中量表(National institute of health stroke scale, NIHSS)评分[(5.16±1.35)分]低于对照组[(6.25±1.69)分],蒙特利尔认知评估量表(Montreal cognitive assessment, MoCA)评分[(24.07±2.59)分]高于对照组[(21.55±3.28)分],差异有统计学意义(P<0.05);治疗8周后研究组脑血流平均通过时间(Mean transit time, MTT)[(1.06±0.12)s]低于对照组[(1.17±0.17) s],脑血容量(Cerebral blood volume, CBV)[(1.49±0.18)×10^-2 mL·g^-1·min^-1]、脑血流量(Cerebral blood flow, CBF)[(1.07±0.33)×10^-2 mL·g^-1·min^-1]高于对照组[(1.38±0.15)×10^-2 mL·g^-1·min^-1、(0.85±0.30)×10^-2 mL·g^-1·min^-1],差异有统计学意义(P<0.05);治疗8周后研究组MMP-9[(254.25±17.22)μg/L]、LP-PLA2[(164.15±17.95)μg/L]低于对照组[(282.36±19.75)μg/L、(175.87±20.23)μg/L],GDNF[(5.76±2.29)μg/L]高于对照组[(4.33±2.15)μg/L],差异均有统计学意义(P<0.05);两组不良反应发生率比较差异无统计学意义(P>0.05)。结论 ACI后认知功能障碍患者采用复方脑蛋白水解物片联合丁苯酞治疗能提升疗效，减轻神经功能和认知功能损害，改善脑血流灌注，有利于减轻神经免疫炎症反应，用药安全性高。

Objective To investigate the effect of compound cerebral proteolytic tablets combined with butylphthalein on cognitive dysfunction after acute cerebral infarction(ACI). Methods From January 2023 to January 2024, 82 patients with post-ACI cognitive dysfunction in Daxing District People′s Hospital were selected and divided into random number table methods. 41 patients in control group were treated with butylphthalide softgel, and 41 patients in study group were treated with compound brain proteolytic tablets. Cognitive function, degree of neurological impairment, cerebral blood perfusion and serological indexes [matrix metalloproteinase-9(MMP-9), lipoprotein-associated phospholipase A2(LP-PLA2) and glial cell-derived neurotrophic factor(GDNF)] were compared between the 2 groups before the treatment and 8 weeks after the treatment. The efficacy and the incidence of adverse reactions in the 2 groups were analyzed. Results The total effective rate of the treatment in study group(38/41) 92.68% was higher than that in control group(31/41) 75.61%(P<0.05). After 8 weeks of the treatment, the National Institute of Health Stroke Scale(NIHSS) score in study group(5.16±1.35) was lower than that in control group(6.25±1.69), and Montreal Cognitive Assessment(MoCA) score in study group(24.07±2.59) was higher than that in control group(21.55±3.28)(P<0.05). After 8 weeks of the treatment, the mean transit time(MTT) in study group(1.06±0.12) was lower than that in control group(1.17±0.17), while the cerebral blood volume(CBV)(1.49±0.18)×10^-2 mL·g^-1·min^-1 and cerebral blood flow(CBF)(1.07±0.33)×10^-2 mL·g^-1·min^-1 in the study group were higher than those in control group(1.38±0.15)×10^-2 mL·g^-1·min^-1,(0.85±0.30)×10^-2 mL·g^-1·min^-1(P<0.05). After 8 weeks of thetreatment, MMP-9(254.25±17.22) μg/L and LP-PLA2(164.15±17.95) μg/L in study group were lower than those in control group(282.36±19.75, 175.87±20.23) μg/L, while GDNF(5.76±2.29) μg/L in study group was higher than that in control group(4.33±2.15) μg/L(P<0.05). There was no significant difference in the incidence of adverse reactions between the 2 groups(P>0.05). Conclusion The treatment of the patients with cognitive dysfunction after ACI with compound brain proteolytic tablets combined with butylphthalein can improve the efficacy, reduce the damage of nerve function and cognitive function, improve cerebral blood perfusion, and help to reduce neuroimmunoinflammatory reaction, with high drug safety.