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目的 从胰岛素抵抗角度,探讨化瘀解毒法治疗轻度认知功能障碍(MCI)患者的临床疗效.方法 选取2013年1月-2014年1月,在上海市同济大学附属杨浦医院就诊且存在胰岛素抵抗的MCI患者135例.采用随机数字表法,将其分为西药组、中药组、中西药结合组,各45例.西药组口服尼莫地平片,中药组口服四高颗粒,中西药结合组同时口服尼莫地平片和四高颗粒,疗程均为6个月.比较3组患者治疗前后的BMI、血压、实验室检测指标及简易智力状态检查量表(MMSE)、蒙特利尔认知评估量表(MoCA)、日常生活能力量表(ADL)得分.结果 共122例(90.4%)患者按要求完成了为期6个月的治疗,其中西药组42例、中药组40例、中西药结合组40例.治疗前3组完成治疗患者BMI、收缩压、舒张压比较,差异无统计学意义(P>0.05).治疗后3组患者BMI、舒张压比较,差异无统计学意义(P>0.05);而收缩压比较,差异有统计学意义(P0.05).治疗后3组患者FPG、TC、Ins、HOMA-IR、IGFBP-1、PAI-1、TNF-α比较,差异有统计学意义(P0.05).治疗前3组患者MMSE、MoCA、ADL得分比较,差异无统计学意义(P>0.05);治疗后3组患者MMSE、MoCA、ADL得分比较,差异有统计学意义(P0.05).There was no significant difference in BMI and diastolic blood pressure of patients in the three groups after treatment(P>0.05);while there was significant difference in systolic blood pressure(P0.05).There were significant differences in FPG,TC,Ins,HOMA-IR,IGFBP-1,PAI-1 and TNF-α of patients in the three groups after treatment(P0.05).There was no significant difference in scores of MMSE,MoCA and ADL of patients in the three groups before treatment after treatmenrt(P>0.05);the scores of MMSE,MoCA and ADL of patients in the three groups were significantly different after treatment(P<0.05).Conclusion Healthy eating habits and appropriate physical exercise can improve the state of insulin resistance in patients with MCI,and the dissolving blood stasis and detoxication method can reduce the level of inflammatory factors by antagonizing the hypercoagulable state,and further reduce patients′ insulin resistance and improve cognitive function.