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目的:探讨美金刚、阿托伐他汀和多奈哌齐联合治疗老年血管性痴呆的临床疗效、安全性及作用机制.方法:老年血管性痴呆患者140例随机分为观察组和对照组,每组70例.对照组在常规治疗基础上给予多奈哌齐片治疗,观察组在对照组基础上再加用美金刚片和阿托伐他汀片治疗.两组均治疗6个月.治疗前后采用简易精神认知量表(MMSE)、Blessed痴呆量表(BDS)、日常生活能力量表(ADL)评定及精神科问卷(NPI)评估两组疗效,采用药物副反应量表(TESS)评估安全性.同时比较治疗前后两组患者血清学指标脑源性神经营养因子(BDNF)、内皮素(ET)、一氧化氮(NO)含量及血脂水平变化.结果:治疗后,两组MMSE、BDS、ADL、NPI评分均较前显著改善(P＜0.05),且观察组各项评分均优于对照组(P＜0.05).两组TESS各项评分比较,差异无统计学意义(P＞0.05).治疗后,观察组各项血脂指标均较治疗前显著改善(P＜0.05),且均显著优于对照组(P＜0.05);两组BDNF含量均较治疗前增加,ET、NO含量均较治疗前降低(P＜0.05),且观察组BDNF、ET、NO含量均优于对照组(P＜0.05).结论:美金刚、阿托伐他汀和多奈哌齐可改善老年血管性痴呆行为能力、日常生活能力、精神认知能力,临床疗效好,可能与联合用药可降低血液ET、NO的含量,升高BDNF含量有关.“,”Objective:To investigate the clinical efficacy,safety and mechanism of using memantine and donepezil combined with atorvastatin to treat senile vascular dementia.Methods:140 cases of patients with senile vascular dementia were chosen and randomly divided into the observation group and the control group (70 cases in each group);The patients of control group were given donepezil treatment on basis of the routine therapy,while the patients of observation group were treated with memantine and donepezil.Two groups were treated for 6 months.Before and after treatment,the Mini Mental Cognition Scale (MMSE),Blessed Dementia Scale (BDS) and activity of daily living scale (ADL) and psychiatric assessment questionnaire (NPI) were used to evaluate the clinical efficacy,side effects scale (TESS) to evaluate the safety,including serum brain-derived neurotrophic factor (BDNF) and endothelin (ET),NO content and blood lipid levels test.Results:After treatment,in the two groups MMSE,BDS,ADL and NPI scores were all significantly improved (P ＜0.05),but the observation group improved more significantly (P ＜ 0.05);In the two groups TESS scorings had no statistically significant difference (P ＞ 0.05);The blood lipid indexes in the observation group were significantly improved compared with before treatment (P ＜ 0.05),which in the observation group improved more significantly (all P ＜ 0.05);Compared with before treatment BDNF content in the two groups all increased significantly,but the observation group increased more obviously,while ET and NO content were all lower than those before treatment (P ＜ 0.05),but the observation group decreased more significantly (P ＜ 0.05).Conclusion:Memantine,atorvastatin combined with donepezil might improve vascular dementia behavior ability and the ability of daily life,the spirit of cognitive ability,which had better clinical effects,higher safety,and its mechanisms might be related to regulating the levels of blood lipid,reducing blood levels of ET,NO and increasing BDNF content.