阿尔茨海默病患者甲状腺功能及石杉碱甲联合美金刚疗效分析

Thyroid function in Alzheimer’s disease patients and therapeutic efficacy of huperzine A combined with memantine

摘要:

目的 探讨阿尔茨海默病(AD)患者甲状腺激素水平变化及石杉碱甲联合美金刚的疗效。方法 入选2014年4月至2016年5月解放军总医院第一附属医院干部病房二科收治的86例AD患者作为AD组,男性48例,女性38例,年龄(69.9±8.6)岁；对照组为本院门诊体检中心的65例普通老年人,男性33例,女性32例,年龄(67.7±9.3)岁。AD组患者根据治疗方案随机分为石杉碱甲组(43例)和奥拉西坦组(43例),石杉碱甲组给予石杉碱甲联合美金刚治疗,奥拉西坦组给予奥拉西坦联合美金刚治疗,检测AD患者治疗前后血清甲状腺激素水平,并进行简明智力状态检查表(MMSE)和日常生活能力量表(ADL)评分。结果 AD组患者治疗前的促甲状腺激素(TSH)、总三碘甲状腺原氨酸(TT3)、总甲状腺素(TT4)、游离T3(FT3)水平均显著低于普通老年人群(P＜0.05)。相比治疗前,服药6个月时石杉碱甲组患者TSH、TT3、TT4、FT3水平明显升高,MMSE评分升高,ADL评分降低,奥拉西坦组患者TT4水平明显升高,MMSE评分升高,ADL评分降低,服用石杉碱甲患者的TSH、TT4以及MMSE和ADL评分改善效果明显高于服用奥拉西坦患者,差异有统计学意义(P＜0.05)。结论AD患者的甲状腺激素水平明显降低,患甲状腺功能减低风险高,石杉碱甲联合美金刚疗效优并可提高甲状腺激素水平。

Abstract:

Objective To investigate the changes of thyroid hormone levels in the patients with Alzheimer’s disease (AD) and the clinical efficacy of huperzine A combined with memantine. Methods Eighty-six AD patients [48 males and 38 females, at an age of (69.9±8.6) years] admitted in our department from April 2014 to May 2016 were recruited in this study. Another 65 age-matched elders [33 males and 32 females, at an age of (67.7±9.3) years] who taking physical examination in our hospital during the same period served as controls. The AD patients were randomly divided into huperzine A group and oxiracetam group (n=43 for each group). Combination of memantine was given the patients of both groups. The serum levels of thyroid hormones were measured before and after the treatment. Mini-mental state examination (MMSE) and activities of daily living (ADL) scaling were used to evaluate their mental status and living abilities. Results Before the treatment, the AD patients had significantly lower serum levels of thyroid-stimulating hormone (TSH), total triiodothyronine (TT3), total thyroxine (TT4), and free T3 (FT3) than the normal elders (P<0.05). After 6 months’ treatment, these levels were increased, the MMSE scores were elevated, and the scores of ADL were decreased in the huperzine A group. While except for the increment of TT4, other hormones had no obvious changes in the oxiracetam group, though the scores of MMSE were improved and the scores of ADL were decreased. Huperzine A treatment resulted in better outcomes in the serum levels of TSH and TT4 and scores of MMSE and TT4 when compared with oxiracetam treatment (P<0.05). Conclusion AD patients have significantly lower levels of thyroid hormones, and are at high risk for reduced thyroid function. Huperzine A combined with memantine shows good efficacy and improves thyroid hormone levels in the aged AD patients.