| Objective: To investigate the impact of Dl-3-n-butylphthalide on thelocal cerebral perfusion and cognitive function in patients with cerebral smallvessel disease.Methods：70patents with cerebral small vessel disease and meeting theinclusion criteria, after informed consent and approved by Medical EthicsReview Committee, were randomly divided into Dl-3-n-butylphthalide group(n=26),nimodipine group (n=26) and conventional treatment group(n=18).Each group accepted corresponding treatment for one month. TheMini-Mental State Examination (MMSE), Montreal Cognitive Assessment(MOCA), were used to evaluate the patients before and after treatment. Inaddition,10patients in Dl-3-n-butylphthalide group and nimodipine groupwere selected randomly to accept64-slice spiral CT perfusion imagingbefore and after treatment, and then the reference value of the perfusion wascalculated and the efficacy was assessed.Results: All patients except two completed the final experiment.1.Changes of the total scores of MMSE and MOCA Scale:1）：Compared withthe baseline, the Dl-3-n-butylphthalide group and nimodipine group, afterone month of corresponding therapy, improved significantly both in MMSEand MOCA scores (Dl-3-n-butylphthalide group:22.72±1.97,19.16±1.75vs25.28±2.25,22.04±2.09; nimodipine group:22.84±2.06,19.12±1.79vs24.84±2.41,21.56±1.98; all P<0.01).2）:Compared with the conventionaltreatment group,the MMSE and MOCA scores after therapy in Dl-3-n-butylphthalide group and nimodipine group were both significantlyimproved (P<0.05),but no significant difference existed between theDl-3-n-butylphthalide group and nimodipine group (P=0.70;P=0.43).2.Changes of sub-item scores of MMSE and MOCA Scale:1）The MMSE: allsub-items scores except orientation after therapy in bothDl-3-n-butylphthalide group and nimodipine group, including memory，attention and computing power,the ability to recall,and linguistic capacity,were significantly improved (P<0.01,or P<0.05);Comparison between theDl-3-n-butylphthalide group and nimodipine group, only the item of theability to recall had statistical difference after treatment (P<0.05).2) TheMOCA: All sub-items scores except the naming and orientation aftertreatment in the Dl-3-n-butylphthalide group, including visuospatial andexecutive force, attention and computing power, language, delayed memoryand the ability of abstraction, improved significantly (P<0.05);All sub-itemsscores except naming, orientation and the ability of abstraction after therapyin the nimodipine group, including visuospatial and executive force,attention and computing power, language and delayed memory, displayedsignificant improvement (P<0.05); Comparison between theDl-3-n-butylphthalide group and nimodipine group, only the item of delayedmemory in the MOCA scale displayed statistical difference after therapy(P<0.01).3. The relationship between MOCA and MMSE scores showed apositive correlation (R2=0.628, P<0.01).4. Changes of CT perfusionimaging parameters in the areas of basal ganglia: the cerebral bloodflow(CBF), cerebral blood volume(CBV) and mean transit time (MTT) inboth Dl-3-n-butylphthalide group and nimodipine group improvedsignificantly after treatment(P<0.01), but no significant difference appeared between the Dl-3-n-butylphthalide group and nimodipine group either beforeor after corresponding treatment.Conclusion: Dl-3-n-butylphthalide may improve the cognitive function,especially the memory, visual spatial ability, executive force and computingpower, and also improve the local cerebral perfusion in patients with smallvessel disease. These effects of Dl-3-n-butylphthalide are at least not weakerthan those of nimodipine. No obvious side effects were observed during theperiod of Dl-3-n-butylphthalide treatment. Therefore, Dl-3-n-butylphthalideis safe and effective in the treatment of patients with small vessel disease.Nevertheless, further study is needed because our small number of patientsand relatively short-tern observation. |
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