【摘要】 目的 探讨维生素D+益生菌治疗对老年痴呆患者认知功能、营养状况及代谢功能的影响。方法 选取2022年5月至2023年1月郑州大学第二附属医院老年医学科收治的102例老年痴呆患者作为研究对象，按随机数表法分为对照组和观察组，每组51例。对照组患者采用维生素D治疗，观察组患者采用维生素D+益生菌治疗，疗程3个月。疗程结束后比较两组患者的疗效及治疗前后的功能状态[智能精神状态检查量表(MMSE)、长谷川痴呆(HDS)、日常生活能力(ADL)]、营养状况[前白蛋白(PA)、白蛋白(ALB)、转铁蛋白(TRF)]、糖脂代谢[空腹血糖(FPG)、总胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)]、神经损伤标志物[中枢神经特异蛋白(S100β)、缓激肽(BK)、Aβ-淀粉样蛋白1-42 (Aβ1-42)]及P38MAPK信号通路的变化。结果 观察组患者的治疗总有效率为94.12%，明显高于对照组的78.43%，差异有统计学意义(P<0.05)；治疗后观察组患者的MMSE、HDS、ADL评分分别为(18.15±3.36)分、(17.62±2.34)分、(58.02±4.34)分，明显高于对照组的(16.64±2.98)分、(15.94±3.10)分、(51.15±5.21)分，差异均有统计学意义(P<0.05)；治疗后，观察组患者的血清PA、ALB、TRF水平分别为(322.06±17.65) mg/L、(37.28±3.45) g/L、(2.57±0.58) mg/L，明显高于对照组的(297.19±19.32) mg/L、(34.12±2.87) g/L、(2.18±0.50) mg/L，差异均有统计学意义(P<0.05)；治疗后观察组患者的FPG、TC、TG、LDL-C水平分别为(4.32±0.85) mmol/L、(3.82±0.41) mmol/L、(1.32±0.28) mmol/L、(2.23±0.33) mmol/L，明显低于对照组的(5.10±0.96) mmol/L、(4.41±0.43) mmol/L、(1.50±0.32) mmol/L、(2.89±0.28) mmol/L,HDL-C水平为(2.53±0.56) mmol/L，明显高于对照组的(1.98±0.47) mmol/L，差异均有统计学意义(P<0.05)；治疗后观察组患者的血清S100β、BK、Aβ1-42水平分别为(0.39±0.12) ng/mL、(12.24±1.56) U/L、(98.54±12.36) ng/L，明显低于对照组的(0.53±0.16) ng/mL、(15.33±2.42) U/L、(137.59±18.29) ng/L，差异均有统计学意义(P<0.05)；治疗后观察组患者的P38MAPK、P-P38MAPK表达分别为1.12±0.21、0.43±0.08，明显高于对照组的1.02±0.19、0.28±0.10，差异均具有统计学意义(P<0.05)。结论 维生素D+益生菌治疗可提高老年痴呆患者的认知功能，改善机体营养状态和代谢功能，减轻神经损伤，调控P38MAPK信号通路。更多还原

【Abstract】 Objective To explore the effects of vitamin D+probiotics treatment on cognitive function, nutritional status, and metabolic function in elderly dementia patients. Methods One hundred and two elderly patients with dementia admitted to Department of Geriatrics, the Second Affiliated Hospital of Zhengzhou University from May 2022 to January 2023 were selected as the research subjects. They were randomly divided into a control group and an observation group, with 51 patients in each group. The patients in the control group were treated with vitamin D, while patients in the observation group were treated with vitamin D+probiotics, both for a period of 3 months. After the end of the treatment period, the efficacy was compared between the two groups, as well as the functional status before and after treatment [Mini-mental state examination(MMSE), Hasegawa dementia scale(HDS), activities of daily living(ADL)], nutritional status [prealbumin(PA), albumin(ALB), transferrin(TRF)], glycometabolism [fasting plasma glucose(FPG), total cholesterol(TC), triglyceride(TG), low-density lipoprotein cholesterol(LDL-C), high-density lipoprotein cholesterol(HDL-C)], neuro-injury markers [central nervous system specific protein(S100β), bradykinin(BK), Aβ-amyloid 1-42(Aβ1-42)], and changes in the P38MAPK signaling pathway. Results The total effective rate in the observation group was 94.12%, which was significantly higher than 78.43% in the control group(P<0.05). After treatment, the scores of MMSE, HDS, and ADL in the observation group were(18.15±3.36) points,(17.62±2.34) points, and(58.02±4.34) points,respectively, which were significantly higher than(16.64±2.98) points,(15.94±3.10) points, and(51.15±5.21) points in the control group(P<0.05). After treatment, the levels of serum PA, ALB, and TRF in the observation group were(322.06 ± 17.65) mg/L,(37.28 ± 3.45) g/L, and(2.57 ± 0.58) mg/L, respectively, which were significantly higher than(297.19±19.32) mg/L,(34.12±2.87) g/L, and(2.18±0.50) mg/L in the control group(P<0.05). After treatment, the levels of FPG, TC, TG, and LDL-C in the observation group were(4.32±0.85) mmol/L,(3.82±0.41) mmol/L,(1.32±0.28) mmol/L,and(2.23±0.33) mmol/L, respectively, significantly lower than(5.10±0.96) mmol/L,(4.41±0.43) mmol/L,(1.50±0.32) mmol/L,and(2.89±0.28) mmol/L in the control group, and the HDL-C level was(2.53±0.56) mmol/L, which was significantly higher than(1.98±0.47) mmol/L in the control group, with statistically significant differences(P<0.05). After treatment, serum S100β, BK, Aβ1-42 levels in the observation group were(0.39±0.12) ng/mL,(12.24±1.56) U/L, and(98.54±12.36) ng/L, respectively, significantly lower than(0.53±0.16) ng/mL,(15.33±2.42) U/L, and(137.59±18.29) ng/L in the control group(P<0.05). After treatment, the expression levels of P38MAPK and P-P38MAPK in the observation group were 1.12±0.21 and 0.43±0.08, respectively, significantly higher than 1.02±0.19 and 0.28±0.10 in the control group(P<0.05). Conclusion Vitamin D+ probiotics treatment can improve cognitive function, improve nutritional status and metabolic function, reduce nerve damage, and regulate the P38MAPK signaling pathway in elderly patients with dementia.更多还原