艾灸头部穴位为主对血管性痴呆患者脑脊液中生长抑素和精氨酸血管加压素水平影响的随机对照试验

1、艾灸头部穴位为主对血管性痴呆患者脑脊液中生长抑素和精氨酸血管加压素水平影响的随机对照试验         11-01-25 09:47:00     编辑：studa20                       作者：王频, 杨骏，柳刚, 陈浩, 杨帆 【

2、摘要】  背景：血管性痴呆（vascular dementia, VaD）患者血浆和脑脊液中多种神经肽类物质发生明显变化；有效地干预神经肽水平，对VaD的预防和治疗十分重要。目的：以艾灸头部穴位为主治疗VaD，观察其改善临床症状和调控脑脊液中与学习记忆相关的神经肽物质生长抑素（somatostatin, SS）和精氨酸血管加压素（arginine vasopressin, AVP）水平的作用。设计、场所、对象和干预措施：65例VaD患者均为安徽中医学院针灸医院门诊或住院病例。按随机数字表法分为艾灸组（33例）和西药组（32例）。艾灸组患者给予隔附子饼压灸，反复灸20 min；西药组口

3、服吡拉西坦素片0.8 g，3次/d。两组均治疗4个疗程，4周为1个疗程。主要结局指标：比较两组治疗前后长谷川痴呆智能检查量表（Hasegawas Dementia Scale, HDS）、简易智能精神状态检查量表（MiniMental State Examination, MMSE）和日常生活能力量表（Activity of Daily Living Scale, ADL）积分变化，以及脑脊液中SS和AVP水平。结果：艾灸组总有效率与西药组比较，差异有统计学意义（P0.01）。两组治疗前后HDS、MMSE和ADL积分比较，差异均有统计学意义（P0.05，P0.01），艾灸组HDS、MMSE和A

4、DL量表积分治疗前后差值较西药组有所改善（P0.05，P0.01）。两组治疗后脑脊液SS和AVP水平较治疗前明显升高（P0.01），艾灸组治疗后SS和AVP升高水平较西药组明显（P0.01）。结论：艾灸能改善临床相关症状积分，调控与学习记忆相关的神经肽物质，是治疗VaD的有效方法。 【关键词】  血管性痴呆; 针灸疗法; 生长抑素; 精氨酸血管加压素; 随机对照试验Design, setting, participants and interventions: A total of 65 VaD patients from Acupuncture Hospital, Anhui Un

5、iversity of Traditional Chinese Medicine, were randomly divided into moxibustion group (33 cases) and Western medicine group (32 cases). Patients in the moxibustion group were treated with indirect moxibustion with common monkshood cake for 20 min. Patients in the Western medicine group were orally

6、administered piracetam tablets, 0.8 g for three times a day. One treatment course was 4 weeks, and they were treated for 4 treatment courses.Main outcome measures: The scores of Hasegawas Dementia Scale (HDS), MiniMental State Examination (MMSE), and Activity of Daily Living Scale (ADL), as well as

7、the levels of learning and memoryrelated neuropeptides from cerebrospinal fluid such as somatostatin (SS) and arginine vasopressin (AVP) were measured before and after treatment in the two groups.Results: Total response rate was significantly higher in the moxibustion group than in the Western medic

8、ine group (P<0.01). There were significant differences in scores of HDS, MMSE and ADL between before and after treatment in the two groups(P0.05 or P0.01). After treatment, the scores of HDS, MMSE and ADL in the moxibustion group were more improved as compared with those in the Western medicine g

9、roup (P0.05 or P0.01). The levels of SS and AVP after treatment were higher than those before treatment in the two groups(P0.01). After treatment, the increased levels of SS and AVP were higher in the moxibustion group than in the Western medicine group (P<0.01).Conclusion: Moxibustion is effecti

10、ve in improving the clinical symptom scores and regulating the levels of neuropeptides associated with learning and memory in VaD patients.Keywords: vascular dementia; acupuncture moxibustion; somatostatin; arginine vasopressin; randomized controlled trial血管性痴呆（vascular dementia, VaD）是一种慢性进行性疾病，其临床表

11、现以神经系统定位损害的症状和体征为主，可引起患者明显的记忆力、认知力、思维能力、计算能力以及情绪和行为障碍，严重影响病人的工作和生活。近年来研究表明，VaD患者的血浆和脑脊液中多种神经肽类物质发生明显变化，如生长抑素（somatostatin, SS）、精氨酸血管加压素（arginine vasopressin, AVP）和内啡肽（betaendorphin, EP）等，而这些神经肽的变化又参与了脑缺血致脑神经损害的过程，是影响学习和记忆过程的重要因素，而有效干预神经肽水平的变化，对VaD的预防和治疗十分重要1。我科自2005年至2007年，采用化瘀通络灸法，以艾灸头部穴位为主治疗VaD，并从

12、神经肽类相关物质变化角度探讨其可能的作用机制，通过检测脑脊液中SS及AVP的水平进行对照研究，取得了预期的结果。1  资料与方法1.1  临床资料65例确诊为VaD的患者均为2005年1月至2007年12月安徽中医学院针灸医院门诊或住院病例。采用美国神经病学会神经病诊断和统计手册（DSM）2关于VaD的诊断标准，采用修改的Hachinski缺血计分法3区分阿尔茨海默病（Alzheimer disease, AD）与VaD；智力障碍程度依据改良长谷川痴呆智能检查量表（Hasegawas Dementia Scale, HDS）3。VaD分级标准按HDS评分分为4个等级：正常3

13、132.5分；轻度痴呆（边缘状态）2230.5分；中度痴呆（疑痴呆）10.521.5分；重度痴呆（痴呆）010.0分。符合美国神经病学会神经病诊断和统计手册（DSM）2关于VaD的诊断标准；Hachinski缺血计分37分；改良HDS评分429.5分。在脑血管病发生以前，已有痴呆症状；影像学检查（CT或MRI）未能证实有脑血管病；脑血管病发病5个月以内；有运动性和混合性失语症或精神疾病；除认识障碍外，不伴有其他脑血管病局灶体征。1.2  研究方法65例VaD患者按随机数字表法分为艾灸组和西药组，其中艾灸组33例，西药组32例。艾灸组：主穴取百会、神庭、大椎。随症配穴：肝肾亏虚配肝俞、肾俞；痰浊阻窍配中脘、丰隆；气虚配气海。穴位定位依据中华人民共和国国家标准·经穴部位（GB 123461990）5。主穴百会用压灸，穴位上以经制备的46 mm厚的附子片作间隔，点燃清艾条，灸火直接压灸在间隔物上，至穴位皮肤局部灼热潮红时立即提起，倾刻再压灸，反复灸20 min；神庭、大椎穴用清艾条悬灸20 min。配穴用毫针针刺。每日1次，每周休息1 d，4周为1个疗程，共治疗4个疗程，疗程之间休息1周。西药组：口服吡拉西