1、艾灸頭部穴位為主對血管性癡呆患者腦脊液中生長抑素和精氨酸血管加壓素水平影響的隨機對照試驗         11-01-25 09:47:00     編輯：studa20                       作者：王頻, 楊駿，柳剛, 陳浩, 楊帆 【

2、摘要】  背景：血管性癡呆（vascular dementia, VaD）患者血漿和腦脊液中多種神經肽類物質發(fā)生明顯變化；有效地干預神經肽水平，對VaD的預防和治療十分重要。目的：以艾灸頭部穴位為主治療VaD，觀察其改善臨床癥狀和調控腦脊液中與學習記憶相關的神經肽物質生長抑素（somatostatin, SS）和精氨酸血管加壓素（arginine vasopressin, AVP）水平的作用。設計、場所、對象和干預措施：65例VaD患者均為安徽中醫(yī)學院針灸醫(yī)院門診或住院病例。按隨機數字表法分為艾灸組（33例）和西藥組（32例）。艾灸組患者給予隔附子餅壓灸，反復灸20 min；西藥組口

3、服吡拉西坦素片0.8 g，3次/d。兩組均治療4個療程，4周為1個療程。主要結局指標：比較兩組治療前后長谷川癡呆智能檢查量表（Hasegawas Dementia Scale, HDS）、簡易智能精神狀態(tài)檢查量表（MiniMental State Examination, MMSE）和日常生活能力量表（Activity of Daily Living Scale, ADL）積分變化，以及腦脊液中SS和AVP水平。結果：艾灸組總有效率與西藥組比較，差異有統(tǒng)計學意義（P0.01）。兩組治療前后HDS、MMSE和ADL積分比較，差異均有統(tǒng)計學意義（P0.05，P0.01），艾灸組HDS、MMSE和A

4、DL量表積分治療前后差值較西藥組有所改善（P0.05，P0.01）。兩組治療后腦脊液SS和AVP水平較治療前明顯升高（P0.01），艾灸組治療后SS和AVP升高水平較西藥組明顯（P0.01）。結論：艾灸能改善臨床相關癥狀積分，調控與學習記憶相關的神經肽物質，是治療VaD的有效方法。 【關鍵詞】  血管性癡呆; 針灸療法; 生長抑素; 精氨酸血管加壓素; 隨機對照試驗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血管性癡呆（vascular dementia, VaD）是一種慢性進行性疾病，其臨床表

11、現(xiàn)以神經系統(tǒng)定位損害的癥狀和體征為主，可引起患者明顯的記憶力、認知力、思維能力、計算能力以及情緒和行為障礙，嚴重影響病人的工作和生活。近年來研究表明，VaD患者的血漿和腦脊液中多種神經肽類物質發(fā)生明顯變化，如生長抑素（somatostatin, SS）、精氨酸血管加壓素（arginine vasopressin, AVP）和內啡肽（betaendorphin, EP）等，而這些神經肽的變化又參與了腦缺血致腦神經損害的過程，是影響學習和記憶過程的重要因素，而有效干預神經肽水平的變化，對VaD的預防和治療十分重要1。我科自2005年至2007年，采用化瘀通絡灸法，以艾灸頭部穴位為主治療VaD，并從

12、神經肽類相關物質變化角度探討其可能的作用機制，通過檢測腦脊液中SS及AVP的水平進行對照研究，取得了預期的結果。1  資料與方法1.1  臨床資料65例確診為VaD的患者均為2005年1月至2007年12月安徽中醫(yī)學院針灸醫(yī)院門診或住院病例。采用美國神經病學會神經病診斷和統(tǒng)計手冊（DSM）2關于VaD的診斷標準，采用修改的Hachinski缺血計分法3區(qū)分阿爾茨海默?。ˋlzheimer disease, AD）與VaD；智力障礙程度依據改良長谷川癡呆智能檢查量表（Hasegawas Dementia Scale, HDS）3。VaD分級標準按HDS評分分為4個等級：正常3

13、132.5分；輕度癡呆（邊緣狀態(tài)）2230.5分；中度癡呆（疑癡呆）10.521.5分；重度癡呆（癡呆）010.0分。符合美國神經病學會神經病診斷和統(tǒng)計手冊（DSM）2關于VaD的診斷標準；Hachinski缺血計分37分；改良HDS評分429.5分。在腦血管病發(fā)生以前，已有癡呆癥狀；影像學檢查（CT或MRI）未能證實有腦血管病；腦血管病發(fā)病5個月以內；有運動性和混合性失語癥或精神疾??；除認識障礙外，不伴有其他腦血管病局灶體征。1.2  研究方法65例VaD患者按隨機數字表法分為艾灸組和西藥組，其中艾灸組33例，西藥組32例。艾灸組：主穴取百會、神庭、大椎。隨癥配穴：肝腎虧虛配肝俞、腎俞；痰濁阻竅配中脘、豐?。粴馓撆錃夂?。穴位定位依據中華人民共和國國家標準·經穴部位（GB 123461990）5。主穴百會用壓灸，穴位上以經制備的46 mm厚的附子片作間隔，點燃清艾條，灸火直接壓灸在間隔物上，至穴位皮膚局部灼熱潮紅時立即提起，傾刻再壓灸，反復灸20 min；神庭、大椎穴用清艾條懸灸20 min。配穴用毫針針刺。每日1次，每周休息1 d，4周為1個療程，共治療4個療程，療程之間休息1周。西藥組：口服吡拉西