黄地散颗粒联合“三焦”针法改善阿尔茨海默病髓海不足证的临床疗效

Clinical Efficacy of Huangdisan Grain Combined with ‘Sanjiao’ Acupuncture in Treating Alzheimer Disease with Symptom of Marrow Sea Deficiency

目的：观察黄地散颗粒联合＂三焦＂针法改善阿尔茨海默病（AD）髓海不足证的临床疗效及对氧化应激和炎症反应的影响。方法：将106例患者随机按数字法分为对照组和观察组各53例。两组均采用盐酸多奈哌齐片,5 mg·d^-1,睡前服用,4周后根据反应增加至10 mg·d^-1。对照组采用＂三焦＂针法。观察组针法同对照组,并口服黄地散颗粒,4 g/次,3次/d。两组疗程均为连续治疗3个月。采用简易精神状态量表（MMSE）和阿尔茨海默病评定量表（ADAS-cog）评价患者认知能力;采用日常生活功能量表（ADL）评价日常生活能力;进行髓海不足证评分;氧化应激包括超氧化物歧化酶（SOD）,丙二醛（MDA）,总抗氧化能力（T-AOC）和总抗氧化能力（T-AOC）,谷胱甘肽过氧化物酶（GSH-PX）,炎症因子包括白细胞介素-1β（IL-1β）,IL-6,肿瘤坏死因子（TNF）-α和γ-干扰素（IFN-γ）。以上指标均为治疗前后各评价1次。结果：经Ridit分析,观察组临床疗效和中医证候疗效均优于对照组（P〈0.05）;治疗后观察组患者MMSE评分高于对照组（P〈0.01）,ADAS-cog,ADL和髓海不足证评分均低于对照组（P〈0.01）;观察组患者T-AOC,SOD和GSH-PX水平均高于对照组,MDA水平低于对照组（P〈0.01）;观察组患者血清IL-1β,IL-6,TNF-α水平和IFN-γ水平均低于对照组（P〈0.01）。结论：采用黄地散颗粒联合＂三焦＂针法能改善AD患者髓海不足证,可以增强患者的认知功能和日常生活能力,调节抗氧化应激反应及抗炎功能的作用。

Objective： To observe the clinical efficacy of Huangdisan grain combined with ‘Sanjiao＇acupuncture in treating treat Alzheimer disease with symptom of marrow sea deficiency and its effect on oxidative stress and inflammatory reaction. Method： Totally 106 patients were randomly divided into control group and observation group by random number table. Both groups patients got donepezil hydrochloride tablets,5 mg/day at bed time,and the dosage increased to 10 mg/day after 4 weeks based on the symptoms. Patients in control group was given ‘Sanjiao＇acupuncture therapy,whereas patients in observation group got Huangdisan grain（4 g/time,3 times/day） combined with ‘Sanjiao＇acupuncture. And course of treatment was 3 months. Patients＇ cognitive ability was evaluated by mini-mental state examination（MMSE） and Alzheimer＇s disease assessment scale（ADAScog）. Activities of daily living were evaluated by activity of daily living scale（ADL）,and marrow sea deficiency was also scored. Levels of superoxide dismutase（SOD）,malondialdehyde（MDA）,total antioxidant capacity（TAOC）,glutathione peroxidase（GSH-PX）,interleukin-1β（IL-1β）,IL-6,tumor necrosis factor-α（TNF-α） and interferon-γ（IFN-γ） were detected. Result： After Ridit analysis,the clinical efficacy of the observation group and the curative effect of traditional Chinese medicine（TCM） syndrome were better than that of the control group（P〈0. 05）. The total effective rate of TCM in observation group was 93. 88%,which was higher than 79. 17% in control group（χ^2= 4. 521,P〈0. 05）. After treatment,score of MMSE was higher than that in control group（P〈0. 01）,and scores of ADAS-cog,ADL and marrow sea deficiency were lower than those in control group（P〈0. 01）. Levels of IL-1β,IL-6,TNF-α and IFN-γ were lower than those in control group（P〈0. 01）. Conclusion：Huangdisan grain combined with ‘Sanjiao ＇acupuncture can improve the cognitive ability of patients and their activities of daily living,and resist oxidant stress and inflammation.