醒脑开窍针法对非痴呆性血管认知障碍的影响

Effect of Xingnao Kaiqiao Acupuncture(醒脑开窍针法) on Vascular Cognitive Impairment of No-dementia

目的观察醒脑开窍针法治疗非痴呆性血管认知障碍(VCIND)的疗效并探讨其可能的作用机制。方法82例VCIND患者基于Zelen’s设计分为针刺组46例和西药组36例,两组患者均给予口服拜阿司匹林肠溶片、阿托伐他汀钙片作为基础治疗;西药组加用口服盐酸多奈哌齐片5 mg,每日1次;针刺组加用醒脑开窍针法治疗,每日2次,每周6天,两组均治疗8周。治疗前及治疗4、8周后评价两组患者蒙特利尔认知评估量表(MoCA)、日常生活能力量表(ADL)评分结果,并观察血清降钙素基因相关肽(CGRP)、淀粉蛋白前β位分解酶1(BACE1)及其mRNA水平。治疗4、8周后评价临床疗效。结果针刺组治疗4、8周后总有效率分别为64.86%(24/37)、89.19%(33/37),均高于西药组的54.84%(17/31)、80.65%(25/31)(P<0.05)。两组患者治疗4、8周后MoCA、ADL评分均较治疗前显著改善,且针刺组优于西药组(P<0.05)。两组患者治疗4、8周后血清CGRP及其mRNA均升高,BACE1及其mRNA均降低,且针刺组治疗4、8周改善均优于西药组(P<0.05)。结论醒脑开窍针法可显著改善VCIND患者临床症状,其机制可能涉及调节神经中枢血管舒张因子CGRP和神经元损害蛋白标志物BACE1表达。

Objective To observe the therapeutic effects of Xingnao Kaiqiao Acupuncture (醒脑开窍针法) on vascular cognitive impairment of no-dementia ( VCIND) patients and its possible action mechanism. Methods A total of 82 patients with VCIND were randomly divided into acupuncture group of 46 cases and western medicine group of 36 cases based on Zelen's design. Both groups were treated with oral aspirin enteric-coated tablets and atorvastatin calcium tablets as basic treatment. In the western medicine group,donepezil hydrochloride tablets 5 mg were given orally on the basic treatment,once a day,while in the acupuncture group,Xingnao Kaiqiao Acupuncture was given on the basic treatment,twice a day,for 6 days in a week. Both groups were treated for 8 weeks. The scores of Montreal Cognitive Assessment Scale ( MoCA scale),Activity of Daily Life Scale ( ADL) before and after 4 and 8 weeks of treatment were evaluated. The serum calcitonin gene related peptide ( CGRP),β-site amyloid precursor protein cleaving enzyme 1 ( BACE1) and their mRNA levels were observed. Clinical efficacy was evaluated after 4 and 8 weeks of treatment. Results After 4 and 8 weeks of treatment,the total effective rates of the acupuncture group were 64. 86%( 24 /37) and 89. 19%( 33 /37) respectively,which were higher than those of the western medicine group 54. 84%( 17 /31) and 80. 65%( 25 /31)( P < 0. 05). After 4 and 8 weeks of treatment,MoCA and ADL scores of 2 groups were significantly improved than those before treatment,and the acupuncture group was superior to the western medicine group ( P < 0. 05). After 4 and 8 weeks of treatment,serum CGRP and its mRNA of both groups were increased,and BACE1 and its mRNA were decreased. The improvement of the acupuncture group was better than the western medicine group ( P < 0. 05). Conclusion Xingnao Kaiqiao Acupuncture can obviously improve the clinical symptoms of VCIND patients,and its mechanism may be related to the regulation of neuronal vasodilator CGRP and neuronal damage protein marker BACE1 expression.