通督调神法针灸治疗轻度认知障碍的临床疗效观察

Efficacy of Acupuncture and Moxibustion in Treating Mild Cognitive Impairment with “Dredging Governor Vessel and Regulating Mentality”

目的:观察"通督调神"法针灸治疗轻度认知障碍(Mild Cognative Impairment,MCI)患者的临床疗效。方法:将64例中医健忘虚证型MCI患者随机分为治疗组(32例)和对照组(32例)。对照组给予健康教育;治疗组在健康教育的基础上给予"通督调神"法针刺配合艾灸治疗,每次治疗30分钟,每周治疗3次,连续治疗8周。分别在治疗前、治疗结束,治疗后2个月随访期,应用MoCA、MMSE以及中医症状、证候量表进行评估,比较两组疗效及不良反应情况。结果:每组均完成30例,各脱落2例,试验最终应用ITT分析。治疗后,治疗组总有效率84.4%;对照组31.3%,具有明显统计学差异(P<0.01)。MoCA和MMSE量表结果分析显示,治疗组治疗8周与治疗前比较差异显著(P<0.01),治疗后2个月随访与治疗前比较差异具有统计学意义(P<0.01)。对照组治疗8周与治疗前比较无统计学意义(P>0.05)。治疗8周时,治疗组评分较对照组有明显提高,具有统计学差异(P<0.01)。中医症状、证候量表结果分析显示,治疗组治疗后较治疗前积分显著降低,具有统计学差异(P<0.05);对照组治疗后积分较治疗前无统计学意义(P>0.05)。治疗8周后,治疗组评分较对照组有显著降低,具有统计学差异(P<0.01)。结论:通督调神法针灸治疗中医虚证型MCI具有显著疗效,能有效提高患者MoCA和MMSE量表评分,有效改善中医虚证(肾精亏耗、心脾两虚)型MCI患者出现的中医症状、证候表现,且安全性可靠。

Objective: To evaluate the efficacy and safety of the acupuncture and moxibustion of dredging governor vessel and regulating mentality for the treatment of mild cognitive impairment(MCI). Methods: Sixty-four participants suffering from MCI were equally allocated into 2 groups. The control group(n = 32) was given health education without any treatment;and the treatment group(n = 32) was treated by the acupuncture and moxibustion. The treatment was given 3 times per week, 30 minutes each time for consecutive 8 weeks. The participants were evaluated by Montreal Cognitive Assessment(MoCA), Mini-Mental State Examination(MMSE) and Syndromes of Traditional Chinese Medicine Symptom Scale at baseline, 8^th week after treatment and 2^nd month after the end of the treatment. All adverse reactions that occurred during the study were recorded and appropriately handled. Results: Two patients dropped out in each group, and the rest 60 patients in deficiency pattern were analyzed with Intention-to-Treat method. The total efficiency of the treatment group was 84.4%, and the control group was 31.3%, with a significant statistical difference(P<0.01). MoCA and MMSE of the treatment group showed a significant improvement at the 8^th week after treatment, compared with the baseline(P<0.01), and the comparison between the 2^nd month follow-up and the baseline also showed also a statistically significant difference(P<0.01). The score of the control group after treatment had no statistically difference, compared with the baseline(P>0.05). Comparison between 2 groups at the 8^th week showed a significant improvement(P<0.01). The comparison of the Syndromes of TCM Symptom Scale scores before and after treatment showed that the treatment group had a statistically significant difference(P<0.05), while the control group had no statistically difference(P>0.05). The results of TCM symptoms and syndrome scales showed that the scores of the treatment group were significantly lower than those before(P <0.05), while the scores of the control group after treatment had no significant difference(P >0.05). The treatment group scores were significantly lower than that of the control group, with statistical difference(P <0.01).Conclusion: The acupuncture and moxibustion of dredging governor vessel and regulating mentality for treating MCI patients in deficiency pattern is effective and safe. Acupuncture and moxibustion can improve the score of MoCA and MMSE, and can improve the symptoms of MCI patients in kidney-essence deficiency pattern and heart-spleen deficiency pattern.