子午流注取穴针刺联合吡拉西坦治疗无痴呆型血管性认知障碍临床研究

Clinical Study of Acupuncture at Acupoints Selected by Zi Wu Liu Zhu plus Piracetam for Vascular Cognitive Impairment-no Dementia

目的观察子午流注取穴针刺联合吡拉西坦治疗无痴呆型血管性认知障碍患者临床疗效。方法将90例无痴呆型血管性认知障碍患者随机分为子午流注组、西药治疗组、综合治疗组,每组30例。子午流注组采用子午流注纳甲法取穴针刺;西药治疗组予口服吡拉西坦片治疗;综合治疗组采用子午流注取穴针刺加口服吡拉西坦片治疗。观察3组治疗前后蒙特利尔认知评估量表(MoCA)评分、日常生活活动能力(ADL)量表评分、血清同型半胱氨酸(Hcy)含量、血浆一氧化氮(NO)含量、血浆内皮素(ET)含量及大脑中动脉脉动指数(PI)值。结果 3组治疗后的MoCA评分、ADL评分、血清Hcy含量、血浆NO含量及大脑中动脉PI值均较同组治疗前有明显改善(P<0.01),且综合治疗组优于子午流注组和西药治疗组(P<0.01,P<0.05),子午流注组与西药治疗组比较差异无统计学意义(P>0.05);3组治疗前后血浆ET含量未见明显变化(P>0.05)。综合治疗组出现不良反应者2例,西药治疗组6例,子午流注组无不良反应发生。结论子午流注取穴针刺联合吡拉西坦在改善认知功能及日常生活能力方面均优于子午流注取穴针刺和吡拉西坦治疗,子午流注取穴针刺安全性优于吡拉西坦治疗;子午流注取穴针刺联合吡拉西坦可能通过降低Hcy水平,增加NO合成,恢复NO与ET之间的平衡,使得脑血管相对扩张,脑血流量增加而起到治疗无痴呆型血管性认知障碍的作用。

Objective To observe the clinical efficacy of acupuncture at acupoints selected by Zi Wu Liu Zhu(midnight-noon ebb-flow) plus Piracetam in treating vascular cognitive impairment-no dementia(VCIND).Method Ninety patients with VCIND were randomized into a Zi Wu Liu Zhu group,a Western medication group and an integrated treatment group,with 30 cases in each group.The Zi Wu Liu Zhu group was intervened by acupuncture at acupoints selected by Wu Liu Zhu Na Jia method;the Western medication group received oral Piracetam;the integrated treatment group was intervened by acupuncture at acupoints selected by Zi Wu Liu Zhu plus oral Piracetam.Before and after treatment,the Montreal Cognitive Assessment(MoCA) score,Activities of Daily Living(ADL) score,the contents of serum homocysteine(Hcy),plasma NO and plasma endothelin(ET),and the pulsatility index(PI) of middle cerebral artery were observed in the three groups.Result After treatment,the MoCA and ADL scores,the contents of serum Hey and plasma NO,and PI of cerebral middle artery improved significantly in the three groups(P<0.01),and the integrated treatment group was markedly superior to the Zi Wu Liu Zhu group and Western medication group(P<0.01),while the difference between the latter two groups was statistically insignificant(P>0.05).The content of plasma ET did not show significant change after treatment in the three groups(P> 0.05).Two cases in the integrated treatment group and 6 cases in the Western medication group presented adverse reactions,while no adverse reaction event happened in the Zi Wu Liu Zhu group.Conclusion Acupuncture at acupoints selected by Zi Wu Liu Zhu plus Piracetam is more effective in improving the cognitive function and ADL compared with the two methods used independently.Acupuncture at acupoints selected by Zi Wu Liu Zhu has advantage of high safety compared with Piracetam;Acupuncture at acupoints selected by Zi Wu Liu Zhu plus Piracetam can dilate cerebral blood vessels and increase cerebral blood flow to treat VCIND through down-regulating the Hey level,encouraging the synthesis of NO and restoring the balance between NO and ET.