基于心脑相关理论观察益气活血开窍法联合针刺治疗血管性痴呆的效果及调节机制

Effect and Regulation Mechanism of Treating Vascular Dementia by the Method of Invigorating Qi,Activating Blood Circulation and Opening Orifice Combined with Acupuncture Based on the Theory of Correlation Between the Heart and Brain

目的:观察益气活血开窍法联合针刺治疗血管性痴呆的效果,对可能的调节机制进行初步探讨。方法:将我院就诊的96例血管性痴呆患者为研究对象,随机分为对照组和观察组患者各48例。对照组患者口服奥拉西坦胶囊,0.8g/次,3次/d;观察组患者在对照组基础上加用益气活血开窍法联合针刺内外合治,连续治疗8周。对比两组治疗的临床效果、简易智能状态量表(MMSE)、美国国立卫生研究院卒中量表(NIHSS)、日常生活活动量表(ADL)评分、脑血流动力学指标、外周血清中相关因子水平及不良反应发生情况。结果:观察组的有效率为93.75%(45/48),显著高于对照组患者的77.08%(37/48)(χ2=5.352,P<0.05);与对照组相比,观察组患者治疗后的认知能力MMSE、日常生活能力ADL评分显著升高,神经功能NIHSS评分则显著降低(P<0.05);与对照组相比,观察组患者治疗后脑血流动力学指标PCA、MCA、ACA、VA均显著升高(P<0.05);治疗后,与对照组相比,观察组患者的血清中BDNF水平显著升高,H-FABP、VEGF、LP-PLA2水平有所降低(P<0.05);对照组患者不良反应发生率10.42%,观察组不良反应发生率6.25%,差异无统计学意义(P>0.05)。结论:益气活血开窍法联合针刺更利于提高血管性痴呆患者的认知能力,修复受损的神经功能,增强日常生活能力,推断可能是通过提高脑组织血液灌注、调控血清中BDNF、H-FABP、VEGF、Lp-PLA2水平以发挥脑保护作用实现的。

Objective: To observe the therapeutic effect of treating vascular dementia by the method of invigorating Qi, activating blood circulation and opening orifice combined with acupuncture, and to discuss the possible regulating mechanism.Methods: A total of 86 patients with vascular dementia admitted to our hospital were randomly divided into controlled group and observation group with 43 patients each.Patients in the controlled group took Oracetam Capsule orally, 0.8 g/time and 3 times/day.In the observation group, on the basis of the controlled group, patients were treated with the method of invigorating Qi, activating blood circulation and opening orifice combined with acupuncture, and the treatment lasted for 8 weeks.The clinical efficacy, MMSE,NIHSS,ADL scores, cerebral hemodynamic indicators, levels of related factors in peripheral blood and adverse reactions were compared between the two groups.Results: The effective rate in the observation group was 93.75%(45/48),which was significantly higher than that in the controlled group of 77.08%(37/48)(χ2=5.352,P < 0.05).Compared with the controlled group, the MMSE and ADL scores of patients in the observation group after treatment were significantly increased, while the NIHSS scores of neurological function were significantly decreased(P < 0.05).Compared with the controlled group, the cerebral hemodynamic indexes PCA,MCA,ACA and VA in the observation group were significantly increased after treatment(P < 0.05).After treatment, compared with the controlled group, serum BDNF level in the observation group was significantly increased, while the serum LEVELS of H-FABP,VEGF and LP-PLA2 were decreased(P < 0.05).The incidence of adverse reactions was 10.42% in the controlled group and 6.25% in the observation group, with no statistically significant difference(P > 0.05).Conclusion: The method of invigorating Qi, activating blood circulation and opening orifice combined acupuncture is more beneficial to improve the cognitive ability of patients with vascular dementia, repair the damaged nerve function, and enhance the ability of daily life.It is speculated that this may be achieved by improving the blood perfusion of brain tissue and regulating the serum levels of BDNF,H-FABP,VEGF,Lp-PLA2 to play a cerebral protective role.