调神益智针法结合定志益聪方对血管性痴呆患者认知功能及肠道微生态的影响

Clinical observation of the cognitive function and intestinal microecology of patients with vascular dementia treated with Tiaoshen Yizhi acupuncture combined with Dingzhi Yicong Fang

目的探讨调神益智针法结合定志益聪方对血管性痴呆患者的智能状态、认知功能以及肠道微生态的影响。方法将符合纳入标准的64例血管性痴呆患者按随机数字表法分为观察组和对照组,每组各32例。除基础治疗外,观察组患者接受调神益智针法联合口服定志益聪方,对照组患者口服盐酸多奈哌齐片。60 d为1个疗程。比较2组患者治疗前及治疗后简易精神状态评价量表(MMSE)、Blessed行为量表(BBS)、日常生活活动能力量表(BI)、阿尔茨海默病评定量表认知部分(ADAS-Cog)评分的变化,中医证候积分的变化以及特定肠道菌群数量变化。结果观察组、对照组总有效率分别为84.38%、62.50%,差异有统计学意义(P<0.05)。2组患者治疗后较治疗前MMSE、BI评分增加,BBS、ADAS-Cog评分及证候积分降低,双歧杆菌、乳酸杆菌、消化球菌、酵母菌、拟杆菌菌群数量增多,肠球菌、大肠杆菌、小梭菌菌群数量减少(P<0.05或P<0.01)。观察组治疗后与对照组治疗后比较,MMSE、BI评分增加,BBS、ADAS-Cog评分及证候积分降低,双歧杆菌、乳酸杆菌、消化球菌、酵母菌、拟杆菌菌群数量增多,肠球菌、大肠杆菌、小梭菌菌群数量减少(P<0.05或P<0.01)。结论调神益智针法联合定志益聪方可改善血管性痴呆患者的智能状态、认知功能、社会行为能力、日常生活功能及中医证候,而且能有效地纠正肠道菌群失调,维持肠道微生态的稳定,其疗效优于常规西药治疗。为血管性痴呆的临床治疗提供了新的方法。

Objective To explore the effect of Tiaoshen Yizhi(Mind-regulating and Intelligence-improving,TSYZ)acupuncture combined with Dingzhi Yicong Fang(Mind-calming and Intelligence-improving Formula,DZYCF)on the mental state,cognitive function and intestinal microecology of patients with vascular dementia(VD).Methods 64 patients with vascular dementia who met the inclusion criteria were randomly divided into the observation group and the control group,32 cases in each group.The observation group was treated with TSYZ acupuncture combined with DZYCF,and the control group was treated with donepezil hydrochloride for 60 days.The changes in MMSE,BBS,BI,cognitive scale of Alzheimer Disease Rating Scale(ADAS-Cog),TCM pattern scores and the numbers specific intestinal floras were assessed and analyzed before and after treatment.Results The total effective rates of the two groups were 84.38%and 62.50%with statistically significant difference(P<0.05).Compared with before treatment,the MMSE and BI scores and the numbers of floras of bifidobacterium,lactobacillus,peptococcus,saccharomycetes,and bacteroides increased,the numbers of floras of enterococcus,bacillus coli,and clostridium parvum and the BBS,ADAS-Cog and TCM pattern scores of both groups decreased after treatment(P<0.05,P<0.01).After treatment,compared with the control group,the MMSE and BI scores and the numbers of floras of bifidobacterium,lactobacillus,peptococcus,saccharomycetes,and bacteroides increased,the numbers of floras of enterococcus,bacillus coli,and clostridium parvum and the BBS,ADAS-Cog and TCM pattern scores of the observation group decreased(P<0.05,P<0.01).Conclusion TSYZ acupuncture combined with DZYCF can improve the mental state,cognitive function,social capability,daily life function,and TCM pattern of VD patients,and can effectively restore the balance of intestinal floras and maintain the stability of intestinal microecology.With better curative effect than conventional treatment using Western medicine,it could be a new way to treat VD clinically.