针灸联合经颅直流电刺激对脑卒中后认知障碍康复疗效的临床随机对照研究

Clinical randomized controlled study of acupuncture combined with transcranial direct current stimulation on rehabilitation of cognitive impairment after stroke

目的观察针灸联合经颅直流电刺激(tDCS)对脑卒中后认知障碍的康复疗效,以及对血清胶质纤维酸性蛋白(GFAP)、脑源性神经营养因子(BDNF)和神经营养素-3(NT-3)的影响。方法选取该院康复医学科收治的92例脑卒中后轻中度认知障碍患者为研究对象,采用随机单盲法将患者分为观察组和对照组,每组46例。对照组予以常规康复治疗,观察组在对照组治疗基础上予以针灸联合tDCS治疗。观察两组治疗前后简易精神状态量表(MMSE)评分、洛文斯顿作业疗法认知评定量表(LOTCA)评分、Rivermead行为记忆测验量表(RBMT)评分、简式Fugl-Meyer运动功能评定量表(FMA)上下肢功能评分、改良Barthel指数(MBI)评分、P300潜伏期、P300波幅、蒙特利尔认知评估量表(MoCA)评分、脑血流动力学指标,以及血清GFAP、BDNF和NT-3水平的变化。结果两组治疗前MMSE评分、LOTCA评分、RBMT评分、FMA上下肢功能评分、MBI评分、P300潜伏期、P300波幅、MoCA评分、Vmean、Vmax、PI、GFAP、BDNF和NT-3比较,差异无统计学意义(P>0.05)。治疗后,两组MMSE评分、LOTCA评分、RBMT评分、FMA上下肢功能评分、MBI评分、P300波幅、MoCA评分,以及BDNF和NT-3水平较治疗前明显升高,Vmean、Vmax加快,而P300潜伏期缩短,PI和GFAP水平较治疗前明显降低,差异有统计学意义(P<0.05);观察组治疗后与对照组治疗后比较,上述指标改善更加明显,差异有统计学意义(P<0.05)。结论针灸联合tDCS对脑卒中后认知障碍的康复具有显著疗效,能够明显改善脑部血流供应,促进神经营养因子对脑神经损伤的修复作用。

Objective To observe the efficacy of acupuncture combined with transcranial direct current stimulation(tDCS)on the rehabilitation of cognitive impairment after stroke and its impact on serum glial fibrillary acidic protein(GFAP),brain-derived neurotrophic factor(BDNF)and neurotrophin-3(NT-3).Methods A total of 92 patients with mild to moderate cognitive impairment after stroke treated in the Department of Rehabilitation Medicine of Shanghai Eighth People's Hospital were selected as the research objects.The patients were randomly divided into observation group and control group by single blind method,with 46 cases in each group.The control group was given routine rehabilitation treatment,the observation group was given acapuncture and tDCS on the basis of treatment in control group.Before and after treatment,mini-mental state examination(MMSE)score,LOTCA score,Rivermead Behavioral Memory Scale(RBMT)score,Fugl-Meyer motor function assessment(FMA)upper and lower limbs function score,modified Barthel index score(MBI score),P300 latency,P300 amplitude,Montreal Cognitive Assessment Scale(MoCA)score,cerebral hemodynamics indexes and serum GFAP,BDNF,NT-3 levels were compared.Results There was no significant difference on MMSE score,LOTCA score,RBMT score,FMA upper and lower limbs function score,MBI score,P300 latency,P300 amplitude,MoCA score,Vmean,Vmax,PI,GFAP,BDNF and NT-3 levels between the two groups before treatment(P>0.05).After treatment,the levels of MMSE score,LOTCA score,RBMT score,FMA upper and lower limbs function score,MBI score,P300 amplitude,MoCA score,BDNF and NT-3 were significantly higher than those before treatment,Vmean,Vmax were significant faster than those before treatment(P<0.05),while the levels of P300 latency was shorter than that before treatment,PI and GFAP were significantly lower than those before treatment(P<0.05),the improve situations in observation group were more obviously than those in control group(P<0.05).Conclusion Acupuncture combined with tDCS has a significant effect on the treatment of cognitive impairment after stroke,which could significantly improve the blood flow supply of brain and promote the repair effect of neurotrophic factors on brain nerve injury.