原络通经针法联合西药治疗遗忘型轻度认知功能障碍临床疗效及机制探讨

Clinical efficacy and mechanism explore of Yuanluo Tongjing acupuncture method combined with western medicine in the treatment of amnestic mild cognitive impairment

目的:探讨原络通经针法联合盐酸多奈哌齐对遗忘型轻度认知功能障碍(aMCI)患者的认知功能改善情况及其作用机制。方法:将90例aMCI患者随机分为针刺组、药物组、针药组,每组30例。治疗前后分别评价各组主要结局指标:简明精神状态检查表(MMSE)评分、蒙特利尔认知量表(MoCA)评分、听觉P300电位检测,次要结局指标:同型半胱氨酸(Hcy)、乙酰胆碱酯酶(AChE)、超氧化物歧化酶(SOD)和丙二醛(MDA)。结果:治疗后,3组患者P300潜伏期及血清Hcy、AChE、MDA水平均较治疗前显著降低(P<0.05),3组患者MMSE、MoCA评分,P300波幅及血清SOD水平均较治疗前显著升高(P<0.05),且针药组患者上述各项指标变化幅度均显著大于针刺组和药物组(P<0.05)。结论:原络通经针法联合盐酸多奈哌齐可有效改善aMCI患者的认知功能,减轻临床症状,提高其生活自理能力,疗效优于单纯针刺或药物治疗,其机制可能与调节血清Hcy、AChE、SOD、MDA水平有关。

Objective:To explore Yuanluo Tongjing acupuncture method combined with donepezil hydrochloride on the improvement of cognitive function in patients with amnestic mild cognitive impairment(aMCI)and its mechanism of action.Methods:A total of 90 patients with amnestic mild cognitive impairment were randomly divided into acupuncture group,drug group,and acupuncture plus drug group,with 30 cases in each group.Before and after treatment,main outcome indexes:the scores of Mini Mental State Examination(MMSE),Montreal Cognitive Assessment(MoCA),auditory P300 potential detection,and other outcome indexes:homocysteine(Hcy),acetylcholinesterase(AChE),superoxide dismutase(SOD)and malondialdehyde(MDA)were evaluated.Results:After treatment,the P300 latency,serum Hcy,AChE and MDA levels of the three groups were lower than before treatment(P<0.05);the MMSE,MoCA score,P300 amplitude,and serum SOD level of the 3 groups were higher than before treatment(P<0.05),and the changes of patients in the acupuncture plus drug group was higher than the acupuncture group and the drug group(P<0.05).Conclusion:Yuanluo Tongjing acupuncture method combined with donepezil hydrochloride can effectively improve the cognitive function of patients with aMCI,reduce clinical symptoms,and improve their self-care ability in life.The efficacy is better than the acupuncture group and the drug group,and its mechanism may be related to the regulation of serum Hcy,AChE,SOD,MDA concentration levels.