针刺辅助治疗轻中度阿尔茨海默病肾虚髓减证44例临床观察

Clinical observation on 44 cases of acupuncture in adjunctive treatment of mild and moderate Alzheimer's disease with kidney deficiency and marrow reduction syndrome

目的 观察针刺辅助治疗轻中度阿尔茨海默病(AD)肾虚髓减证的临床疗效。方法 将90例轻中度AD肾虚髓减证患者采用随机数字表法分为对照组(45例,其中脱落2例、死亡1例)和治疗组(45例,其中脱落1例)。对照组给予常规疗法治疗,包括基础治疗(调控血压、降血脂、降血糖、抗血小板聚集、营养脑神经、改善脑局部微循环、抗炎等)和康复训练(运动训练、记忆力训练、专注力训练、注意力训练等);治疗组在对照组治疗方法的基础上给予针刺治疗,主穴取百会、四神聪,配穴取神门、神庭、神通、本神,每日针刺1次,每次留针20 min。治疗4周后比较2组的临床疗效、不良反应发生率,以及治疗前后阿尔茨海默病行为病理评定量表(BEHAVE-AD)评分、日常生活功能量表(ADL)评分,脑血流动力学指标[大脑基底动脉(BA)、中动脉(MCA)血流速度]和血清蛋白[高迁移率族蛋白B1(HMGB1)、髓鞘碱性蛋白(MBP)]水平。结果 治疗组总有效率为90.9%(40/44),对照组为78.6%(33/42),2组比较差异有统计学意义(P<0.05);治疗后2组BEHAVE-AD评分,血清HMGB1、MBP水平均明显降低,ADL评分,BA、MCA血流速度均明显升高,与同组治疗前比较差异有统计学意义(P<0.05或P<0.01),且治疗组改善更明显,与对照组治疗后比较差异均有统计学意义(P<0.01);2组在治疗期间均未出现明显不良反应。结论 针刺辅助治疗轻中度AD肾虚髓减证疗效显著,可明显改善患者的临床症状,提高日常生活能力,其作用可能与改善患者脑部血流动力学指标及血清蛋白水平有关。

Objective To observe the clinical eficacy of acupuncture in the adjunctive treatment of mild and moderate Alzheimer's disease(AD)with kidney deficiency and marrow reduction syndrome.Methods 90 cases of mild and moderate AD with kidney deficiency and marrow reduction syndrome were divided into a control group(45 cases,including 2 cases of drop-out,and 1 case of death)and a treatment group(45 cases,including 1 case of dropout).The control group was given routine treatment,including basic treatment(regulating blood pressure,lowering blood fat,lowering blood sugar,anti-platelet aggregation,nourishing brain nerves,improving local cerebral microcirculation,anti-inflammatory,etc.)and rehabilitation training(exercise training,memory training,concentration training,attention training,etc.);The treatment group was given acupuncture treatment on the basis of the treatment method of the control group.The main points were Baihui(GV20)and Sishencong(EX-HN1),and the matching points were Shenmen(Ht7),Shenting(GV24),Shentong(DU11)and Benshen(CB15).Acupuncture was performed once a day,and the needles were retained for 20 minutes each time.After 4 weeks of treatment,the clinical efficacy and adverse reaction rate of the two groups were compared,as well as the scores of BEHAVE-AD,ADL,cerebral hemodynamic indexes[blood flow velocity of cerebral basilar artery(BA)and middle artery(MCA)J,serum protein[high mobility group protein B1(HMGBI),myelin basic protein(MBP)]levels before and after treatment.Results The total effective rate of the treatment group was 90.9%(40/44),and that of the control group was 78.6%(33/42).The difference between the two groups was statistically significant(P<0.05);After treatment,the BEHAVEAD score,serum HMGBI and MBP levels in the two groups were significantly decreased,and the ADL score,BA and MCA blood flow velocity were significantly increased,with a statistically significant difference compared with the same group before treatment(P<0.05 or P<0.01),and the improvement of the treatment group was more obvious,with a statistically significant difference compared with the control group after treatment(P<0.01);There were no obvious adverse reactions in both groups during the treatment.ConclusionnAcupuncture in the adjunctive treatment can significantly improve the clinical symptoms and the ability of daily living of patients with mild and moderate AD of kidney deficiency and marrow reduction syndrome,which may be related to improving the cerebral hemodynamic indexes and serum protein level of patients.