复元胶囊联合醒脑开窍针刺法治疗血管性痴呆研究

Treatment of Vascular Dementia by Using Fuyuan Capsule Combined with"Xingnao Kaiqiao"Acupuncture

目的:观察复元胶囊联合醒脑开窍针刺法治疗血管性痴呆(VD)的临床疗效并探讨其作用机制。方法法:纳入2020年5月—2021年9月在衡水市中医医院脑病科住院的脾肾两虚、瘀阻脑络型VD患者150例为研究对象,按照1∶1的随机分配原则分为对照组和治疗组各75例。对照组施行醒脑开窍针刺法治疗,治疗组在醒脑开窍针刺法治疗的同时加复元胶囊口服治疗。连续治疗12周后,分别比较2组治疗前后的简易智能精神状态检查量表(MMSE)评分、改良长谷川痴呆量表(HDS-R)评分以及改良Barthel指数评定量表(MBI)评分;基于比色分析法比较2组治疗前后血清超氧化物歧化酶(SOD)活性和丙二醛(MDA)含量变化;通过酶联免疫法检测治疗前后白细胞介素-6(IL-6)和肿瘤坏死因子(TNF-α)蛋白表达量的变化;以MMSE评分为疗效指标分别评估2组总有效率;采用Pearson相关性分析对干预前后的MMSE评分差值与血清生化指标水平变化的相关性进行探讨。结果:2组MMSE、HDS-R和MBI评分经治疗后均有所提高(P<0.05),其中治疗组的MMSE、HDS-R、MBI评分相对较高,差异有统计学意义(P<0.05);治疗后2组SOD活性均升高,MDA含量均下降,IL-6、TNF-α蛋白表达量均下降(P<0.05);与对照组相比,治疗组的SOD活性较高,MDA含量及IL-6、TNF-α蛋白表达量均较低(P<0.05);治疗组总有效率为82.19%,显著优于对照组的68.06%(P<0.05);治疗组MMSE评分的变化量与SOD活性变化呈正相关(r=0.520,P=0.003),与TNF-α蛋白表达量呈负相关(r=-0.308,P=0.026)。结论:复元胶囊联合醒脑开窍针刺法可有效提高VD患者的认知功能,改善痴呆症状以及提高日常生活活动能力,其机制可能与缓解氧化应激损伤和抑制炎症反应有关。

Objective:To observe the clinical effect of Fuyuan capsule combined with"Xingnao Kaiqiao"acupuncture on vascular dementia(VD)and explore its mechanism.Methods:A total of 150 VD patients with deficiency of spleen and kidney and blood stasis were enrolled in the Hengshui Traditional Chinese Medicine Hospital of Hebei Province from May 2020 to September 2021.According to the principle of 1∶1 random allocation,they were divided into treatment group and control group,with 75 cases in each group.The control group received"Xingnao Kaiqiao"acupuncture treatment and the treatment group received oral administration of Fuyuan capsule in addition to the treatment of the control group for 12 weeks.The mini-mental state examination(MMSE)score,modified Hasegawa dementia scale(HDS-R)score,and modified Barthel index(MBI)score were compared between the two groups before and after treatment;the levels of serum superoxide dismutase(SOD)and malondialdehyde(MDA)of patients before and after treatment were measured and analyzed by colorimetry.The expression of protein interleukin-6(IL-6)and tumor necrosis factor-α(TNF-α)before and after treatment were determined by enzyme-linked immunoassay.Improvement in MMSE score was used as an index to assess the total effective rate in the two groups after treatment.Pearson correlation analysis was used to explore the correlation between MMSE score difference and changes of blood index levels before and after treatment.Results:The MMSE,HDS-R and MBI scores of both groups improved after treatment(P<0.05),those of the treatment group improved more,and the differences was statistically significant(P<0.05).After treatment,SOD activity increased,and MDA content,expression of protein IL-6 and TNF-αdecreased in the two groups(P<0.05).Compared with the control group,SOD activity in the treatment group was higher,MDA content and expression of protein IL-6 and TNF-αwere lower(P<0.05).The total effective rate of the treatment group(82.19%)was significantly better than that of the control group(68.06%)(P<0.05).The change of MMSE score was positively correlated with the change of SOD activity(r=0.520,P=0.003)and negatively correlated with the expression of TNF-αprotein(r=-0.308,P=0.026).Conclusion:Fuyuan capsule combined with"Xingnao Kaiqiao"acupuncture could effectively improve the cognitive function of VD patients,improve the symptoms of vascular dementia and improve the ability of daily living activities,which may be related to relieving oxidative stress injury and inhibiting inflammatory response.