通督益脑针药并用治疗轻度血管性认知功能障碍的临床观察

Clinical Observation on Tongdu Yinao Acupuncture and Medication in Treatment of Mild VCI

目的:评价通督益脑针药并用治疗轻度血管性认知功能障碍(MCI)的临床疗效。方法:选择北京中医医院顺义医院符合纳入标准的轻度血管性认知功能障碍患者120例,依据随机数字表随机分为针药组60例和对照组60例。针药组采用督脉十三针+口服通督益颈汤进行治疗,对照组口服茴拉西坦分散片(0.2 g/次,3次/d),两组均治疗8周。分别于治疗前和治疗2、4、8周后对两组患者整体认知功能、核心认知功能、日常生活能力、中医证候积分进行评价;治疗前及治疗8周后检测两组患者血清hs-CRP和Hcy水平;比较两组患者临床疗效和不良反应发生情况。结果:针药组临床总有效率为88.33%(54/60),高于对照组临床总有效率71.67%(43/60),两组比较差异有统计学意义(P<0.05)。治疗8周后,两组患者血清中hs-CRP、Hcy水平均显著降低(P<0.05),且针药组改善程度优于对照组(P<0.05)。治疗后,针药组和对照组患者MMSE、MoCA、视空间/执行评分、记忆力功能评分、语言功能评分、中医证候积分和工具性日常生活能力评分改善明显(P<0.05,P<0.01),针药组ADL显著提高(P<0.01)。与对照组比较,针药组患者MMSE、MoCA、视空间/执行评分、记忆力功能评分、语言功能评分、中医证候积分、ADL和工具性日常生活能力评分改善明显(P<0.05,P<0.01)。结论:通督益脑针药并用能有效改善轻度血管性认知功能障碍患者临床整体认知功能、核心认知功能、日常生活能力和中医证候积分,并可降低hs-CRP、Hcy水平,安全有效,预后良好,值得临床推广。

Objective:To evaluate the clinical efficacy of Tongdu Yinao acupuncture and medication in treatment of mild vascular cognitive impairment(VCI).Methods:120 mild VCI patients were randomly divided into the study group and the control group,with 60 patients in each group.The study group was treated with 13-needle Du meridian acupuncture combined with Tongdu Yijing Decoction,and the control group was treated with Aniracetam Dispersible Tablet(0.2g,t.i.d.,orally).Both group were treated for 8 weeks.Overall cognitive function,core cognitive function,daily life ability and TCM symptoms score were evaluated before the treatment,after 2 weeks,4 weeks and 8 weeks of the treatment in the two groups.Serum levels of hs-CRP and Hcy were detected before and after 8 weeks of the treatment in the two groups.Clinical efficacy and adverse reactions were compared between the two groups.Results:The total effective rate of the study group was 88.33%(54/60),which was significantly higher than 71.67%(43/60)of the control group(P<0.05).The serum levels of hs-CRP and Hcy were significantly decreased after 8 weeks of the treatment in both groups(P<0.05),and the decreases in the study group were more significant than those in the control group(P<0.05).The scores of MMSE,MoCA,visual space/performance,memory function,speech function,TCM symptoms,ability of daily living(ADL)and instrumental ability of daily living(IADL)significantly improved after the treatment in the two groups(P<0.05,P<0.01);of which the improvements in the study group were more significant than those in the control group(P<0.05,P<0.01).Conclusion:Tongdu Yinao acupuncture and medication can effectively improve the overall clinical cognitive function,the core cognitive function,ADL and TCM symptoms scores,it can reduce the levels of hs-CRP and Hcy in the patients with MVCI,with its high safety and favourable prognosis.The therapy is worthy of clinical promotion.