基于“天灸”理论运用通督灸疗法治疗阿尔茨海默病伴睡眠障碍的临床研究

Clinical Study on the Treatment of Alzheimer's Disease with Sleep Disor⁃ders Using Tongdu Moxibustion Therapy Based on the Theory of Tian Moxibustion

目的 探究基于“天灸”理论运用通督灸疗法治疗阿尔茨海默病(Alzheimer’s disease, AD)伴睡眠障碍的临床疗效分析。方法 选取2021年2月-2022年7月于中国科学院大学深圳医院(光明)中医科接受治疗的90例AD伴睡眠障碍的患者为研究对象,根据治疗方式与治疗时间的不同将患者分为3组,各30例。其中三伏通督灸组患者于三伏天选用通督灸疗法治疗,普通通督灸组患者于三伏天结束后1个月选用通督灸疗法治疗,对照组选用常规西药治疗。治疗前后对比3组睡眠质量、认知功能、生活质量、血清5-羟色胺(5-hydroxy tryptamin, 5-HT)水平、脑源性神经营养因子(brain derived neurotrophic factor, BDNF)水平以及不良反应等情况。结果 治疗后,三伏通督灸组、普通通督灸组睡眠效率、睡眠障碍、主观睡眠质量、日间功能评分以及PQSI总分均低于对照组,且三伏通督灸组评分低于普通通督灸组,差异有统计学意义(P<0.05)。治疗后,三伏通督灸组、普通通督灸组MMSE评分、ADL评分优于对照组,且三伏通督灸组评分优于普通通督灸组,差异有统计学意义(P<0.05)。治疗前,3组血清5-HT、BDNF水平比较,差异无统计学意义(P>0.05);治疗后,三伏通督灸组、普通通督灸组血清5-HT、BDNF水平高于对照组,三伏通督灸组高于普通通督灸组,差异有统计学意义(P<0.05)。治疗过程中,三伏通督灸组不良反应发生率为13.33%(4/30),普通通督灸组不良反应发生率为16.67%(5/30),对照组不良反应发生率为16.67%(5/30),3组不良反应发生率比较,差异无统计学意义(χ^(2)=0.255,P>0.05)。结论 AD伴睡眠障碍患者采用基于“天灸”理论运用通督灸疗法治疗,能够有效改善患者睡眠状态,增强自身认知功能,提高生活质量,控制不良事件的发生。

Objective To investigate the clinical efficacy of Tongdu moxibustion therapy based on the theory of"Tian moxibustion"in the treatment of Alzheimer´s disease(AD)with sleep disorders.Methods 90 AD patients with sleep disorder who were treated in the Department of Traditional Chinese Medicine,University of Chinese Academy of Sci⁃ences,Shenzhen Hospital(Guangming)from February 2021 to July 2022 were selected as the study subjects.Accord⁃ing to the different treatment methods and treatment time,the patients were divided into three groups,30 cases in each group.Among them,the patients in the Sanfu Tongdu moxibustion group were treated with tongdu moxibustion therapy on the three dog days,the patients in the ordinary Tongdu moxibustion group were treated with Tongdu moxi⁃bustion therapy one month after the end of the three dog days,and the control group was treated with conventional Western medicine.Before and after treatment,the sleep quality,cognitive function,quality of life,serum 5-hydroxy⁃tryptamine(5-HT)level,brain-derived neurotrophic factor(BDNF)level and adverse reactions of the three groups were compared.Results After treatment,the sleep efficiency,sleep disorder,subjective sleep quality,daytime func⁃tion score and total PQSI score of the Sanfu Tongdu moxibustion group and the ordinary Tongdu moxibustion group were lower than those of the control group,and scores of the Sanfu Tongdu moxibustion group was lower than the ordi⁃nary Tongdu moxibustion group,and the difference was statistically significant(P<0.05).After treatment,the MMSE and ADL scores of the Sanfu Tongdu moxibustion group and the ordinary Tongdu moxibustion group were better than the control group,and the Sanfu Tongdu moxibustion group was better than the ordinary Tongdu moxibustion group,and the difference was statistically significant(P<0.05).Before treatment,there was not statistically significant differ⁃ence in the levels of serum 5-HT and BDNF among the three groups(P>0.05);after treatment,the serum levels of 5-HT and BDNF in the sanfu Tongdu moxibustion group and the ordinary Tongdu moxibustion group were higher than those in the control group,while the Sanfu Tongdu moxibustion group was higher than the ordinary Tongdu moxibus⁃tion group,and the difference was statistically significant(P<0.05).During the treatment process,the incidence of ad⁃verse reactions in the Sanfu Tongdu moxibustion group was 13.33%(4/30),the incidence of adverse reactions in the ordinary Tongdu moxibustion group was 16.67%(5/30),and the incidence of adverse reactions in the control group was 16.67%(5/30),there was no statistically significant difference in the incidence of adverse reactions among the three groups(χ^(2)=0.255,P>0.05).Conclusion The treatment of AD patients with sleep disorders with Tongdu moxibus⁃tion therapy based on the theory of"Tian moxibustion"can effectively improve the sleep state of patients,enhance their cognitive function,improve the quality of life,and control the occurrence of adverse events.