针刺调节主观认知功能下降患者肠道菌群及认知功能随机对照试验

Acupuncture Modulates Gut Microbiota and Improves Cognition in Patients with Subjective Cognitive Decline:A Randomized Controlled Trial

目的观察针刺对主观认知功能下降(SCD)患者的临床疗效以及针刺前后SCD患者肠道菌群的变化。方法筛查196例SCD患者,纳入72例患者随机分为针刺组和假针组,每组各36例,针刺组采用“调和气血,补心益智”针刺法,百会与神庭连接1对电极(2/100 Hz,1~5 mA),其余穴位手针治疗,20 min/次,每周治疗2次,连续治疗12周;假针组采用非穴位的非穿透性治疗,治疗时间和疗程同针刺组。采用综合Z分数、蒙特利尔认知评估量表(MOCA)、主观认知下降量表、简易精神状态量表、老年抑郁量表、匹兹堡睡眠量表和功能活动问卷评价SCD患者的认知功能。采用16S核糖体RNA基因测序法进行肠道菌群分析。结果最终每组完成26例患者资料纳入分析。与假针组比较,治疗12周后,针刺组的综合Z分数和MOCA评分显著提高(P=0.045,P=0.007)。针刺治疗后变形菌门(大肠埃希氏菌-志贺氏菌和克雷伯氏菌)丰度降低(P<0.05),拟杆菌门(拟杆菌)和厚壁菌门(瘤胃球菌科UCG-014)丰度增加(P<0.05)。相关性分析发现罗氏菌属与综合Z分数和MOCA评分成正相关(P<0.05)。结论针刺可有效缓解SCD患者的认知障碍,并平衡SCD患者体内肠道菌群生态。

Objective To investigate the therapeutic efficacy of acupuncture on cognitive function and explore the characteristics of gut microbiota in subjective cognitive declines(SCD)patients before and after acupuncture treatment.Methods A total of 196 patients with SCD were screened and 72 cases were randomly assigned to an acupuncture group and a sham acupuncture group,with 36 patients in each group.In the acupuncture group,the acupuncture method of"harmonizing qi and blood,invigorating heart and intelligence"was adopted.Baihui(DU20)and Shenting(DU24)were connected with a pair of electrodes(2/100 Hz,1-5 mA),and the other acupoints were treated with hand acupuncture to retained for 20 min,receiving twice-weekly treatment for 12 weeks.The sham acupuncture group was treated with non-penetrating treatment at non-acupoints,and the duration and course of treatment were the same as those of acupuncture group.Comprehensive Z-scores,Montreal Cognitive Assessment(MOCA),Subjective Cognitive Decline Questionnaire(SCDQ),Mini-Mental State Examination(MMSE),Geriatric Depression Scale(GDS),Pittsburgh Sleep Quality Index scale(PSQI),and Functional Activities Questionnaire(FAQ)were used to evaluate cognitive function in patients with SCD.16S ribosomal RNA gene sequencing was used for gut microbiota analysis.Results Finally,26 patients in each group were included in the analysis due to case withdrawal and shedding.After 12 weeks of treatment,the comprehensive Z scores(P=0.045)and MOCA scores(P=0.007)in the acupuncture group were higher than those in the SA group.The abundance of pathogenic bacteria Proteobacteria(Escherichia-Shigella and Klebsiella)decreased dramatically,and the abundance of beneficial bacteria,such as Bacteroidetes(Bacteroides)and Firmicutes(Ruminococcaceae_UCG-014)increased(P<0.05).Correlation analysis showed that the Roseburia was positively correlated with Z-score and MOCA score(P<0.05).Conclusion Acupuncture treatment effectively alleviates cognitive impairment and balances gut microbiota ecology in patients with SCD.