针灸联合经颅直流电刺激治疗脑卒中伴认知障碍的随机对照试验

Acupuncture Combined with Transcranial Direct Current Stimulation for the Treatment of Stroke with Cognitive Impairment:A Randomized Controlled Trial

目的:观察针灸联合经颅直流电刺激(tDCS)治疗脑卒中后血管性认知障碍的疗效及对同型半胱氨酸(Hcy)、神经元特异性烯醇化酶(NSE)和脑源性神经营养因子(BDNF)水平的影响。方法:选取2021年11月至2022年11月陕西省人民医院康复医学科收治的缺血性脑卒中伴认知障碍患者102例作为研究对象,按照随机数字表法随机分为针刺联合组(34例,脱落2例)、tDCS联合组(34例,脱落1例)和西药组(34例),进行为期4周的治疗。结果:治疗后,针灸联合组的蒙特利尔认知评分、洛文斯坦因作业疗法认知评定(LOTCA)评分、巴塞尔(Barthel)指数评分和血清BDNF均明显升高(P<0.05),且高于其他2组;针灸联合组和tDCS组的行为记忆测验评分均显著提高(P<0.05),且优于西药组;治疗后,3组的血清Hcy和NSE水平均明显降低,且针灸联合组明显低于其他2组(P<0.05)。结论:针灸联合tDCS治疗能显著改善脑卒中伴认知障碍患者的认知功能,提高日常活动能力和生命质量。

Objective:To observe the efficacy of acupuncture combined with transcranial direct current stimulation(tDCS)in the treatment of post-stroke vascular cognitive impairment and the effects on the levels of homocysteine(Hcy),neuron-specific enolase(NSE)and brain-derived neurotrophic factor(BDNF).Methods:A total of 102 patients with ischemic stroke with cognitive impairment,admitted to the Department of Rehabilitation of Shaanxi Provincial People′s Hospital from November 2021 to November 2022,were selected as the research subjects.The patients were randomly divided into acupuncture combination group(34 cases,with 2 dropouts),tDCS combination group(34 cases,with 1 dropout)and Western medicine group(34 cases).The treatment lasted for 4 weeks.Results:After treatment,the Montreal cognitive score,Lowenstein Occupational Therapy Cognitive Assessment(LOTCA)score,Barthel Index score and serum BDNF of the combined acupuncture group were significantly increased(P<0.05)and higher than those of the other two groups.The Behavioral Memory Test scores of the acupuncture combination group and tDCS group were significantly higher(P<0.05)than those of the Western medicine group.After the treatment,the serum Hcy and NSE levels of all three groups were significantly reduced,with the acupuncture combination group being significantly lower than the other two groups(P<0.05).Conclusion:The combination of acupuncture and tDCS treatment can significantly improve the cognitive function,enhances daily activity abilities,and improves the quality of life in patients with stroke with cognitive impairment.