针刺配合通络益气汤治疗脑小血管病致认知功能障碍的疗效观察

Therapeutic observation of acupuncture combined with Tong Luo Yi Qi Tang for cognitive impairment due to cerebral small vessel disease

目的观察针刺配合通络益气汤治疗脑小血管病致认知功能障碍的临床疗效及其对患者脑微循环、步态平衡和血清神经元PAS结构域蛋白4(neuronal PAS domain protein 4,NPAS4)、P-选择素(CD62P)表达的影响。方法将98例脑小血管病致认知功能障碍患者随机分为治疗组和对照组,每组49例。治疗组采用针刺配合通络益气汤治疗,对照组采用单纯通络益气汤治疗。观察两组治疗前后各项实验室指标[谷胱甘肽过氧化物酶(glutathione peroxidase,GSH-Px)、晚期糖基化终末产物(advanced glycation end products,AGEs)、NPAS4、CD62P、一氧化氮(NO)、亲环素A(cyclophilin A,CyPA)、脂蛋白相关磷脂酶A2(lipoprotein-associated phospholipase A2,Lp-PLA2)、血管性血友病因子(von Willebrand factor,vFW)水平]、脑微循环指标[血脑屏障通透性、血管差压、临界压力(critical pressure,CP)、脑血管动态阻力(dynamic resistance,DR)]及各量表[Berg平衡量表(Berg balance scale,BBS)、Tinetti平衡与步态量表、蒙特利尔认知评估量表(Montreal cognitive assessment,MoCA]评分的变化情况,并比较两组临床疗效。结果两组治疗后GSH-Px、NO水平及CP、各量表评分均较同组治疗前显著上升,AGEs、NPAS4、CD62P、CyPA、Lp-PLA2、vFW水平及血脑屏障通透性、血管差压、DR显著下降,差异均具有统计学意义(P<0.05)。治疗组治疗后GSH-Px、NO水平及CP、各量表评分均明显高于对照组,AGEs、NPAS4、CD62P、CyPA、Lp-PLA2、vFW水平及血脑屏障通透性、血管差压、DR均明显低于对照组,两组比较差异均具有统计学意义(P<0.05)。治疗组总有效率为98.0%,明显高于对照组的87.8%,两组比较差异具有统计学意义(P<0.05)。结论针刺配合通络益气汤治疗脑小血管病致认知功能障碍疗效确切,可减少氧化应激反应及炎症反应,降低NPAS4、CD62P水平,减少血管内皮功能及认知功能损伤,改善血脑屏障通透性、脑微循环及步态平衡。

Objective To observe the clinical efficacy of acupuncture plus Tong Luo Yi Qi Tang in treating cognitive impairment due to cerebral small vessel disease and its effects on the patient’s cerebral microcirculation,gait balance,and expression of serum neuronal PAS domain protein 4(NPAS4)and CD62P.Method Ninety-eight patients with cognitive impairment due to cerebral small vessel disease were randomized into a treatment group and a control group,with 49 cases in each group.The treatment group received acupuncture plus Tong Luo Yi Qi Tang,and the control group only received Tong Luo Yi Qi Tang for treatment.Before and after the treatment,the two groups were observed for changes in the laboratory indexes[glutathione peroxidase(GSH-Px),advanced glycation end products(AGEs),NPAS4,CD62P,NO,cyclophilin A(CyPA),lipoprotein-associated phospholipase A2(Lp-PLA2),and von Willebrand factor(vFW)],cerebral microcirculation indicators[blood-brain barrier permeability,vascular differential pressure,critical pressure(CP),and cerebral vascular dynamic resistance(DR)],and scale scores[Berg balance scale(BBS),Tinetti balance and gait scale,and Montreal cognitive assessment(MoCA)].The clinical efficacy was also compared between the two groups.Result After the treatment,the levels of GSH-Px and NO,CP,and each scale score increased,and the levels of AGEs,NPAS4,CD62P,CyPA,Lp-PLA2,vFW,blood-brain barrier permeability,vascular differential pressure,and DR dropped in both groups,all showing statistical significance(P<0.05).After the treatment,the levels of GSH-Px and NO,CP,and each scale score were higher in the treatment group than in the control group,and the levels of AGEs,NPAS4,CD62P,CyPA,Lp-PLA2,vFW,blood-brain barrier permeability,vascular differential pressure,and DR were lower in the treatment group;the between-group differences were statistically significant(P<0.05).The treatment group achieved a total effective rate of 98.0%,higher than 87.8%in the control group,and the difference was statistically significant(P<0.05).Conclusion Acupuncture plus Tong Luo Yi Qi Tang is effective in treating cognitive impairment due to cerebral small vessel disease.This method can reduce oxidative stress and inflammatory responses,down-regulate the levels of NPAS4 and CD62P,curb the damage to vascular endothelial function and cognitive function,and improve blood-brain barrier permeability,cerebral microcirculation,and gait balance.