电针改善阿尔茨海默病患者MMSE评分的远期疗效及安全性评价
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摘要
目的:观察电针改善阿尔茨海默病患者简易精神状态量表(mini-mental state examination,MMSE)评分的有效性与安全性,同时评价远期疗效。方法:将40例患者随机分为试验组和对照组,每组20例(试验组脱落3例,对照组脱落4例)。试验组穴取百会、风府、神庭、太阳、上印堂及大钟,其中太阳、百会、神庭连接电针,疏密波,频率10 Hz/50 Hz,电流强度0.5～5.0 mA,隔日1次,每周3次;对照组予口服盐酸多奈哌齐片5 mg,每日1次,睡前服用,两组均治疗12周。于治疗前、治疗12周±3 d、随访期24周±7 d对两组MMSE评分进行评价。结果:治疗12周±3 d时,两组治疗前后MMSE总分的差值组间比较差异无统计学意义(P>0.05);两组治疗后MMSE总分均较治疗前升高(均P<0.05);试验组瞬时记忆力评分较治疗前升高(P<0.05),且提高程度优于对照组(P<0.05)。随访24周±7d时,两组MMSE总分均较治疗前下降(均P<0.05),试验组下降程度少于对照组(P<0.05);两组瞬时记忆力治疗前后差值的组间比较差异有统计学意义(P<0.05)。两组均无不良反应发生。结论:电针改善阿尔茨海默病患者MMSE评分的疗效与盐酸多奈哌齐片类似,电针疗法对改善阿尔茨海默病患者MMSE评分可能有一定持续效应,且瞬时记忆力方面的改善电针可能存在优势,并具有安全性。
Objective To observe the efficacy and safety of electroacupuncture(EA) on improving mini-mental state examination(MMSE) in patients with Alzheimer's disease(AD), and to evaluate the efficacy during follow-up visit. Methods Forty patients were randomly divided into a treatment group and a control group, 20 patients in each one(3 patients dropped off in the treatment group and 4 patients in the control group). The patients in the treatment group were treated with acupuncture at Baihui(GV 20), Fengfu(GV 16), Shenting(GV 24), Taiyang(EX-HN 5), Shangyintang(Extra 3) and Dazhong(KI 14); besides, EA was applied at Taiyang(EX-HN 5), Baihui(GV 20) and Shenting(GV 24) with dilatational wave, 10 Hz/50 Hz in frequency, 0.5 to 5.0 mA in intensity, once every two days, three treatments per week. The patients in the control group were treated with oral administration of donepezil hydrochloride tablets, once a day, taken before sleep. The treatment was given for 12 weeks in the two groups. The MMSE was evaluated before treatment, 12 weeks±3 days into treatment, and 24 weeks±7 days after treatment, respectively. Results The difference of total score of MMSE before and 12 weeks±3 days into treatment was not significant between the two groups(P>0.05); the total score of MMSE after treatment was higher than that before treatment(both P<0.05); compared before treatment, the short-term memory score was increased in the treatment group(P<0.05), and the increasing range was superior to that in the control group(P<0.05). Compared before treatment, the total score of MMSE in the two groups were reduced 24 weeks ±7 days after treatment(both P<0.05), and the reduction in the treatment group was less than that in the control group(P<0.05); the differences of short-term memory score before and after treatment was significant between the two groups(P<0.05). No adverse reaction occurred in the two groups. Conclusion The effect of EA on improving MMSEin patients with AD is similar to donepezil supported by evidence-based medicine. The effect of EA may have a certain continuous effect, and may have advantages in instantaneous memory. In addition, the EA is safe.
Objective To observe the efficacy and safety of electroacupuncture(EA) on improving mini-mental state examination(MMSE) in patients with Alzheimer's disease(AD), and to evaluate the efficacy during follow-up visit. Methods Forty patients were randomly divided into a treatment group and a control group, 20 patients in each one(3 patients dropped off in the treatment group and 4 patients in the control group). The patients in the treatment group were treated with acupuncture at Baihui(GV 20), Fengfu(GV 16), Shenting(GV 24), Taiyang(EX-HN 5), Shangyintang(Extra 3) and Dazhong(KI 14); besides, EA was applied at Taiyang(EX-HN 5), Baihui(GV 20) and Shenting(GV 24) with dilatational wave, 10 Hz/50 Hz in frequency, 0.5 to 5.0 mA in intensity, once every two days, three treatments per week. The patients in the control group were treated with oral administration of donepezil hydrochloride tablets, once a day, taken before sleep. The treatment was given for 12 weeks in the two groups. The MMSE was evaluated before treatment, 12 weeks±3 days into treatment, and 24 weeks±7 days after treatment, respectively. Results The difference of total score of MMSE before and 12 weeks±3 days into treatment was not significant between the two groups(P>0.05); the total score of MMSE after treatment was higher than that before treatment(both P<0.05); compared before treatment, the short-term memory score was increased in the treatment group(P<0.05), and the increasing range was superior to that in the control group(P<0.05). Compared before treatment, the total score of MMSE in the two groups were reduced 24 weeks ±7 days after treatment(both P<0.05), and the reduction in the treatment group was less than that in the control group(P<0.05); the differences of short-term memory score before and after treatment was significant between the two groups(P<0.05). No adverse reaction occurred in the two groups. Conclusion The effect of EA on improving MMSEin patients with AD is similar to donepezil supported by evidence-based medicine. The effect of EA may have a certain continuous effect, and may have advantages in instantaneous memory. In addition, the EA is safe.
引文
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[11]Folstein MF,Folstein SE,McHugh PR.“Mini-mental state”.Apractical method for grading the cognitive state of patients for the clinician[J].J Psychiatric Res,1975,12(3):189-198.
[12]Lee MS,Shin BC,Ernst E.Acupuncture for Alzheimer’s disease:a systematic review[J].Int J Clin Pract,2009,63(6):874-879.
[13]杨松堤,李亚东,姜国华,等.应用CT测量风府针刺深度的研究[J].中国针灸,2008,28(1):47-49.
[14]曹瑾,唐银杉,李志刚.电针治疗阿尔茨海默病的动物实验研究进展[J].中华中医药杂志,2014,29(10):3177-3180.
[15]李婧,孙国杰.电针预刺激对阿尔茨海默病模型大鼠学习记忆能力的影响[J].湖北中医杂志,2011,33(3):3-4.
[16]马骏,王彦春,王述菊,等.电针对阿尔茨海默病模型大鼠海马区神经营养因子及其受体表达的影响[J].针灸临床杂志,2010,26(7):63-66.
[2]Zhang ZX,Zahner GE,Román GC,et al.Dementia subtypes in China:prevalence in Beijing,Xian,Shanghai,and Chengdu[J].Arch Neurol,2005,62(3):447-453.
[3]Mischoulon D,RaabMF.The role of folate in depression and dementia1[J].Clin Psychiatry,2007,68(S10):28-33.
[4]Seow D,Gauthier S.Pharmacotherapy of Alzheimer disease[J].Can J Psychiatry,2007,52(10):620-629.
[5]谈珉佳,马妍,李强,等.针灸治疗阿尔茨海默病的文献计量学分析[J].针灸临床杂志,2012,28(3):46-48.
[6]McKhann GM,Knopman DS,Chertkow H,et al.The diagnosis of dementia due to Alzheimer’s disease:Recommendations from the National Institute on Aging-Alzheimer’s Association workgroups on diagnostic guidelines for Alzheimer’s disease[J].Alzheimers Dement,2011,7(3):263-269.
[7]中国痴呆临床实践指南工作组.中国痴呆诊疗指南[M].北京:人民卫生出版社,2012:17-21.
[8]张立苹,田金洲,时晶,等.轻度认知损害海马结构MR定量与波谱的研究[J].实用放射学杂志,2011,27(6):823-829.
[9]Scheltens P,Launer LJ,Barkhof F,et al.Visual assessment of medial temporal lobe atrophy on magnetic resonance imaging:interobserver reliability[J].J Neurol,1995,242(9):557-560.
[10]彭丹涛,李鹤,张占军.2010年欧洲神经病学联盟阿尔茨海默病诊疗指南[J].中华老年医学杂志,2011,30(2):89-94.
[11]Folstein MF,Folstein SE,McHugh PR.“Mini-mental state”.Apractical method for grading the cognitive state of patients for the clinician[J].J Psychiatric Res,1975,12(3):189-198.
[12]Lee MS,Shin BC,Ernst E.Acupuncture for Alzheimer’s disease:a systematic review[J].Int J Clin Pract,2009,63(6):874-879.
[13]杨松堤,李亚东,姜国华,等.应用CT测量风府针刺深度的研究[J].中国针灸,2008,28(1):47-49.
[14]曹瑾,唐银杉,李志刚.电针治疗阿尔茨海默病的动物实验研究进展[J].中华中医药杂志,2014,29(10):3177-3180.
[15]李婧,孙国杰.电针预刺激对阿尔茨海默病模型大鼠学习记忆能力的影响[J].湖北中医杂志,2011,33(3):3-4.
[16]马骏,王彦春,王述菊,等.电针对阿尔茨海默病模型大鼠海马区神经营养因子及其受体表达的影响[J].针灸临床杂志,2010,26(7):63-66.