头穴丛刺联合奥拉西坦治疗血管性痴呆疗效及对血清Livin、NOS和脑神经递质的调节
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摘要
目的研究头穴丛刺联合奥拉西坦注射液治疗血管性痴呆(VD)的临床疗效及对血清抗凋亡因子(Livin)、一氧化氮合成酶(NOS)和脑神经递质的调节作用,旨在为更好地治疗VD提供有效的理论依据。方法选取88例VD患者作为研究对象,按照随机数字表法分为对照组和观察组,每组44例。对照组给予奥拉西坦注射液治疗,观察组给予头穴丛刺联合奥拉西坦注射液治疗。观察并比较两组患者的临床疗效及治疗前后简易精神状态量表(MMSE)、日常生活活动能力量表(ADL)评分,比较两组治疗前后血清血管内皮生长因子(VEGF)、白细胞介素-1?(IL-1?)、Livin、一氧化氮(NO)、NOS水平及脑神经递质的调节,同时记录治疗期间不良反应发生情况。结果观察组总有效率(90.9%)显著高于对照组(70.5%)(P<0.05);两组治疗后MMSE、ADL评分均较治疗前升高(P<0.05),且观察组高于对照组(P<0.05);两组治疗后血清VEGF、Livin水平均较治疗前明显升高(P<0.05),IL-1?水平均较治疗前明显降低(P<0.05),且观察组改变幅度大于对照组(P<0.05);两组治疗后血清NO、NOS水平较治疗前均明显下降(P<0.05),且观察组低于对照组(P<0.05);观察组治疗后乙酰胆碱(Ach)、多巴胺(DA)、去甲肾上腺素(NE)及兴奋性递质(EXC)水平明显高于治疗前(P<0.05),且明显高于对照组(P<0.05),对照组治疗前后Ach、DA、NE及EXC水平比较差异无统计学意义(P>0.05);两组治疗前后抑制素(INH)、5-羟色胺(5-HT)水平比较差异均无统计学意义(P>0.05);观察组不良反应总发生率低于对照组,但差异无统计学意义(P>0.05)。结论头穴丛刺联合奥拉西坦注射液治疗VD可显著提高总体临床疗效,改善患者生活质量和认知功能,安全性好,其作用机制与改善患者血清VEGF、Livin、IL-1?水平及脑内神经递质水平,降低NO、NOS水平有关。
Objective To observe the clinical efficacy of cluster needling at scalp acupoints plus oxiracetam injection for vascular dementia(VD) and its regulatory effect on serum apoptosis inhibitor Livin, nitric oxide synthase(NOS) and brain neurotransmitters, and to provide theoretical evidence for the treatment of VD. Method Eighty-eight VD patients were enrolled and divided into a control group and an observation group by the random number table, with44 cases in each group. The control group was intervened by oxiracetam injection, and the observation group was given cluster needling at scalp acupoints plus oxiracetam injection. The clinical efficacies of the two groups were compared,as well as the scores of the Mini-Mental State Examination(MMSE) and activities of daily living(ADL), and the serum levels of vascular endothelial growth factor(VEGF), interleukin(IL)-1?, Livin, NO, NOS and brain neurotransmitters before and at the end of treatment. Meanwhile, the adverse events that occurred during the intervention were recorded.Result The total effective rate of the observation group(90.9%) was significantly higher than that in the control group(70.5%)(P<0.05); the scores of MMSE and ADL increased after treatment in both groups(P<0.05), and the observation group was higher than the control group(P<0.05); after intervention, the serum levels of VEGF and Livin increased(P<0.05) and the level of IL-1? declined(P<0.05) in the two groups, and the changes in the observation group were more significant than those in the control group(P<0.05); the serum levels of NO and NOS went down after treatment in the two groups(P<0.05), and the observation group was lower than the control group(P<0.05); the levels of Ach, DA, NE and EXC all increased after intervention in the observation group(P<0.05), and were significantly higher than those in the control group(P<0.05), while the changes in the levels of Ach, DA, NE and EXC were statistically insignificant in the control group(P > 0.05); the post-treatment changes in INH and5-hydroxytryptamine(5-HT) were statistically insignificant in the two groups(P>0.05); the occurrence of adverse events in the observation group was lower than that in the control group, but the difference was statistically insignificant(P>0.05). Conclusion Cluster needling plus oxiracetam injection can enhance the overall clinical efficacy in treating VD. It can improve the quality of life and cognitive function of VD patients and is highly safe. Its mechanism is related to the improvement of serum levels of VEGF, Livin and IL-1?, as well as the brain neurotransmitters, and the down-regulation of NO and NOS.
Objective To observe the clinical efficacy of cluster needling at scalp acupoints plus oxiracetam injection for vascular dementia(VD) and its regulatory effect on serum apoptosis inhibitor Livin, nitric oxide synthase(NOS) and brain neurotransmitters, and to provide theoretical evidence for the treatment of VD. Method Eighty-eight VD patients were enrolled and divided into a control group and an observation group by the random number table, with44 cases in each group. The control group was intervened by oxiracetam injection, and the observation group was given cluster needling at scalp acupoints plus oxiracetam injection. The clinical efficacies of the two groups were compared,as well as the scores of the Mini-Mental State Examination(MMSE) and activities of daily living(ADL), and the serum levels of vascular endothelial growth factor(VEGF), interleukin(IL)-1?, Livin, NO, NOS and brain neurotransmitters before and at the end of treatment. Meanwhile, the adverse events that occurred during the intervention were recorded.Result The total effective rate of the observation group(90.9%) was significantly higher than that in the control group(70.5%)(P<0.05); the scores of MMSE and ADL increased after treatment in both groups(P<0.05), and the observation group was higher than the control group(P<0.05); after intervention, the serum levels of VEGF and Livin increased(P<0.05) and the level of IL-1? declined(P<0.05) in the two groups, and the changes in the observation group were more significant than those in the control group(P<0.05); the serum levels of NO and NOS went down after treatment in the two groups(P<0.05), and the observation group was lower than the control group(P<0.05); the levels of Ach, DA, NE and EXC all increased after intervention in the observation group(P<0.05), and were significantly higher than those in the control group(P<0.05), while the changes in the levels of Ach, DA, NE and EXC were statistically insignificant in the control group(P > 0.05); the post-treatment changes in INH and5-hydroxytryptamine(5-HT) were statistically insignificant in the two groups(P>0.05); the occurrence of adverse events in the observation group was lower than that in the control group, but the difference was statistically insignificant(P>0.05). Conclusion Cluster needling plus oxiracetam injection can enhance the overall clinical efficacy in treating VD. It can improve the quality of life and cognitive function of VD patients and is highly safe. Its mechanism is related to the improvement of serum levels of VEGF, Livin and IL-1?, as well as the brain neurotransmitters, and the down-regulation of NO and NOS.
引文
[1]魏居瑞,刘喆,何方,等.血管性痴呆临床诊治研究进展[J].中国康复医学杂志,2009,24(1):92-95.
[2]李宪章.血管性痴呆的诊断治疗进展[J].山东医药,2009,49(33):103-104.
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[4]王太山.通窍活血汤化裁联合奥拉西坦治疗瘀血阻窍证血管性痴呆的临床研究[J].现代中西医结合杂志,2016,25(3):316-317,342.
[5]翁映虹,黄坚红.血管性痴呆的定义及诊断进展[J].广东医学,2010,31(14):1881-1882.
[6]李睿婷,李涛,李承晏,等.解析老年人血管性痴呆[J].家庭医学(上半月),2015,(10):28-29.
[7]庄新云,冉令梅.脑血管性痴呆防治与护理[J].社区医学杂志,2006,4(3S):25-26.
[8]洪震,周玢,黄茂盛,等.上海部分城乡地区血管性痴呆的发病率及危险因素研究[J].中华老年心脑血管病杂志,2004,6(3):174-177.
[9]Xu X,Zhang B,Lu K,et al.Prevention of hippocampal neuronal damage and cognitive function deficits in vascular dementia by dextromethorphan[J].Mol Neurobiol,2016,53(5):3494-3502.
[10]陈娟.醒脑开窍针刺法对血管性痴呆患者IGF-1、MMP-2、MMP-9表达的影响[J].中医学报,2017,32(10):2022-2025.
[11]张传慧,姜华,张雅丽.血管性痴呆的中医病机理论[J].黑龙江中医药,2007,(3):58-59.
[12]杨辰华,王永炎.血管性痴呆的中医病机及辨治思路[J].中医研究,2005,18(5):6-7.
[13]李卫民,李飞,梁丹丹,等.颞三针结合康复训练治疗血管性痴呆的临床观察[J].云南中医学院学报,2017,40(3):66-68.
[14]姜海波.针灸治疗血管性痴呆患者的临床研究进展[J].医疗装备,2017,30(12):182-183.
[15]张校军,张庆萍.近3年针灸治疗血管性痴呆临床研究概况[J].中医药临床杂志,2017,(5):623-626.
[16]李燕宏.脑心通胶囊对238例血管性痴呆患者血清Livin、VEGF、IL-18、IFN-?水平的临床研究[J].中医药信息,2017,34(4):67-70.
[17]郝美美,李晨曦.血清Livin、IFN-γ水平在血管性痴呆患者中的变化及其临床意义[J].卒中与神经疾病,2018,(6):668-671,680.
[18]宋元成.探究血管性痴呆患者血清Livin、INF-γ及IL-18表达水平及临床意义[J].中国继续医学教育,2017,9(2):148-150.
[19]钱采,吕传真,王新德.血管性痴呆诊断标准草案[J].中华神经科杂志,2002,35(4):246.
[20]郑筱萸.中药新药临床研究指导原则(试行)[S].北京:中国医药科技出版社,2002:153-154.
[21]高明月,杨珉,况伟宏,等.简易精神状态量表得分的影响因素和正常值的筛查效度评价[J].北京大学学报(医学版),2015,47(3):443-449.
[22]韩学青,冯锋,陈建,等.日常生活能力量表辅助诊断痴呆值的界定[J].中国组织工程研究,2005,9(37):13-15.
[23]田金洲,韩明向,涂晋文,等.血管性痴呆的诊断、辨证及疗效判定标准[J].北京中医药大学学报,2000,23(5):16-24.
[24]樊小辉.吡拉西坦联合尼莫地平对脑梗死后血管性痴呆患者认知功能恢复及生活质量的影响[J].淮海医药,2019,37(2):200-202.
[25]董毅,史振娟.心理护理对血管性痴呆患者功能康复及生活质量的影响[J].世界最新医学信息文摘(电子版),2018,18(42):229-230.
[26]冯德琳,张倩,孙远征.头穴丛刺为主治疗血管性痴呆的临床研究[J].中医药信息,2014,31(4):139-141.
[27]Ye Y,Xiao LY,Liu YH,et al.Acupuncture for patients with vascular dementia:a systematic review protocol[J].BMJ Open,2017,7(12):e19066.
[28]王永新,张红顺,王利春,等.头穴丛刺联合认知康复对脑梗死后认知障碍患者血UA、ACA及VEGF水平的影响[J].河北中医药学报,2017,32(5):36-38.
[29]马莉,梅晨健,孙士红,等.头穴丛刺长留针法治疗血管性痴呆的临床观察[J].针灸临床杂志,2017,33(5):49-51.
[30]王洲羿,黄虎翔,肖展翅,等.丹红注射液联合尼莫地平治疗血管性痴呆的临床疗效及其对血清VEGF、E2、Livin、?-Ap的影响[J].成都中医药大学学报,2017,40(2):53-55.
[31]赵玉广,李凤盛,乔钦增,等.中药组方联合奥拉西坦治疗老年血管性痴呆的临床研究[J].山西医药杂志,2016,45(4):457-459.
[32]井沆,田茂,董艳军,等.骨髓间充质干细胞移植对血管性痴呆大鼠认知功能及一氧化氮合酶的表达的影响[J].临床神经病学杂志,2015,28(4):276-280.
[33]张孟,隋晓琳,张春燕.地黄导痰汤制剂对血管性痴呆患者血清NO、ET-1、SOD及MDA的影响[J].中医药导报,2017,23(20):87-89.
[34]马献中,陈怡名,王保平,等.龙首参葛丸对血管性痴呆大鼠认知功能的改善作用观察[J].中药材,2017,40(1):204-207.
[35]翟阳,唐农,黎军宏,等.五脏温阳化瘀胶囊治疗血管性痴呆的随机对照临床研究[J].辽宁中医杂志,2017,44(6):1212-1214.
[2]李宪章.血管性痴呆的诊断治疗进展[J].山东医药,2009,49(33):103-104.
[3]王慧媛,赵捷,赵志刚,等.血管性痴呆的药物治疗进展[J].中国药房,2007,(23):1821-1823.
[4]王太山.通窍活血汤化裁联合奥拉西坦治疗瘀血阻窍证血管性痴呆的临床研究[J].现代中西医结合杂志,2016,25(3):316-317,342.
[5]翁映虹,黄坚红.血管性痴呆的定义及诊断进展[J].广东医学,2010,31(14):1881-1882.
[6]李睿婷,李涛,李承晏,等.解析老年人血管性痴呆[J].家庭医学(上半月),2015,(10):28-29.
[7]庄新云,冉令梅.脑血管性痴呆防治与护理[J].社区医学杂志,2006,4(3S):25-26.
[8]洪震,周玢,黄茂盛,等.上海部分城乡地区血管性痴呆的发病率及危险因素研究[J].中华老年心脑血管病杂志,2004,6(3):174-177.
[9]Xu X,Zhang B,Lu K,et al.Prevention of hippocampal neuronal damage and cognitive function deficits in vascular dementia by dextromethorphan[J].Mol Neurobiol,2016,53(5):3494-3502.
[10]陈娟.醒脑开窍针刺法对血管性痴呆患者IGF-1、MMP-2、MMP-9表达的影响[J].中医学报,2017,32(10):2022-2025.
[11]张传慧,姜华,张雅丽.血管性痴呆的中医病机理论[J].黑龙江中医药,2007,(3):58-59.
[12]杨辰华,王永炎.血管性痴呆的中医病机及辨治思路[J].中医研究,2005,18(5):6-7.
[13]李卫民,李飞,梁丹丹,等.颞三针结合康复训练治疗血管性痴呆的临床观察[J].云南中医学院学报,2017,40(3):66-68.
[14]姜海波.针灸治疗血管性痴呆患者的临床研究进展[J].医疗装备,2017,30(12):182-183.
[15]张校军,张庆萍.近3年针灸治疗血管性痴呆临床研究概况[J].中医药临床杂志,2017,(5):623-626.
[16]李燕宏.脑心通胶囊对238例血管性痴呆患者血清Livin、VEGF、IL-18、IFN-?水平的临床研究[J].中医药信息,2017,34(4):67-70.
[17]郝美美,李晨曦.血清Livin、IFN-γ水平在血管性痴呆患者中的变化及其临床意义[J].卒中与神经疾病,2018,(6):668-671,680.
[18]宋元成.探究血管性痴呆患者血清Livin、INF-γ及IL-18表达水平及临床意义[J].中国继续医学教育,2017,9(2):148-150.
[19]钱采,吕传真,王新德.血管性痴呆诊断标准草案[J].中华神经科杂志,2002,35(4):246.
[20]郑筱萸.中药新药临床研究指导原则(试行)[S].北京:中国医药科技出版社,2002:153-154.
[21]高明月,杨珉,况伟宏,等.简易精神状态量表得分的影响因素和正常值的筛查效度评价[J].北京大学学报(医学版),2015,47(3):443-449.
[22]韩学青,冯锋,陈建,等.日常生活能力量表辅助诊断痴呆值的界定[J].中国组织工程研究,2005,9(37):13-15.
[23]田金洲,韩明向,涂晋文,等.血管性痴呆的诊断、辨证及疗效判定标准[J].北京中医药大学学报,2000,23(5):16-24.
[24]樊小辉.吡拉西坦联合尼莫地平对脑梗死后血管性痴呆患者认知功能恢复及生活质量的影响[J].淮海医药,2019,37(2):200-202.
[25]董毅,史振娟.心理护理对血管性痴呆患者功能康复及生活质量的影响[J].世界最新医学信息文摘(电子版),2018,18(42):229-230.
[26]冯德琳,张倩,孙远征.头穴丛刺为主治疗血管性痴呆的临床研究[J].中医药信息,2014,31(4):139-141.
[27]Ye Y,Xiao LY,Liu YH,et al.Acupuncture for patients with vascular dementia:a systematic review protocol[J].BMJ Open,2017,7(12):e19066.
[28]王永新,张红顺,王利春,等.头穴丛刺联合认知康复对脑梗死后认知障碍患者血UA、ACA及VEGF水平的影响[J].河北中医药学报,2017,32(5):36-38.
[29]马莉,梅晨健,孙士红,等.头穴丛刺长留针法治疗血管性痴呆的临床观察[J].针灸临床杂志,2017,33(5):49-51.
[30]王洲羿,黄虎翔,肖展翅,等.丹红注射液联合尼莫地平治疗血管性痴呆的临床疗效及其对血清VEGF、E2、Livin、?-Ap的影响[J].成都中医药大学学报,2017,40(2):53-55.
[31]赵玉广,李凤盛,乔钦增,等.中药组方联合奥拉西坦治疗老年血管性痴呆的临床研究[J].山西医药杂志,2016,45(4):457-459.
[32]井沆,田茂,董艳军,等.骨髓间充质干细胞移植对血管性痴呆大鼠认知功能及一氧化氮合酶的表达的影响[J].临床神经病学杂志,2015,28(4):276-280.
[33]张孟,隋晓琳,张春燕.地黄导痰汤制剂对血管性痴呆患者血清NO、ET-1、SOD及MDA的影响[J].中医药导报,2017,23(20):87-89.
[34]马献中,陈怡名,王保平,等.龙首参葛丸对血管性痴呆大鼠认知功能的改善作用观察[J].中药材,2017,40(1):204-207.
[35]翟阳,唐农,黎军宏,等.五脏温阳化瘀胶囊治疗血管性痴呆的随机对照临床研究[J].辽宁中医杂志,2017,44(6):1212-1214.