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.
引文
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