脑梗死所致血管性痴呆患者头针治疗前后MRI的对比分析
|
摘要
目的:
探讨头针对脑梗死(cerebral infarction,CI)所致血管性痴呆(vascular dementia,VaD)患者颅脑MRI及临床症状的影响。为脑梗死所致血管性痴呆治疗方法的优选提供临床根据。
方法:
108例确诊的CI所致VaD患者均为2005年9月～2007年6月就诊于武汉市中西医结合医院针灸科、神经内科以及武汉市中心医院康复科的住院及门诊病例。92例患者最终完成观察,按随机数字表法随机分为头针治疗组(47例)和西药治疗组(45例)。头针治疗组取穴:根据中国针灸学会制订的《头皮针穴名国际标准化方案》取顶颞前斜线(前神聪至悬厘)、顶颞后斜线(百会至曲鬓),均为双侧取穴。局部常规消毒,选用华佗牌30号1.5寸毫针进行针刺。针尖与头皮呈15°左右夹角,沿顶颞前斜线、顶颞后斜线快速刺入头皮下,当针尖抵达帽状腱膜下层时,指下感到阻力减小,然后使针与头皮平行,沿刺激线刺入1.0～1.5寸,再快速连续捻转,速度应保持在220次/min左右,每次捻转2～3min,留针30min,每15min重复捻转1次,1次/d,6d为1个疗程,疗程间隔1d,连续治疗5个疗程,共30d。西药治疗组:尼莫地平片,口服,每次40mg,3次/d,6d为1个疗程,疗程间隔1d,连续治疗5个疗程,共30d。各组分别于治疗30d后、治疗结束后1个月、治疗结束后2个月统一评定疗效。观察治疗前后患者颅脑MRI片下的外侧裂宽度、第三脑室宽度、平均脑室宽度、额角指数、尾状核指数、侧脑室体积指数,并运用简易智力状态检查(MMSE)、Blesse痴呆量表(BBS)、长谷川痴呆量表(HDS)、日常生活能力量表(ADL)进行智能评分。
结果:
经过30d的治疗后,两组HDS、BBS和MMSE得分上升,ADL得分下降,与治疗前比较,差异有统计学意义(P＜0.05);治疗后两组HDS、ADL、BBS和MMSE分值的差异无统计学意义(P＞0.05),提示头针与西药疗效相当。治疗后两组患者颅脑MRI各指标变化均不明显(P＞0.05),说明头针治疗和西药治疗对颅脑MRI各指标的影响不大。
结论:
头针治疗不能改善患者颅脑形态指标,但可以改善脑梗死所致血管性痴呆患者的临床症状。
Objective:
To explore the effects of Scalp-acupuncture on encephalic MRI and clinical symptoms in vascular dementia (VaD) and the clinical evidence for vascular dementia (VaD) treatment optimization.
Methods:
108 patients suffered from VaD were from department of acupuncture and neurology, integration of traditional and western medicine hospital of Wuhan and department of rehabilitation medicine, central hospital of Wuhan, including inpatients and outpatients, from September 2005 to June 2007. 92 patients finished the observation finally, they were randomly divided into two groups: Scalp-acupuncture group (47 patients) and drug group (45 patients). The patients of Scalp-acupuncture group were hibaterally punctured top temple linea oblique anterior (Qian Shen Cong to Xuan Li)、top temple linea obliqe posterior ( Bai Hui to Qu Bin )according to China association of acupuncture-moxibustionformulated "China scalp point programme of the international standardization". After conventional disinfection, 0. 25 mm×40 mm filiform needles were selected to acupuncture. Along the top temple linea oblique anterior and top temple linea obliqe posterior prick into scalp quickly by 15 degrees angle. When the needle tip reached the aponeurosis of occipitofron talis muscle underlayer, resistance decreasion could be felt . The needle was put at equal pace with scalp, and punctured follow the line prick into 1 to 1. 5 cun, rotated rapidly and continuously. The speed was kept by 220 times per minute. The needles were kept for 30 min, one time per day, one course of treatment contains 6 times, 5 continuous courses of treatment consisted 30 days. The patients of the drug group taken Nimodipine Tablets orally 40mg, three times daily, one course of treatment contains 6 times, 5 continuous courses of treatment consisted 30 days. The therapeutic effect was evaluated 30 days, 60 days and 90 days after the treatment. The changes of Lateral cerebral fissure width, Third ventricle sulcus, Cerebral sulcus average width, Frontal horn index, Caudate nudeus index, Lateral ventrie body index, scoring value of HDS (Hasegawa dementia scale), ADL (ability of daily life), MMSE (mini-mental state examination) and BBS (Blesse dementia scale) were measured pre and post treatment.
Results:
After 30 days treatment, two groups' scores of HDS, BDS, MMSE increased, while the score of ADL decreased. Compared with pre-treatment,The difference had statistical significance ( P< 0. 05 ) . After the treatment, the score difference of HDS, BBS, MMSE and ADL of two groups didn't have statistical significance ( P> 0. 05 ) , it suggested that the therapeutic effect of the Scalp-acupuncture and drug were similar. There were no significant changes in encephalic MRI (P> 0.05 ) . The influence to MRI by Scalp-acupuncture and drug were all no obvious.
Conclusions:
Scalp-acupuncture therapy can' t ameliorate encephalic MRI, but can improve the symptoms of patients suffered from VaD.
探讨头针对脑梗死(cerebral infarction,CI)所致血管性痴呆(vascular dementia,VaD)患者颅脑MRI及临床症状的影响。为脑梗死所致血管性痴呆治疗方法的优选提供临床根据。
方法:
108例确诊的CI所致VaD患者均为2005年9月～2007年6月就诊于武汉市中西医结合医院针灸科、神经内科以及武汉市中心医院康复科的住院及门诊病例。92例患者最终完成观察,按随机数字表法随机分为头针治疗组(47例)和西药治疗组(45例)。头针治疗组取穴:根据中国针灸学会制订的《头皮针穴名国际标准化方案》取顶颞前斜线(前神聪至悬厘)、顶颞后斜线(百会至曲鬓),均为双侧取穴。局部常规消毒,选用华佗牌30号1.5寸毫针进行针刺。针尖与头皮呈15°左右夹角,沿顶颞前斜线、顶颞后斜线快速刺入头皮下,当针尖抵达帽状腱膜下层时,指下感到阻力减小,然后使针与头皮平行,沿刺激线刺入1.0～1.5寸,再快速连续捻转,速度应保持在220次/min左右,每次捻转2～3min,留针30min,每15min重复捻转1次,1次/d,6d为1个疗程,疗程间隔1d,连续治疗5个疗程,共30d。西药治疗组:尼莫地平片,口服,每次40mg,3次/d,6d为1个疗程,疗程间隔1d,连续治疗5个疗程,共30d。各组分别于治疗30d后、治疗结束后1个月、治疗结束后2个月统一评定疗效。观察治疗前后患者颅脑MRI片下的外侧裂宽度、第三脑室宽度、平均脑室宽度、额角指数、尾状核指数、侧脑室体积指数,并运用简易智力状态检查(MMSE)、Blesse痴呆量表(BBS)、长谷川痴呆量表(HDS)、日常生活能力量表(ADL)进行智能评分。
结果:
经过30d的治疗后,两组HDS、BBS和MMSE得分上升,ADL得分下降,与治疗前比较,差异有统计学意义(P＜0.05);治疗后两组HDS、ADL、BBS和MMSE分值的差异无统计学意义(P＞0.05),提示头针与西药疗效相当。治疗后两组患者颅脑MRI各指标变化均不明显(P＞0.05),说明头针治疗和西药治疗对颅脑MRI各指标的影响不大。
结论:
头针治疗不能改善患者颅脑形态指标,但可以改善脑梗死所致血管性痴呆患者的临床症状。
Objective:
To explore the effects of Scalp-acupuncture on encephalic MRI and clinical symptoms in vascular dementia (VaD) and the clinical evidence for vascular dementia (VaD) treatment optimization.
Methods:
108 patients suffered from VaD were from department of acupuncture and neurology, integration of traditional and western medicine hospital of Wuhan and department of rehabilitation medicine, central hospital of Wuhan, including inpatients and outpatients, from September 2005 to June 2007. 92 patients finished the observation finally, they were randomly divided into two groups: Scalp-acupuncture group (47 patients) and drug group (45 patients). The patients of Scalp-acupuncture group were hibaterally punctured top temple linea oblique anterior (Qian Shen Cong to Xuan Li)、top temple linea obliqe posterior ( Bai Hui to Qu Bin )according to China association of acupuncture-moxibustionformulated "China scalp point programme of the international standardization". After conventional disinfection, 0. 25 mm×40 mm filiform needles were selected to acupuncture. Along the top temple linea oblique anterior and top temple linea obliqe posterior prick into scalp quickly by 15 degrees angle. When the needle tip reached the aponeurosis of occipitofron talis muscle underlayer, resistance decreasion could be felt . The needle was put at equal pace with scalp, and punctured follow the line prick into 1 to 1. 5 cun, rotated rapidly and continuously. The speed was kept by 220 times per minute. The needles were kept for 30 min, one time per day, one course of treatment contains 6 times, 5 continuous courses of treatment consisted 30 days. The patients of the drug group taken Nimodipine Tablets orally 40mg, three times daily, one course of treatment contains 6 times, 5 continuous courses of treatment consisted 30 days. The therapeutic effect was evaluated 30 days, 60 days and 90 days after the treatment. The changes of Lateral cerebral fissure width, Third ventricle sulcus, Cerebral sulcus average width, Frontal horn index, Caudate nudeus index, Lateral ventrie body index, scoring value of HDS (Hasegawa dementia scale), ADL (ability of daily life), MMSE (mini-mental state examination) and BBS (Blesse dementia scale) were measured pre and post treatment.
Results:
After 30 days treatment, two groups' scores of HDS, BDS, MMSE increased, while the score of ADL decreased. Compared with pre-treatment,The difference had statistical significance ( P< 0. 05 ) . After the treatment, the score difference of HDS, BBS, MMSE and ADL of two groups didn't have statistical significance ( P> 0. 05 ) , it suggested that the therapeutic effect of the Scalp-acupuncture and drug were similar. There were no significant changes in encephalic MRI (P> 0.05 ) . The influence to MRI by Scalp-acupuncture and drug were all no obvious.
Conclusions:
Scalp-acupuncture therapy can' t ameliorate encephalic MRI, but can improve the symptoms of patients suffered from VaD.
引文
[1]Association.Diagnostic and Statictical Manual of Mental Disorders,4thed.(DSM-IV)[C].WashingtonDC:AmericanPsychia tric Association,1992,143.
[2]梁亦邓.用于痴呆的修订长谷川量表[J].日本医学介绍,1992;19(9):420.
[3]陈清堂.脑卒中患者临床神经功能缺损程度评分标准[J].中华神经科杂志,1996;29(6):381.
[4]莫飞智,刘颂豪.激光穴位照射与针刺对血管性痴呆症状的疗效对比研究[J].现代康复,2001;5(3):36.
[5]何坚,嘉世健.电针国际标准头针穴位治疗血管性痴呆[J].四川中医,1999;17(10):54.
[6]张雪朝.针刺对血管性痴呆的治疗及其机理的研究进展.针刺研究,2002;19(3):556.
[7]傅仁杰.老年痴呆病的诊断、辨证分型及疗效评定标准.中医杂志,1991;(1):56.
[8]Gereliok PB,Chatterjee AM,Patel DM.Cranial computed tomographic observation in multi-infarct dementia.Stroke,2002;23(6):804.
[9]Liu CK,Miuer BL,Cummings KL.A quantitative MRI study of vascular dementia.Neurology,1992;42(1):138.
[10]Pohiasvaara T,Eikinjuntti Y.Dementia three months after stroke.Stroke,2003;28(6):785.
[11]Lindsay J,Hebert R,Rockwood K.Yhe Canadian study of health and aging risk fators for vascular dementia.Stroke,1999;28(3):526.
[12]Prencipe M,Casini R,Ferarri C,et al.Prevelence of dementia in an olderly rural population.J Neurol Neurosury Psychiatry,2004;60(6):658.
[13]Pohjasvaara T,Erkinjjuntti T,Ylikoski R,et al.Clinical determinants of poststroke dementia.Stroke,2001;28(1):75.
[14]Hachinski.Multi-infarct dementia:a canse mental cleteri oration in elderly.Lancet 1974;(5):207.
[15]Rocca M A,Hoffman A,Brayne C,et al.The prevalence of vascular dementia in Europe:facts and fragments from 1980-1990studies.Ann Neurol,1991;18(4):817.
[16]陈湛,刘春红,张桂青,等.腔隙性脑梗死患者的智能障碍.中国神经免疫学和神经病学杂志,1997;4(4):216.
[17]Koshi Y,Kitamura S,Nagazumi A,et al.Regional cerebral blood flow and periventricular hyperiotensity in silent cerebral infarction-comparision with multi-infarct dementia.Stroke,2003;6(23):804.
[18]Fomasellid K,Ment F,Ogura G,et al.Clinical and instrumental diagnosis of Alzheimer' s and multi-infarct dementia.Radiol Med,1997;92(12):22.
[19]Gundersn HJG,Jensen ER.The efficiency of systematic sampling in stereology and its prediction.J Microsurg,1997;14(7):227.
[20]Ginbilei F,Bastianello S,Paolillo A,et al.Ouantitative magnetic resonance analysis in vascular dementia.J Neurol,1997;24(4):251.
[21]牛金贵.阿尔茨海默病和Binswanger病脑影像学与认知水平的对照.中国临床康复,2003;7(7):1100.
[22]韦云飞,刘建荣,赵伟佳,等.阿尔茨海默病与血管性痴呆的临床、神经心理、影像学对比.中国临床康复,2003;7(7):1098.
[23]何国军,陈俊抛,温志波,等.阿尔茨海默病与血管性痴呆患者侧脑室、外侧裂的定量测定及影像学特征.中国临床康复,2004;8(13):2450.
[24]Lin CK,Miller BC,Cummings JL,et al.Medical temporal lobe atrophy on MRI in dementia with Lewy bodies.Neurology,1999;52(5):1153.
[25]Tanabe JL,Amend D,Schuff N,et al.Tissue segmentation of the brain in Alzheimer disease.Am J Neuroradial,1997;18(40):115.
[26]张秋娟.血管性痴呆的影像学诊断研究进展.实用放射学杂志,2002;18(1):58.
[27]David L,Michaeal E,Jeffrey L,et al.Cortical abnormalities associated with subcortical lesions in vascular dementia.Arch Neurol,1995;52:773.
[28]Shane M,Frank E,Victoria D,et al.Regional gray and white matter metabolite differences in subjects with AD,with subcortical ischemia vascular dementia,and elderly controls with ~1H magnetic resonance spectroscopic imaging.Arch Neurol,1996;53:167.
[29]Giubilei F,BastianbelloS,Paolillo A,etal.Quantitative magnetic resonance analysis in vascular dementia.J Neurol,1997;244(4):246.
[30]C.K.Liu,B.L.Miller.Corpus callosum in Alzheimer' s and vascular dementia-a quantitative magnetic resonance study.N Neural Transm Suppl,1998;54:129.
[31]司全明,吴根诚,曹小定.电针对脑缺血后期损伤的保护作用.上海针灸杂志,1998;17(4):40.
[32]陈湛,娄海燕,张秀侠,等.脑梗死早期智能障碍与脑影像学改变 关系分析.中国神经精神疾病杂志,2000;26(1):33.
[33]于志远,郁阿丽,张玉珍.多发脑梗塞痴呆相关因素的临床研究.脑与神经疾病杂志,1998;6(2):113.
[34]许利刚,李作汉.血管性痴呆的临床与CT改变的研究.中国神经和精神疾病杂志,2001;14(2):94-96.
[35]高素荣,袁锦楣主编.痴呆诊疗学,第一版.北京:北京科学技术出版社,1998,84.
[36]田金洲.血管性痴呆,第一版.北京:人民卫生出版社,2003,413.
[37]田金洲,王永炎.血管性痴呆研究述评.北京中医药大学学报,1997;20(4):2-7.
[3 8]鱼博浪,郭佑民,张明主编.中枢神经系统CT和MRⅠ鉴别诊断,第一版.西安:陕西科学技术出版社,1996,210.
[39]钱采韵,马燕珊,方昆豪.多梗塞性痴呆的CT与临床探讨.中国神经精神疾病杂志,1997;17(6):336-338.
[40]孟加眉,孟琛.多发性脑梗塞患者智能障碍与病变关系的研究.中华内科杂志,1994;33(5):322-326.
[41]胡孝全,周农,尹世杰.多发性脑梗塞性痴呆的CT和MRⅠ对比分析.临床荟萃,1999;14(2):60.
[42]平井俊策.基底核异常与痴呆.日本医学介绍,1987:8(10):454.
[43]王亮,李坤成.血管性痴呆的MRⅠ定量研究.中华放射学杂志,2000;34(11):738.
[44]王群,钱采韵.血管性痴呆的研究进展.卒中与神经疾病杂志,1995:12(4):248.
[45]韩济生.神经科学纲要,第一版.北京:北京医科大学中国协和医科大学联合出版社,1993,723-729.
[46]张培林.神经解剖学,第一版.北京:人民卫生出版社,1987,384-398.
[47]盛树力.老年性痴呆:从分子生物学到临床诊治,第一版.北京: 科学技术文献出版社,1998,126-135.
[48]东仪英夫.脑血管性痴呆及其危险因素.日本医学介绍,1996;17(9):58.
[49]赖新生,余瑾,庄礼兴,等.针刺治疗血管性痴呆近期临床效果观察.广州中医药大学学报,2000;17(4):301-305.
[50]症谅,李艳慧,庄礼兴,等.针灸配合中药治疗血管性痴呆的临床观察.广州中医药大学学报,1999;16(4):165-168.
[51]黄文川.针刺治疗多梗塞性痴呆的研究.中国针灸,1992;(3):13.
[52]候安乐.药氧针刺治疗多梗塞性痴呆的临床观察.上海针灸杂志,1998;17(2):12.
[53]张雪朝.针刺对学管性痴呆大鼠记忆障碍及c-fosmRNA和蛋白表达的影响.中国康复医学杂志,2001;16(2):74-76.
[54]石学敏,韩景献.针刺对老化痴呆大鼠脑兴奋性氨基酸水平影响的实验研究.中国针灸,1998;18(11):689.
[55]贾建民.大鼠脑反复缺血致不可逆性学习记忆障碍的研究.心理学报,1995;27(1):69.
[56]沈德凯,候思伟,许能贵,等.电针对局灶性脑缺血大鼠神经元损伤保护作用的病理组织.中国中医药科技,1998;5(5):269-270.
[57]赖新生,莫飞智,江钢绘,等.针刺治疗血管性痴呆的临床疗效及对超氧化物歧化酶、脂质过氧化物及一氧化氮的影响.中国中西医结合杂志,1998;18(11):713-716.
[58]王新德,陈海波,蔡晓杰.老年人脑血管性痴呆德研究.中华老年医学杂志,1992;11(3):138-141.
[59]李炎生,谢敦祥.长谷川痴呆量表在老年人血管性痴呆德应用.衡阳医学院学报,1997;25(2):156-157.
[60]王春雪,龙洁,陆菁菁.血管性痴呆患者认知功能障碍德临床分析.中国心理卫生杂志,2001;15(5):321-323.
[61]蒋洪春,郭述苏,毕淑英,等.血管性痴呆认知功能障碍德相关因素研究.中国心理卫生杂志,1995;9(6):254-255.
[62]包烨华,冯伟民,朱国祥,等.头穴久留针治疗血管性痴呆的随机对照研究.中国针灸,2004;24(2):81-84.
[63]中华人民共和国卫生部.中药新药临床研究指导原则·中药新药治疗老年期痴呆的临床研究指导原则(草案)[s].2000(内部资料).
[64]谢颖桢,邹忆怀,张云岭,等.血管性痴呆病因病机探讨.北京中医药大学学报,2000;23(6):1-3.
[1]田金州,韩明向,涂晋文,等.血管性痴呆诊断、辨证及疗效评定标准(研究用).中国老年学杂志,2002;9(22):329-331.
[2]李艳慧,庄礼兴,郑琼,等.针灸治疗血管性痴呆的临床观察.中国针灸,1998;11:645-647.
[3]赖新生,余瑾,庄礼兴,等.针刺治疗血管性痴呆近期临床疗效观察.广州中医药大学学报,2000;4(17):301-306.
[4]刘清国,汤立新,贺江宁,等.针刺治疗多发脑梗塞性痴呆46例临床观察.北京中医药大学学报,2003;2(26):81-85.
[5]刘翼程,骆明军,陈邦国,等.针刺对血管性痴呆颅脑MRⅠ和临床症状的影响.中国康复医学杂志,2005;1(20):58-59.
[6]王玲.针刺夹脊穴治疗血管性痴呆38例.上海针灸杂志,2 005;7(24):27.
[7]包烨华,冯伟民,朱国祥,等.头穴久留针治疗血管性痴呆的随机对照研究.中国针灸,2004;2(24):81-84.
[8]聂志华,钟志伦.靳三针治疗脑血管性痴呆的临床观察.上海针灸杂志,2004;8(23):5-6.
[9]李应昆,李季.头电针对脑卒中后痴呆患者智能恢复的作用.中国临床康复,2005;9(28):228.
[10]李建强,莫飞智,赖新生,等.电针与氢化麦角碱治疗血管性痴呆临床对照研究.中国康复理论与实践,2001;2(7):73-75.
[11]于晓曦.电针治疗血管性痴呆46例临床观察.针灸临床杂志,2003;9(19):27-28.
[12]李常度,蒋振亚,吴大容,等.麝香注射液穴位注射治疗血管性痴呆的临床随机对照研究.中国针灸,2000;12:709-712.
[13]吕红霞.针刺加穴注治疗血管性痴呆的临床观察.心血管康复医学杂志,2005:3(14):250-251.
[14]金肖青,宋双临,俞迈红,等.头穴电针结合穴位注射治疗血管性痴呆临床观察.上海针灸杂志,2002;5(21):7-9.
[15]郑谅,李艳慧,庄礼兴.针灸配合中药治疗血管性痴呆的临床观察.广州中医药大学学报,1999;4(16):292-295.
[16]唐胜修,唐萍.针刺四神聪联合脑多肽穴注治疗血管性痴呆的临床研究.医学文选,2002;2(21):166-168.
[17]于颂华,王春梅,刘占芬,等.“调神益智”针法治疗血管性痴呆21例临床观察.针灸临床杂志,2005;6(21):25-26.
[18]李淑芝,麻红,贺鑫.针刺配合药氧治疗血管性痴呆的临床观察.中国针灸,1999;12:719-720.
[19]莫飞智,刘颂豪,李建强,等.激光穴位照射与针刺对血管性痴呆症状的疗效对照研究.现代康复,2001;3(5):36-37.
1.刘悦平,胡晶晶,张唐法,等.针灸颈夹脊穴治疗神经根型颈椎病临床研究进展.湖北中医杂志.2008;30(1):63-64.
2.刘翼程,张红星,陈国华,等.头针治疗对脑梗死所致血管性痴呆的随机对照临床试验.中西医结合学报.2008;6(8):806-809.
3.胡晶晶,张唐法,张红星,等.头针对血管性痴呆患者智能量表的临床观察.上海针灸杂志.2009;28(1):15-17.
4.刘悦平,胡晶晶,张唐法,等.穴位注射颈夹脊穴治疗神经根型颈椎病.中国康复.2009;24(2):128.
5.刘悦平,胡晶晶,张红星,等.穴位注射颈夹脊穴对神经根型颈椎病镇痛作用的研究.中国中医骨伤科杂志.2009:17(4):28-29.
[2]梁亦邓.用于痴呆的修订长谷川量表[J].日本医学介绍,1992;19(9):420.
[3]陈清堂.脑卒中患者临床神经功能缺损程度评分标准[J].中华神经科杂志,1996;29(6):381.
[4]莫飞智,刘颂豪.激光穴位照射与针刺对血管性痴呆症状的疗效对比研究[J].现代康复,2001;5(3):36.
[5]何坚,嘉世健.电针国际标准头针穴位治疗血管性痴呆[J].四川中医,1999;17(10):54.
[6]张雪朝.针刺对血管性痴呆的治疗及其机理的研究进展.针刺研究,2002;19(3):556.
[7]傅仁杰.老年痴呆病的诊断、辨证分型及疗效评定标准.中医杂志,1991;(1):56.
[8]Gereliok PB,Chatterjee AM,Patel DM.Cranial computed tomographic observation in multi-infarct dementia.Stroke,2002;23(6):804.
[9]Liu CK,Miuer BL,Cummings KL.A quantitative MRI study of vascular dementia.Neurology,1992;42(1):138.
[10]Pohiasvaara T,Eikinjuntti Y.Dementia three months after stroke.Stroke,2003;28(6):785.
[11]Lindsay J,Hebert R,Rockwood K.Yhe Canadian study of health and aging risk fators for vascular dementia.Stroke,1999;28(3):526.
[12]Prencipe M,Casini R,Ferarri C,et al.Prevelence of dementia in an olderly rural population.J Neurol Neurosury Psychiatry,2004;60(6):658.
[13]Pohjasvaara T,Erkinjjuntti T,Ylikoski R,et al.Clinical determinants of poststroke dementia.Stroke,2001;28(1):75.
[14]Hachinski.Multi-infarct dementia:a canse mental cleteri oration in elderly.Lancet 1974;(5):207.
[15]Rocca M A,Hoffman A,Brayne C,et al.The prevalence of vascular dementia in Europe:facts and fragments from 1980-1990studies.Ann Neurol,1991;18(4):817.
[16]陈湛,刘春红,张桂青,等.腔隙性脑梗死患者的智能障碍.中国神经免疫学和神经病学杂志,1997;4(4):216.
[17]Koshi Y,Kitamura S,Nagazumi A,et al.Regional cerebral blood flow and periventricular hyperiotensity in silent cerebral infarction-comparision with multi-infarct dementia.Stroke,2003;6(23):804.
[18]Fomasellid K,Ment F,Ogura G,et al.Clinical and instrumental diagnosis of Alzheimer' s and multi-infarct dementia.Radiol Med,1997;92(12):22.
[19]Gundersn HJG,Jensen ER.The efficiency of systematic sampling in stereology and its prediction.J Microsurg,1997;14(7):227.
[20]Ginbilei F,Bastianello S,Paolillo A,et al.Ouantitative magnetic resonance analysis in vascular dementia.J Neurol,1997;24(4):251.
[21]牛金贵.阿尔茨海默病和Binswanger病脑影像学与认知水平的对照.中国临床康复,2003;7(7):1100.
[22]韦云飞,刘建荣,赵伟佳,等.阿尔茨海默病与血管性痴呆的临床、神经心理、影像学对比.中国临床康复,2003;7(7):1098.
[23]何国军,陈俊抛,温志波,等.阿尔茨海默病与血管性痴呆患者侧脑室、外侧裂的定量测定及影像学特征.中国临床康复,2004;8(13):2450.
[24]Lin CK,Miller BC,Cummings JL,et al.Medical temporal lobe atrophy on MRI in dementia with Lewy bodies.Neurology,1999;52(5):1153.
[25]Tanabe JL,Amend D,Schuff N,et al.Tissue segmentation of the brain in Alzheimer disease.Am J Neuroradial,1997;18(40):115.
[26]张秋娟.血管性痴呆的影像学诊断研究进展.实用放射学杂志,2002;18(1):58.
[27]David L,Michaeal E,Jeffrey L,et al.Cortical abnormalities associated with subcortical lesions in vascular dementia.Arch Neurol,1995;52:773.
[28]Shane M,Frank E,Victoria D,et al.Regional gray and white matter metabolite differences in subjects with AD,with subcortical ischemia vascular dementia,and elderly controls with ~1H magnetic resonance spectroscopic imaging.Arch Neurol,1996;53:167.
[29]Giubilei F,BastianbelloS,Paolillo A,etal.Quantitative magnetic resonance analysis in vascular dementia.J Neurol,1997;244(4):246.
[30]C.K.Liu,B.L.Miller.Corpus callosum in Alzheimer' s and vascular dementia-a quantitative magnetic resonance study.N Neural Transm Suppl,1998;54:129.
[31]司全明,吴根诚,曹小定.电针对脑缺血后期损伤的保护作用.上海针灸杂志,1998;17(4):40.
[32]陈湛,娄海燕,张秀侠,等.脑梗死早期智能障碍与脑影像学改变 关系分析.中国神经精神疾病杂志,2000;26(1):33.
[33]于志远,郁阿丽,张玉珍.多发脑梗塞痴呆相关因素的临床研究.脑与神经疾病杂志,1998;6(2):113.
[34]许利刚,李作汉.血管性痴呆的临床与CT改变的研究.中国神经和精神疾病杂志,2001;14(2):94-96.
[35]高素荣,袁锦楣主编.痴呆诊疗学,第一版.北京:北京科学技术出版社,1998,84.
[36]田金洲.血管性痴呆,第一版.北京:人民卫生出版社,2003,413.
[37]田金洲,王永炎.血管性痴呆研究述评.北京中医药大学学报,1997;20(4):2-7.
[3 8]鱼博浪,郭佑民,张明主编.中枢神经系统CT和MRⅠ鉴别诊断,第一版.西安:陕西科学技术出版社,1996,210.
[39]钱采韵,马燕珊,方昆豪.多梗塞性痴呆的CT与临床探讨.中国神经精神疾病杂志,1997;17(6):336-338.
[40]孟加眉,孟琛.多发性脑梗塞患者智能障碍与病变关系的研究.中华内科杂志,1994;33(5):322-326.
[41]胡孝全,周农,尹世杰.多发性脑梗塞性痴呆的CT和MRⅠ对比分析.临床荟萃,1999;14(2):60.
[42]平井俊策.基底核异常与痴呆.日本医学介绍,1987:8(10):454.
[43]王亮,李坤成.血管性痴呆的MRⅠ定量研究.中华放射学杂志,2000;34(11):738.
[44]王群,钱采韵.血管性痴呆的研究进展.卒中与神经疾病杂志,1995:12(4):248.
[45]韩济生.神经科学纲要,第一版.北京:北京医科大学中国协和医科大学联合出版社,1993,723-729.
[46]张培林.神经解剖学,第一版.北京:人民卫生出版社,1987,384-398.
[47]盛树力.老年性痴呆:从分子生物学到临床诊治,第一版.北京: 科学技术文献出版社,1998,126-135.
[48]东仪英夫.脑血管性痴呆及其危险因素.日本医学介绍,1996;17(9):58.
[49]赖新生,余瑾,庄礼兴,等.针刺治疗血管性痴呆近期临床效果观察.广州中医药大学学报,2000;17(4):301-305.
[50]症谅,李艳慧,庄礼兴,等.针灸配合中药治疗血管性痴呆的临床观察.广州中医药大学学报,1999;16(4):165-168.
[51]黄文川.针刺治疗多梗塞性痴呆的研究.中国针灸,1992;(3):13.
[52]候安乐.药氧针刺治疗多梗塞性痴呆的临床观察.上海针灸杂志,1998;17(2):12.
[53]张雪朝.针刺对学管性痴呆大鼠记忆障碍及c-fosmRNA和蛋白表达的影响.中国康复医学杂志,2001;16(2):74-76.
[54]石学敏,韩景献.针刺对老化痴呆大鼠脑兴奋性氨基酸水平影响的实验研究.中国针灸,1998;18(11):689.
[55]贾建民.大鼠脑反复缺血致不可逆性学习记忆障碍的研究.心理学报,1995;27(1):69.
[56]沈德凯,候思伟,许能贵,等.电针对局灶性脑缺血大鼠神经元损伤保护作用的病理组织.中国中医药科技,1998;5(5):269-270.
[57]赖新生,莫飞智,江钢绘,等.针刺治疗血管性痴呆的临床疗效及对超氧化物歧化酶、脂质过氧化物及一氧化氮的影响.中国中西医结合杂志,1998;18(11):713-716.
[58]王新德,陈海波,蔡晓杰.老年人脑血管性痴呆德研究.中华老年医学杂志,1992;11(3):138-141.
[59]李炎生,谢敦祥.长谷川痴呆量表在老年人血管性痴呆德应用.衡阳医学院学报,1997;25(2):156-157.
[60]王春雪,龙洁,陆菁菁.血管性痴呆患者认知功能障碍德临床分析.中国心理卫生杂志,2001;15(5):321-323.
[61]蒋洪春,郭述苏,毕淑英,等.血管性痴呆认知功能障碍德相关因素研究.中国心理卫生杂志,1995;9(6):254-255.
[62]包烨华,冯伟民,朱国祥,等.头穴久留针治疗血管性痴呆的随机对照研究.中国针灸,2004;24(2):81-84.
[63]中华人民共和国卫生部.中药新药临床研究指导原则·中药新药治疗老年期痴呆的临床研究指导原则(草案)[s].2000(内部资料).
[64]谢颖桢,邹忆怀,张云岭,等.血管性痴呆病因病机探讨.北京中医药大学学报,2000;23(6):1-3.
[1]田金州,韩明向,涂晋文,等.血管性痴呆诊断、辨证及疗效评定标准(研究用).中国老年学杂志,2002;9(22):329-331.
[2]李艳慧,庄礼兴,郑琼,等.针灸治疗血管性痴呆的临床观察.中国针灸,1998;11:645-647.
[3]赖新生,余瑾,庄礼兴,等.针刺治疗血管性痴呆近期临床疗效观察.广州中医药大学学报,2000;4(17):301-306.
[4]刘清国,汤立新,贺江宁,等.针刺治疗多发脑梗塞性痴呆46例临床观察.北京中医药大学学报,2003;2(26):81-85.
[5]刘翼程,骆明军,陈邦国,等.针刺对血管性痴呆颅脑MRⅠ和临床症状的影响.中国康复医学杂志,2005;1(20):58-59.
[6]王玲.针刺夹脊穴治疗血管性痴呆38例.上海针灸杂志,2 005;7(24):27.
[7]包烨华,冯伟民,朱国祥,等.头穴久留针治疗血管性痴呆的随机对照研究.中国针灸,2004;2(24):81-84.
[8]聂志华,钟志伦.靳三针治疗脑血管性痴呆的临床观察.上海针灸杂志,2004;8(23):5-6.
[9]李应昆,李季.头电针对脑卒中后痴呆患者智能恢复的作用.中国临床康复,2005;9(28):228.
[10]李建强,莫飞智,赖新生,等.电针与氢化麦角碱治疗血管性痴呆临床对照研究.中国康复理论与实践,2001;2(7):73-75.
[11]于晓曦.电针治疗血管性痴呆46例临床观察.针灸临床杂志,2003;9(19):27-28.
[12]李常度,蒋振亚,吴大容,等.麝香注射液穴位注射治疗血管性痴呆的临床随机对照研究.中国针灸,2000;12:709-712.
[13]吕红霞.针刺加穴注治疗血管性痴呆的临床观察.心血管康复医学杂志,2005:3(14):250-251.
[14]金肖青,宋双临,俞迈红,等.头穴电针结合穴位注射治疗血管性痴呆临床观察.上海针灸杂志,2002;5(21):7-9.
[15]郑谅,李艳慧,庄礼兴.针灸配合中药治疗血管性痴呆的临床观察.广州中医药大学学报,1999;4(16):292-295.
[16]唐胜修,唐萍.针刺四神聪联合脑多肽穴注治疗血管性痴呆的临床研究.医学文选,2002;2(21):166-168.
[17]于颂华,王春梅,刘占芬,等.“调神益智”针法治疗血管性痴呆21例临床观察.针灸临床杂志,2005;6(21):25-26.
[18]李淑芝,麻红,贺鑫.针刺配合药氧治疗血管性痴呆的临床观察.中国针灸,1999;12:719-720.
[19]莫飞智,刘颂豪,李建强,等.激光穴位照射与针刺对血管性痴呆症状的疗效对照研究.现代康复,2001;3(5):36-37.
1.刘悦平,胡晶晶,张唐法,等.针灸颈夹脊穴治疗神经根型颈椎病临床研究进展.湖北中医杂志.2008;30(1):63-64.
2.刘翼程,张红星,陈国华,等.头针治疗对脑梗死所致血管性痴呆的随机对照临床试验.中西医结合学报.2008;6(8):806-809.
3.胡晶晶,张唐法,张红星,等.头针对血管性痴呆患者智能量表的临床观察.上海针灸杂志.2009;28(1):15-17.
4.刘悦平,胡晶晶,张唐法,等.穴位注射颈夹脊穴治疗神经根型颈椎病.中国康复.2009;24(2):128.
5.刘悦平,胡晶晶,张红星,等.穴位注射颈夹脊穴对神经根型颈椎病镇痛作用的研究.中国中医骨伤科杂志.2009:17(4):28-29.