| 引用本文: |
谢慧敏, 罗小元, 唐健, 倪伟, 李硕, 许明.脑肠同调针刺法联合重复经颅磁刺激治疗轻中度血管性痴呆的随机对照研究[J].湖南中医药大学学报,2025,45(12):2352-2357[点击复制] |
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| 脑肠同调针刺法联合重复经颅磁刺激治疗轻中度血管性痴呆的随机对照研究 |
| 谢慧敏,罗小元,唐健,倪伟,李硕,许明 |
| (湖南中医药大学, 湖南 长沙 410208;湖南中医药大学第一附属医院, 湖南 长沙 410007;中南大学湘雅医院, 湖南 长沙 410008;湖南中医药大学湘杏学院, 湖南 岳阳 414615) |
| 摘要: |
| 目的 观察脑肠同调针刺法联合重复经颅磁刺激（rTMS）治疗轻中度血管性痴呆（VD）的临床疗效。方法 选取2023年3月至2025年3月在湖南中医药大学第一附属医院就诊的VD患者60例，随机分为对照组和观察组，每组各30例。两组均予以常规用药和康复训练；对照组采用rTMS联合针刺治疗，主穴取百会、四神聪、神庭，辅以内关（双侧）、三阴交（双侧）；观察组在对照组基础上加用中脘、关元、天枢（双侧）、足三里（双侧）、上巨虚（双侧）及下巨虚（双侧）。两组治疗均每日1次，每周5次，周末休息，连续治疗6周。采用简易精神状态检查（MMSE）量表和蒙特利尔认知评估(MoCA)量表评估两组患者治疗前后的认知功能状态；采用肌电诱发电位仪评估两组患者治疗前后事件相关电位P300潜伏期和波幅；ELISA检测两组患者治疗前后外周血中核苷酸结合寡聚结构域样受体蛋白3（NLRP3）炎症小体、白介素（IL）-18和IL-1β含量；比较两组患者治疗后临床疗效。结果 与治疗前相比，两组患者治疗后MoCA、MMSE量表评分均升高（P＜0.05），且观察组高于对照组（P＜0.05）；P300潜伏期缩短（P＜0.05），波幅延长（P＜0.05），且观察组P300潜伏期短于对照组（P＜0.05），波幅长于对照组（P＜0.05）；外周血中NLRP3炎症小体、IL-1β和IL-18含量均降低（P＜0.05），且观察组低于对照组（P＜0.05）；治疗后，观察组总有效率（85.7%）高于对照组（74.1%）（P＜0.05）。结论 脑肠同调针刺法联合rTMS治疗可有效改善VD患者事件相关电位P300，提高认知功能；其可能机制与抑制NLRP3炎症小体、IL-1β及IL-18含量有关。 |
| 关键词: 血管性痴呆 脑肠同调针刺 重复经颅磁刺激 核苷酸结合寡聚结构域样受体蛋白3炎症小体 事件相关电位P300 |
| DOI：10.3969/j.issn.1674-070X.2025.12.015 |
| 投稿时间：2025-08-30 |
| 基金项目:湖南省中医药科研计划项目（D2022051）。 |
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| A randomized controlled trial of acupuncture therapy for brain gut co-regulation combined with repeated transcranial magnetic stimulation in treating mild to moderate vascular dementia |
| XIE Huimin, LUO Xiaoyuan, TANG Jian, NI Wei, LI Shuo, XU Ming |
| (Hunan University of Chinese Medicine, Changsha, Hunan 410208, China;The First Hospital of Hunan University of Chinese Medicine, Changsha, Hunan 410007, China;Xiangya Hospital of Central South University, Changsha, Hunan 410008, China;Xiangxing College, Hunan University of Chinese Medicine, Yueyang, Hunan 414615, China) |
| Abstract: |
| Objective To observe the clinical efficacy of acupuncture therapy for brain gut co-regulation combined with repeated transcranial magnetic stimulation (rTMS) in treating mild to moderate vascular dementia (VD). Methods Sixty VD patients treated at the First Hospital of Hunan University of Chinese Medicine from March 2023 to March 2025 were selected and randomly divided into control group and observation group, with 30 patients in each group. Both groups were given conventional medication and rehabilitation training. The control group was treated with rTMS combined with acupuncture at main points Baihui (GV20), Sishencong (EX-HN1), and Shenting (GV24), supplemented by Neiguan (PC6, bilateral) and Sanyinjiao (SP6, bilateral). The observation group received additional acupuncture at Zhongwan (CV12), Guanyuan (CV4), Tianshu (ST25, bilateral), Zusanli (ST36, bilateral), Shangjuxu (ST37, bilateral), and Xiajuxu (ST39, bilateral) based on the control group's protocol. Both groups received treatment once daily, five times per week (with rest on weekends), for six consecutive weeks. The cognitive function of the two groups of patients before and after treatment was assessed using the Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) scale. The event-related potential P300 latency and amplitude of the two groups of patients before and after treatment were evaluated using an electromyography-evoked potential instrument. Peripheral blood levels of nucleotide-binding oligomerization domain-like receptor domain-containing 3 (NLRP3) inflammasome, interleukin (IL)-18, and IL-1β in the two groups of patients before and after treatment were measured by ELISA. The clinical efficacy was compared between the two groups after treatment. Results Compared with before treatment, both groups showed increased MoCA and MMSE scale scores after treatment (P<0.05), with the observation group scoring higher than the control group (P<0.05). P300 latency shortened (P<0.05), and amplitude prolonged (P<0.05). Furthermore, P300 latency in the observation group was shorter than that in the control group (P<0.05), while amplitude was longer than that in the control group (P<0.05). The peripheral blood levels of NLRP3 inflammasome, IL-1β, and IL-18 decreased in both groups after treatment (P<0.05), and the levels in the observation group were lower than those in the control group (P<0.05). After treatment, the total effective rate in the observation group (85.7%) was higher than that in the control group (74.1%) (P<0.05). Conclusion Acupuncture therapy for brain gut co-regulation combined with rTMS treatment can effectively improve the event-related potential P300 and enhance cognitive function in VD patients. The possible mechanism may be related to the inhibition of NLRP3 inflammasome and the reduction in IL-1β and IL-18 levels. |
| Key words: vascular dementia acupuncture therapy for brain gut co-regulation repeated transcranial magnetic stimulation nucleotide-binding oligomerization domain-like receptor protein 3 inflammasome event-related potential P300 |
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