靳三针及经颅磁刺激治疗血管性痴呆疗效观察
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摘要
【目的】观察靳三针及经颅磁刺激(TMS)治疗血管性痴呆的疗效差异。【方法】将60例血管性痴呆患者随机分为观察组(靳三针组)和对照组(TMS组),每组各30例,分别给予靳三针(取穴四神针、智三针和脑三针)及TMS治疗,治疗前后采用简易智力状态检查量表(MMSE)及长谷川痴呆量表(HDS)进行评分,并评估2组疗效。【结果】(1)治疗4周后,观察组的MMSE疗效和HDS疗效的总有效率分别为86.67%和73.33%,对照组分别为76.67%和66.67%,2组的MMSE疗效和HDS疗效比较,差异均无统计学意义(P>0.05)。(2)治疗后,2组MMSE和HDS评分均较治疗前改善(P<0.01),但治疗后组间比较,差异均无统计学意义(P>0.05)。(3)经多元回归模型分析,HDS的效应值观察组女性为负值,对照组男性为负值(P<0.05),且在调整年龄的混杂因素后,效果依旧有显著性差异(P<0.05)。【结论】靳三针及TMS治疗均能改善血管性痴呆患者的临床症状,男性采用靳三针疗效可能会更优于女性,女性则更倾向于TMS治疗。
Objective To observe the curative effect of Jin's three-needle therapy and transcranial magneticstimulation(TMS)in treating patients with vascular dementia(VD). Methods Sixty VD patients were randomizedinto treatment group and control group,30 cases in each group. The treatment group was given Jin's three-needletherapy(acupuncture on Sishenzhen,Zhisanzhen and Naosanzhen),and the control group was treated with TMS.The scores of Mini-Mental State Examination(MMSE)and Hastgawa Dementia Scale(HDS)scores were comparedbetween the two groups before and after treatment,and the clinical efficacy of the two groups was also evaluated.Results(1)After treatment for 4 weeks,the total effective rate for improving MMSE scores and HDS scores in thetreatment group was 86.67%, 73.33% respectively, and that in the control group was 76.67, 66.67%respectively, the difference being insignificant between the two groups(P>0.05).(2)After treatment, thescores of MMSE and HDS were improved as compared with those before treatment(P < 0.01),but the differencesof MMSE and HDS scores between the two groups after treatment were insignificant(P>0.05).(3)The results ofmultivariable regression analysis showed that the HDS effect value was negative in the female patients of thetreatment group,and the HDS effect value was negative in the male patients of the control group(P < 0.05). Afteradjusting the confounding factor of age,the difference of the effect was still significant(P < 0.05). Conclusion Both Jin's three-needle therapy and TMS can significantly relieve the clinical symptoms of VD patients. The effect of Jin's three-needle therapy for the male patients is superior to that of the therapy for the female,and the femalepatients can achieve better efficacy by using TMS.
Objective To observe the curative effect of Jin's three-needle therapy and transcranial magneticstimulation(TMS)in treating patients with vascular dementia(VD). Methods Sixty VD patients were randomizedinto treatment group and control group,30 cases in each group. The treatment group was given Jin's three-needletherapy(acupuncture on Sishenzhen,Zhisanzhen and Naosanzhen),and the control group was treated with TMS.The scores of Mini-Mental State Examination(MMSE)and Hastgawa Dementia Scale(HDS)scores were comparedbetween the two groups before and after treatment,and the clinical efficacy of the two groups was also evaluated.Results(1)After treatment for 4 weeks,the total effective rate for improving MMSE scores and HDS scores in thetreatment group was 86.67%, 73.33% respectively, and that in the control group was 76.67, 66.67%respectively, the difference being insignificant between the two groups(P>0.05).(2)After treatment, thescores of MMSE and HDS were improved as compared with those before treatment(P < 0.01),but the differencesof MMSE and HDS scores between the two groups after treatment were insignificant(P>0.05).(3)The results ofmultivariable regression analysis showed that the HDS effect value was negative in the female patients of thetreatment group,and the HDS effect value was negative in the male patients of the control group(P < 0.05). Afteradjusting the confounding factor of age,the difference of the effect was still significant(P < 0.05). Conclusion Both Jin's three-needle therapy and TMS can significantly relieve the clinical symptoms of VD patients. The effect of Jin's three-needle therapy for the male patients is superior to that of the therapy for the female,and the femalepatients can achieve better efficacy by using TMS.
引文
[1]陈惠金.缺氧缺血性脑病的发病机制研究进展及潜在的治疗对策[J].临床儿科杂志,2000,15(2):3.
[2]中华医学会神经病学分会.血管性痴呆诊断标准(草案)[J].中华神经科杂志,2002,35(4):246.
[3]国家卫生部.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.
[4]李巧薇,李丽娟,许倩瑜,等.电针智三针对血管性痴呆患者认知功能和行为能力的影响[J].中国实用神经疾病杂志,2015,18(8):1.
[5]朱崇瑞.“益气调血、扶本培元”针法结合黄地散治疗血管性痴呆的临床观察[D].南京:南京中医药大学,2011.
[6]伦新,荣莉,杨文辉.头颅CT定位围针治疗多发梗塞性痴呆的临床研究[C]//中华中医药学会学术年会创新优秀论文汇篇.2002.
[7]丁新华,韩肖华,温新义,等.电针不同穴位结合高压氧治疗脑损害认知障碍[J].中国康复,2007,22(1):29.
[8]Delvendah I,Jung N H,Kuhnke N G,et al.Plasticity of motor threshold and motor-evoked potential amplitude--a model of intrinsic and synaptic plasticity in human motor cortex[J].Brain Stimulation,2012,5(4):586.
[9]Guerra A,Assenza F,Bressi F,et al.Transcranial magnetic stimulation studies in Alzheimer’s disease[J].Int J Alzheimers Dis,2011,2011:263817.
[10]吴瑞鹏,张华.经颅磁刺激疗法联合尼莫地平对脑梗死后血管性痴呆的疗效观察[J].宁夏医学杂志,2012,34(3):220.
[11]汪艳,张兆蓬,王学员.电针配合重复经颅磁刺激治疗血管性痴呆49例[J].陕西中医,2012,33(1):82.
[12]陆强彬,朱祖福,张慧萍.重复经颅磁刺激治疗轻中度血管性痴呆的对照研究[J].实用医学杂志,2013,29(17):2846.
[13]Ziemann U,Reis J,Schwenkreis P,et al.TMS and drugs revisited 2014[J].Clin Neurophysiol,2015,126(10):1847.
[14]Pennisi M,Lanza G,Cantone M,et al.Correlation between motor cortex excitability changes and cognitive impairment in vascular depression:pathophysiological insights from a longitudinal TMS study[J].Neural Plasticity,2016(2):1.
[15]Elder G J,Taylor J P.Transcranial magnetic stimulation and transcranial direct current stimulation:treatments for cognitive and neuropsychiatric symptoms in the neurodegenerative dementias[J].Alzheimer’s Res Ther,2014,74(6):2.
[2]中华医学会神经病学分会.血管性痴呆诊断标准(草案)[J].中华神经科杂志,2002,35(4):246.
[3]国家卫生部.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.
[4]李巧薇,李丽娟,许倩瑜,等.电针智三针对血管性痴呆患者认知功能和行为能力的影响[J].中国实用神经疾病杂志,2015,18(8):1.
[5]朱崇瑞.“益气调血、扶本培元”针法结合黄地散治疗血管性痴呆的临床观察[D].南京:南京中医药大学,2011.
[6]伦新,荣莉,杨文辉.头颅CT定位围针治疗多发梗塞性痴呆的临床研究[C]//中华中医药学会学术年会创新优秀论文汇篇.2002.
[7]丁新华,韩肖华,温新义,等.电针不同穴位结合高压氧治疗脑损害认知障碍[J].中国康复,2007,22(1):29.
[8]Delvendah I,Jung N H,Kuhnke N G,et al.Plasticity of motor threshold and motor-evoked potential amplitude--a model of intrinsic and synaptic plasticity in human motor cortex[J].Brain Stimulation,2012,5(4):586.
[9]Guerra A,Assenza F,Bressi F,et al.Transcranial magnetic stimulation studies in Alzheimer’s disease[J].Int J Alzheimers Dis,2011,2011:263817.
[10]吴瑞鹏,张华.经颅磁刺激疗法联合尼莫地平对脑梗死后血管性痴呆的疗效观察[J].宁夏医学杂志,2012,34(3):220.
[11]汪艳,张兆蓬,王学员.电针配合重复经颅磁刺激治疗血管性痴呆49例[J].陕西中医,2012,33(1):82.
[12]陆强彬,朱祖福,张慧萍.重复经颅磁刺激治疗轻中度血管性痴呆的对照研究[J].实用医学杂志,2013,29(17):2846.
[13]Ziemann U,Reis J,Schwenkreis P,et al.TMS and drugs revisited 2014[J].Clin Neurophysiol,2015,126(10):1847.
[14]Pennisi M,Lanza G,Cantone M,et al.Correlation between motor cortex excitability changes and cognitive impairment in vascular depression:pathophysiological insights from a longitudinal TMS study[J].Neural Plasticity,2016(2):1.
[15]Elder G J,Taylor J P.Transcranial magnetic stimulation and transcranial direct current stimulation:treatments for cognitive and neuropsychiatric symptoms in the neurodegenerative dementias[J].Alzheimer’s Res Ther,2014,74(6):2.