艾灸头部穴位为主对血管性痴呆患者脑脊液中生长抑素和精氨酸血管加压素水平影响的随机对照试验

背景：血管性痴呆（vascular dementia,VaD）患者血浆和脑脊液中多种神经肽类物质发生明显变化;有效地干预神经肽水平,对VaD的预防和治疗十分重要。目的：以艾灸头部穴位为主治疗VaD,观察其改善临床症状和调控脑脊液中与学习记忆相关的神经肽物质生长抑素（somatostatin,SS）和精氨酸血管加压素（arginine vasopressin,AVP）水平的作用。设计、场所、对象和干预措施：65例VaD患者均为安徽中医学院针灸医院门诊或住院病例。按随机数字表法分为艾灸组（33例）和西药组（32例）。艾灸组患者给予隔附子饼压灸,反复灸20min;西药组口服吡拉西坦素片0.8g,3次/d。两组均治疗4个疗程,4周为1个疗程。主要结局指标：比较两组治疗前后长谷川痴呆智能检查量表（Hasegawas Dementia Scale,HDS）、简易智能精神状态检查量表（Mini-Mental State Examination,MMSE）和日常生活能力量表（Activity of Daily Living Scale,ADL）积分变化,以及脑脊液中SS和AVP水平。结果：艾灸组总有效率与西药组比较,差异有统计学意义（P〈0.01）。两组治疗前后HDS、MMSE和ADL积分比较,差异均有统计学意义（P〈0.05,P〈0.01）,艾灸组HDS、MMSE和ADL量表积分治疗前后差值较西药组有所改善（P〈0.05,P〈0.01）。两组治疗后脑脊液SS和AVP水平较治疗前明显升高（P〈0.01）,艾灸组治疗后SS和AVP升高水平较西药组明显（P〈0.01）。结论：艾灸能改善临床相关症状积分,调控与学习记忆相关的神经肽物质,是治疗VaD的有效方法。

Effects of moxibustion at head-points on levels of somatostatin and arginine vasopressin from cerebrospinal fluid in patients with vascular dementia: a randomized controlled trial

Background：There are obvious changes in neuropeptides from plasma and cerebrospinal fluid in patients with vascular dementia （VaD）,and regulating the levels of neuropeptides is a key for prevention and treatment of VaD.Objective：To observe the clinical efficacy of moxibustion at head-points in treatment of vascular dementia （VaD）,and assess its effects on memory-related neuropeptides.Design,setting,participants and interventions：A total of 65 VaD patients from Acupuncture Hospital,Anhui University of Traditional Chinese Medicine,were randomly divided into moxibustion group （33 cases） and Western medicine group （32 cases）.Patients in the moxibustion group were treated with indirect moxibustion with common monkshood cake for 20 min.Patients in the Western medicine group were orally administered piracetam tablets,0.8 g for three times a day.One treatment course was 4 weeks,and they were treated for 4 treatment courses.Main outcome measures：The scores of Hasegawa’s Dementia Scale （HDS）,Mini-Mental State Examination （MMSE）,and Activity of Daily Living Scale （ADL）,as well as the levels of learning and memory-related neuropeptides from cerebrospinal fluid such as somatostatin （SS） and arginine vasopressin （AVP） were measured before and after treatment in the two groups.Results：Total response rate was significantly higher in the moxibustion group than in the Western medicine group （P0.01）.There were significant differences in scores of HDS,MMSE and ADL between before and after treatment in the two groups（P0.05 or P0.01）.After treatment,the scores of HDS,MMSE and ADL in the moxibustion group were more improved as compared with those in the Western medicine group （P0.05 or P0.01）.The levels of SS and AVP after treatment were higher than those before treatment in the two groups（P0.01）.After treatment,the increased levels of SS and AVP were higher in the moxibustion group than in the Western medicine group （P0.01）.Conclusion：Moxibustion is effective in improving the clinical symptom scores and regulating the levels of neuropeptides associated with learning and memory in VaD patients.