“智三针”配合经颅磁刺激治疗血管性痴呆的临床与实验研究

发布时间：2018-04-03 12:55

本文选题：靳三针　切入点：经颅磁刺激　出处：《广州中医药大学》2017年博士论文

【摘要】：目的:现代研究表明,我国老年人群中痴呆患者比例呈逐年上升趋势,发病率已超过5%,其中血管性痴呆是痴呆中的多发类型,约占痴呆总数的1/5左右,随着现代社会老年化进程的加快,脑血管疾病也逐渐成为了疾病中十分重要的一点,血管性痴呆的发病率明显增加,因此寻找有效治疗血管性痴呆的方法尤其重要。中医药以及针灸治疗血管性痴呆的研究报道逐年增多,在疗效方面取得了一定的进展。有报道表明,针灸治疗可通过清除氧化的生化物质、促进神经递质释放等途径改善脑部认知功能。但本病病因在世界范围内也未得到明确证实,试验中的结论只能提供可能的治疗机理,并不能完全解释针灸治疗本病的确切原理。靳三针治疗血管性痴呆有较多的相关报道,但较多的是临床疗效报道,相关对照研究(西药对照)较少。经颅磁刺激(TMS)是利用时变磁场改变皮质神经细胞的动作电位,进而影响脑代谢和神经电活动的生物刺激技术。国内外已进行相当多的实验研究,经颅磁刺激可引起神经细胞膜形态的改变、增加神经细胞增殖以及促进细胞分化,增强突触可塑性,改善大鼠空间记忆能力及认知功能。在一些临床研究也显示,经颅磁刺激对血管性痴呆患者疗效确切,可改善其认知功能障碍,从而改善生活质量。但目前仍缺乏经颅磁刺激对血管性痴呆分子生物学等机制的研究。基于此,本研究旨在观察针灸及经颅磁刺激治疗血管性痴呆的临床治疗效果,为治疗血管性痴呆进行有益的探索。通过动物实验,在现有的相关文献的学习基础上,观察相关关键指标,为靳三针及经颅磁刺激治疗血管性痴呆的机理提供参考。观察靳三针及经颅磁刺激(Transcranial magnetic stimulation,TMS)治疗血管性痴呆(vascular dementia,VD)患者的临床疗效,探讨两者治疗血管性痴呆的效果,为治疗血管性痴呆提供依据。方法:研究1:动物实验中制备40只VD大鼠模型,随机分组后给予假手术组、针刺组、针刺加TMS组治疗,针刺用28号25mm毫针,取穴为百会、脑户、脑空。于模型大鼠头部"百会"穴(顶骨正中)斜刺10mm,脑户、脑空直刺5mm,连接电针仪,施以连续波,频率150Hz,强度以大鼠安静耐受为度(约1mA),电针1次/日,留针20min,连续治疗5天后,休息2天,再治疗5天。对大鼠采用行为学观测,观察假手术组、针刺组、针刺加TMS组各组治疗VD的康复疗效;30天后将大鼠处死,检测脑组织中LTP,AVP和Aβ的含量。研究2:收集确诊为血管性痴呆患者60例,将患者随机分为治疗组和对照组各30例。两组患者在一般治疗及基础性疾病的常规治疗基础上,治疗组给予靳三针治疗,对照组给予TMS治疗。分别在治疗前后对两组患者进行MMSE、HDS评分,比较两组的临床疗效。结果:研究1:动物实验中,治疗后VD大鼠的各项脑部功能如学习与记忆能力均较前有明显提高。靳三针加TMS组VD大鼠脑组织中相关递质含量较靳三针组及假手术组均有不同程度的提高;靳三针加TMS组的治疗效果优于单纯靳三针治疗组,而后者又优于假手术组。研究2:两组治疗前后MMSE、HDS总有效率比较有显著性差异(P0.01),但两组之间的比较无明显统计学意义(P0.05)。结论:靳三针及TMS治疗均能显著改善血管性痴呆患者临床症状,效果显著,安全可靠,但尚不能认为哪一种方法更有效。
[Abstract]:Objective: modern research shows that the proportion of patients with dementia in elderly population in China increased year by year, the incidence rate has exceeded 5%, including vascular dementia, dementia in multiple types of dementia, accounting for about 1/5 of the total, with the development of modern society the aging process accelerated, cerebrovascular disease has become a very an important disease, vascular dementia incidence increased significantly, so to find an effective method for the treatment of vascular dementia is particularly important. Traditional Chinese medicine and acupuncture in the treatment of vascular dementia research reports increased year by year, has made some progress in terms of efficacy. It is reported that the acupuncture treatment by biochemical substances removal, promotion neurotransmitter release and other ways to improve the cognitive function of the brain. But the cause of this disease in the world has not been clearly confirmed in the test conclusion can only provide treatment possible, and not Fully explain the exact principle of acupuncture treatment of this disease. Reports of Jin's 3-needle treatment of vascular dementia have more, but is more clinical reports, the relevant control study (control) less. Transcranial magnetic stimulation (TMS) is the use of a time-varying magnetic field action potential changes in cortical nerve cells, thereby affecting the cerebral metabolism and nerve the electrical activity of biological stimulation. Experiments have been carried out considerable research at home and abroad, transcranial magnetic stimulation can cause nerve cell morphology changes of membrane, increase nerve cell proliferation and promote cell differentiation, synaptic plasticity of rats improved the spatial memory and cognitive function. Also shown in some clinical studies, transcranial magnetic stimulate the exact therapeutic effect on patients with vascular dementia, which can improve the cognitive dysfunction, so as to improve the quality of life. But there is still a lack of transcranial magnetic stimulation on vascular dementia by molecular biological mechanism Study. Based on this, the purpose of this study was to observe the acupuncture and transcranial magnetic stimulation treatment of vascular dementia, made a useful exploration for the treatment of vascular dementia. Through animal experiment, study based on the existing literature on the observation of key indicators for Jin three needles and transcranial magnetic stimulation treatment mechanism vascular dementia reference. Observation of Jin's 3-needle and transcranial magnetic stimulation (Transcranial magnetic, stimulation, TMS) for the treatment of vascular dementia (vascular dementia, VD) in patients with clinical efficacy, to explore both the treatment of vascular dementia, and provide the basis for the treatment of vascular dementia. Methods: 40 VD rat model research 1: in animal experiments, after randomization to sham operation group, acupuncture group, acupuncture plus TMS treatment group, acupuncture with 28 25mm needle, acupuncture Baihui, brain, brain empty. In rat model of head acupoints "Baihui" (right parietal bone In group 10mm, brain), empty brain into 5mm, connected to electro acupuncture device, continuous wave, frequency of 150Hz, strength to quiet tolerance for rats (about 1mA), EA 1 times / day, for 20min, 5 days after treatment, rest for 2 days, and 5 days of treatment. The rats with behavioral observation, acupuncture group, sham operation group, observation group, acupuncture plus TMS treatment VD rehabilitation effect; 30 days later, the rats were sacrificed. The detection of LTP in brain tissue, the content of AVP and A beta. Research on collection of 2: diagnosed 60 cases of vascular dementia patients, the patients were randomly divided into treatment group and control 30 cases in each group. The two groups of patients in the conventional treatment based therapy and basic diseases, the treatment group was given acupuncture treatment, the control group was treated with TMS. Compared with MMSE, two groups of patients before and after treatment HDS score, clinical efficacy of the two groups were compared. Results: the study of 1: in animal experiments, the brain function of VD rats after treatment Such as learning and memory ability were significantly improved. Jin's 3-needle plus related neurotransmitters in the brain tissue of rats in TMS group than in VD acupuncture group and sham operation group were improved; therapeutic effect of Jin's 3-needle plus TMS group is better than that of simple acupuncture treatment group, and the latter is better than that of sham group. The study group before and after 2: two the treatment of MMSE, the total effective rate of HDS had significant difference (P0.01), but between the two groups was not statistically significant (P0.05). Conclusion: Acupuncture and TMS therapy can significantly improve clinical symptoms in patients with vascular dementia, the effect is significant, safe and reliable, but it is not that which is a more effective way.

【学位授予单位】：广州中医药大学
【学位级别】：博士
【学位授予年份】：2017
【分类号】：R246.6

【参考文献】