通调带脉针刺法治疗腹型肥胖伴轻度认知功能障碍的临床研究

发布时间：2018-05-24 04:46

本文选题：痴呆 + 腹型肥胖　；参考：《北京中医药大学》2017年博士论文

【摘要】：目的:腹型肥胖的流行和快速蔓延已成为全球性的公共卫生问题,近年来的研究表明,腹型肥胖不仅是多种心脑血管疾病的危险因素,对认知功能障碍、痴呆的发展也具有明显的不利影响。作为影响认知功能的重要、且可预防的危险因素,干预腹型肥胖已成为医学界早期防治认知功能障碍、痴呆的重要探索途径之一。然而药物、手术等减肥方法临床适用性并不广泛,故寻找普遍被患者接受、临床效果明显、实用性高的减肥手段对目前早期防治认知功能疾病具有重要意义。本研究通过通调带脉针刺法干预腹型肥胖伴轻度认知功能障碍患者的临床研究,探讨该法对腹型肥胖伴轻度认知功能障碍患者的有效性,并初步探索针刺有效性在腹型肥胖与认知功能障碍之间相互作用中的可能机制。方法:将符合标准的60例患者随机分为针刺组30例及对照组30例。针刺组采用通调带脉针刺法及健康宣教干预,对照组予健康宣教干预,干预时间为3个月。比较两组患者治疗前后的神经心理学量表测评,包括:简易精神状态检查表(MMSE)、蒙特利尔认知评估量表(MoCA)、逻辑记忆测验(LMT)、霍普金斯言语学习测试修订版(HVLT-R)、画钟试验(CDT);体脂参数测量指标,包括:腰围(WC)、臀围(HC)、腰臀比(WHR)、腰围身高比(WHtR)、体重、体重指数(BMI)、体脂率;腹部脂肪厚度测量指标,包括:V1、V2、S1、S2、肝前脂肪厚度、右肾周脂肪厚度、内脏脂肪指数(UVI);生化指标,包括:空腹血糖(FBG)、空腹胰岛素(FINS)、胰岛素抵抗指数(HOMA-IR)、胰岛素敏感指数(HOMA-ISI)、总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白(LDL-C)、高密度脂蛋白(HDL-C);血压:收缩压(DBP)、舒张压(SBP)。评价通调带脉针刺法对腹型肥胖伴轻度认知障碍患者认知功能、肥胖指标、糖脂代谢的影响。结果:(1)神经心理学量表评价:针刺组治疗前后MoCA量表评分提高,有显著性差异(P0.05);LMT、HVLT3、HVLT4、HVLT前三次评分之和呈上升趋势,有显著性差异(P0.01);HVLT2评分呈上升趋势,但无显著性差异(P0.05)。对照组治疗前后MoCA、HVLT3、HVLT4量表评分无显著性差异(P0.05);LMT评分下降,有显著性差异(P0.01);HVLT2、HVLT前三次评分之和评分呈下降趋势,且有显著性差异(P0.05)。针刺组及对照组治疗前后MMSE、HVLT1、HVLT保存百分比、CDT量表评分均无显著性差异(P0.05)。两组间比较MoCA、LMT、HVLT3、HVLT4、HVLT前三次评分之和具有显著性差异(P0.01),HVLT2、MMSE评分具有显著性差异(P0.05),针刺组对以上量表的改善程度优于对照组。HVLT1上两组作用无显著性差异(P0.05)。(2)体脂参数测量指标:针刺组治疗前后WC、HC、WHR、WHtR、体重、BMI、体脂率明显降低,有显著性差异(P0.01)。对照组治疗前后WC下降,有显著性差异(P0.05);HC下降,有显著性差异(P0.01);WHtR、体重、BMI、体脂率下降,但无显著性差异(P0.05);WHR上升,无显著性差异(P0.05)。两组间比较WC、WHR、WHtR、体重、BMI、体脂率具有显著性差异(P0.01),针刺组的改善程度优于对照组;HC上两组作用无显著性差异(P0.05)。(3)腹部脂肪厚度测量指标:针刺组治疗前后V1、V2、S1明显降低,有显著性差异(P0.01);S2、右肾周脂肪厚度降低,有显著性差异(P0.05)。对照组治疗前后V1、V2、S1下降,有显著性差异(P0.05);S2、右肾周脂肪厚度下降,但无显著性差异(P0.05)。针刺组及对照组UVI均有上升、肝前脂肪厚度均有下降,但均无显著性差异(P0.05)。两组间比较V1具有显著性差异(P0.01),V2有显著性差异(P0.05),针刺组的改善程度优于对照组;S1、S2、UVI、肝前脂肪厚度、右肾周脂肪厚度上两组作用无显著性差异(P0.05)。(4)生化指标:针刺组治疗前后TC、TG、LDL-C明显降低,有显著性差异(P0.01);FINS、HOMA-IR降低,有显著性差异(P0.05);HOMA-ISI有所提高,具有显著性差异(P0.05)。对照组治疗前后TC下降,有显著性差异(P0.01);HOMA-ISI、LDL-C下降,无显著性差异(P0.05);对照组FINS、HOMA-IR、TG有所上升,无显著性差异(P0.05)。针刺组FPG下降,对照组FPG有所上升;针刺组HDL-C有所上升,对照组HDL-C有所下降,但均无显著性差异(P0.05)。两组间比较TG、LDL-C具有显著性差异(P0.01),FINS、HOMA-IR、HOMA-ISI有显著性差异(P0.05)针刺组的改善程度优于对照组;FBG、TC、HDL-C上两组作用无显著性差异(P0.05)。(5)血压:针刺组及对照组SBP、DBP均有下降,且均具有显著性差异(P0.05)。两组间比较,针刺组及对照组在SBP、DBP的改善方面无显著性差异(P0.05)。(6)各指标与认知功能改变的相关分析中,MoCA评分的变化与WC、HC、WHtR、FINS的降低及胰岛素敏感性的提高具有明显相关性(P0.05);MMSE评分的变化与WC、WHR、V1、TG的下降有明显相关性(P0.05);LMT评分的变化与WC、HC、WHR、WHtR、体重、BMI、体脂率、V1、V2、S2、肝前脂肪厚度、FINS、HOMA-IR、TG的降低具有明显相关性(P0.01,P0.05)。HVLT3的变化与WC、HC、WHtR、体重、BMI、体脂率、S1的下降具有明显相关性(P0.01,P0.05)。HVLT4的变化与WC、WHR、WHtR、S1呈负相关(P0.01,P0.05)。Logistic回归分析,结果表明,MMSE的变化情况与TG相关(P=0.042),LMT的变化情况与HOMA-IR、LDL-C相关(P=0.034,P=0.049),HVLT4的变化情况与LDL-C相关(P=0.049),HVLT保存百分比的变化情况与WHR、TC、LDL-C相关(P=0.038,P=0.016,P=0.004)。结论:针刺组在对神经心理学量表得分、体脂参数、腹部脂肪厚度及生化指标的改善上,具有较好的良性调整作用,其作用在多数指标上优于对照组。说明通调带脉针刺法可通过有效干预腹型肥胖,同时对其认知功能损害起到了延缓病程发展及治疗提高的作用;而其可能机制与针刺在腹型肥胖与认知功能障碍之间相互作用的脂肪代谢、胰岛素抵抗等机制中的调节作用有关。
[Abstract]:Objective: the prevalence and rapid spread of abdominal obesity has become a global public health problem. Recent studies have shown that abdominal obesity is not only a risk factor for many cardiovascular and cerebrovascular diseases, but also has obvious adverse effects on cognitive dysfunction and development of dementia. The intervention of abdominal obesity has become one of the most important ways to prevent cognitive impairment and dementia in the medical field. However, the clinical application of drugs, surgery and other methods of losing weight is not widespread, so it is of great significance to find the widely accepted, clinically effective and high practical weight loss methods for the prevention and treatment of cognitive functional diseases. In this study, the clinical study of abdominal obesity with mild cognitive impairment was studied by means of acupuncture and pulse acupuncture, and the effectiveness of this method on patients with abdominal obesity with mild cognitive impairment was explored, and the possible mechanism of the interaction between abdominal obesity and cognitive dysfunction was preliminarily explored. 60 patients were randomly divided into acupuncture group (30 cases) and control group (30 cases). The acupuncture group was treated with tone pulse acupuncture and health education intervention, and the control group was given health education intervention for 3 months. The neuropsychological scale of the two groups was compared before and after treatment, including the simple mental state Checklist (MMSE), and the Montreal cognitive assessment. The scale (MoCA), the logical memory test (LMT), the Hopki language learning test revision (HVLT-R), the clock test (CDT), the body fat parameter measurement index, including the waist circumference (WC), the hip circumference (HC), the waist to hip ratio (WHR), the waist height ratio (WHtR), body weight, body mass index (BMI), body fat rate, and the abdominal fat thickness measurement index, including V1, V2, S1, prehepatic fat thickness, Peripheral fat thickness of right kidney, visceral fat index (UVI), biochemical indexes, including fasting blood glucose (FBG), fasting insulin (FINS), insulin resistance index (HOMA-IR), insulin sensitivity index (HOMA-ISI), total cholesterol (TC), triglyceride (TG), low density lipoprotein (LDL-C), high density lipoprotein (HDL-C); systolic blood pressure (DBP), diastolic pressure (SBP). The effect of acupuncture on cognitive function, obesity index and glycolipid metabolism in patients with abdominal obesity with mild cognitive impairment. Results: (1) the neuropsychological scale evaluation: the MoCA scale in the acupuncture group was improved before and after the treatment (P0.05); the three scores of LMT, HVLT3, HVLT4, and HVLT were on the rise, and there were significant differences (P0.0 1); the HVLT2 score showed a rising trend, but there was no significant difference (P0.05). There was no significant difference in the score of MoCA, HVLT3 and HVLT4 before and after treatment in the control group (P0.05); the LMT score decreased, and there was a significant difference (P0.01); HVLT2, the score and score of the first three times of HVLT were decreasing, and there was a significant difference (P0.05). The MMSE in the acupuncture group and the control group before and after treatment, The percentage of T1, HVLT preservation and CDT scale had no significant difference (P0.05). The two groups compared with MoCA, LMT, HVLT3, HVLT4, and HVLT had significant difference (P0.01), HVLT2, and MMSE scores had significant differences. The improvement of the above scale in the acupuncture group was better than that of the two groups. 05) (2) measurement index of body fat parameters: WC, HC, WHR, WHtR, weight, BMI, body fat decreased significantly in the acupuncture group before and after treatment. There was a significant difference (P0.01) in the control group. There was a significant difference (P0.05) before and after treatment in the control group; HC decreased (P0.01); WHtR, weight, BMI, body fat rate decreased, but no significant difference (P0.05); there was no significant difference Sex difference (P0.05). The two groups were compared with WC, WHR, WHtR, body weight, BMI and body fat (P0.01), the improvement of the acupuncture group was better than the control group; there was no significant difference between the two groups on HC (P0.05). (3) the measurement index of abdominal fat thickness: V1, V2, S1 before and after treatment in the acupuncture group, with significant difference (P0.01); right renal pericenal fat thickness There was significant difference (P0.05). There was a significant difference in V1, V2, S1 (P0.05) before and after treatment in the control group (P0.05); S2, the thickness of right perirenal fat decreased, but there was no significant difference (P0.05). The UVI in the acupuncture group and the control group had increased, but there was a decrease in the thickness of the prehepatic fat, but there was no significant difference (P0.05). There was a significant difference between the two groups (P0). (P0) (P0) (P0) .01), V2 had significant difference (P0.05), the improvement of acupuncture group was better than that of the control group; S1, S2, UVI, the thickness of the prehepatic fat and the right renal peri fat thickness had no significant difference between the two groups (P0.05). (4) the biochemical indexes: TC, TG and LDL-C decreased significantly in the acupuncture group before and after the treatment, and there was a significant difference (P0.01); FINS, there was significant difference. A-ISI had a significant difference (P0.05). The decrease of TC in the control group was significantly different (P0.01), HOMA-ISI, LDL-C decreased, no significant difference (P0.05), FINS, HOMA-IR, TG in the control group were up, and there was no significant difference (P0.05). The needle group FPG decreased and the control group rose; the acupuncture group rose and the control group rose. There was no significant difference (P0.05). The two groups were compared with TG, LDL-C had significant difference (P0.01), FINS, HOMA-IR, HOMA-ISI had significant difference (P0.05), the improvement of the acupuncture group was better than the control group; FBG, TC, HDL-C on the two groups had no significant difference (P0.05). (5) blood pressure: both the acupuncture group and the control group were all decreased and both had There was no significant difference (P0.05) between the two groups. There was no significant difference in the improvement of SBP and DBP between the acupuncture group and the control group (P0.05). (6) in the correlation analysis between the indexes and the changes of cognitive function, the change of the MoCA score was significantly correlated with the decrease of WC, HC, WHtR, FINS and the increase of insulin sensitivity (P0.05); MMSE score changes with WC The decrease of TG has a significant correlation (P0.05), and the changes in LMT score and WC, HC, WHR, WHtR, weight, BMI, body fat rate, V1, V2, S2, prehepatic fat thickness, FINS, body fat rate, and decrease have obvious correlation. R, WHtR, and S1 are negatively correlated (P0.01, P0.05).Logistic regression analysis. The results show that the change of MMSE is related to TG (P=0.042), and the change of LMT is related to HOMA-IR, LDL-C. The acupuncture group has a good positive adjustment effect on the score of neuropsychological scale, body fat parameter, abdominal fat thickness and biochemical index, and its effect is better than the control group in most of the indexes. It shows that the acupuncture method can effectively intervene the abdominal obesity and delay the development of the cognitive function at the same time. And the effect of treatment, and its possible mechanism is related to the regulatory role of acupuncture in the mechanism of lipid metabolism, insulin resistance, and other interactions between abdominal obesity and cognitive dysfunction.
【学位授予单位】：北京中医药大学
【学位级别】：博士
【学位授予年份】：2017
【分类号】：R246.1

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