本文選題：靳三針　切入點(diǎn)：經(jīng)顱磁刺激　出處：《廣州中醫(yī)藥大學(xué)》2017年博士論文

【摘要】：目的:現(xiàn)代研究表明,我國老年人群中癡呆患者比例呈逐年上升趨勢,發(fā)病率已超過5%,其中血管性癡呆是癡呆中的多發(fā)類型,約占癡呆總數(shù)的1/5左右,隨著現(xiàn)代社會(huì)老年化進(jìn)程的加快,腦血管疾病也逐漸成為了疾病中十分重要的一點(diǎn),血管性癡呆的發(fā)病率明顯增加,因此尋找有效治療血管性癡呆的方法尤其重要。中醫(yī)藥以及針灸治療血管性癡呆的研究報(bào)道逐年增多,在療效方面取得了一定的進(jìn)展。有報(bào)道表明,針灸治療可通過清除氧化的生化物質(zhì)、促進(jìn)神經(jīng)遞質(zhì)釋放等途徑改善腦部認(rèn)知功能。但本病病因在世界范圍內(nèi)也未得到明確證實(shí),試驗(yàn)中的結(jié)論只能提供可能的治療機(jī)理,并不能完全解釋針灸治療本病的確切原理。靳三針治療血管性癡呆有較多的相關(guān)報(bào)道,但較多的是臨床療效報(bào)道,相關(guān)對照研究(西藥對照)較少。經(jīng)顱磁刺激(TMS)是利用時(shí)變磁場改變皮質(zhì)神經(jīng)細(xì)胞的動(dòng)作電位,進(jìn)而影響腦代謝和神經(jīng)電活動(dòng)的生物刺激技術(shù)。國內(nèi)外已進(jìn)行相當(dāng)多的實(shí)驗(yàn)研究,經(jīng)顱磁刺激可引起神經(jīng)細(xì)胞膜形態(tài)的改變、增加神經(jīng)細(xì)胞增殖以及促進(jìn)細(xì)胞分化,增強(qiáng)突觸可塑性,改善大鼠空間記憶能力及認(rèn)知功能。在一些臨床研究也顯示,經(jīng)顱磁刺激對血管性癡呆患者療效確切,可改善其認(rèn)知功能障礙,從而改善生活質(zhì)量。但目前仍缺乏經(jīng)顱磁刺激對血管性癡呆分子生物學(xué)等機(jī)制的研究�；诖�,本研究旨在觀察針灸及經(jīng)顱磁刺激治療血管性癡呆的臨床治療效果,為治療血管性癡呆進(jìn)行有益的探索。通過動(dòng)物實(shí)驗(yàn),在現(xiàn)有的相關(guān)文獻(xiàn)的學(xué)習(xí)基礎(chǔ)上,觀察相關(guān)關(guān)鍵指標(biāo),為靳三針及經(jīng)顱磁刺激治療血管性癡呆的機(jī)理提供參考。觀察靳三針及經(jīng)顱磁刺激(Transcranial magnetic stimulation,TMS)治療血管性癡呆(vascular dementia,VD)患者的臨床療效,探討兩者治療血管性癡呆的效果,為治療血管性癡呆提供依據(jù)。方法:研究1:動(dòng)物實(shí)驗(yàn)中制備40只VD大鼠模型,隨機(jī)分組后給予假手術(shù)組、針刺組、針刺加TMS組治療,針刺用28號25mm毫針,取穴為百會(huì)、腦戶、腦空。于模型大鼠頭部"百會(huì)"穴(頂骨正中)斜刺10mm,腦戶、腦空直刺5mm,連接電針儀,施以連續(xù)波,頻率150Hz,強(qiáng)度以大鼠安靜耐受為度(約1mA),電針1次/日,留針20min,連續(xù)治療5天后,休息2天,再治療5天。對大鼠采用行為學(xué)觀測,觀察假手術(shù)組、針刺組、針刺加TMS組各組治療VD的康復(fù)療效;30天后將大鼠處死,檢測腦組織中LTP,AVP和Aβ的含量。研究2:收集確診為血管性癡呆患者60例,將患者隨機(jī)分為治療組和對照組各30例。兩組患者在一般治療及基礎(chǔ)性疾病的常規(guī)治療基礎(chǔ)上,治療組給予靳三針治療,對照組給予TMS治療。分別在治療前后對兩組患者進(jìn)行MMSE、HDS評分,比較兩組的臨床療效。結(jié)果:研究1:動(dòng)物實(shí)驗(yàn)中,治療后VD大鼠的各項(xiàng)腦部功能如學(xué)習(xí)與記憶能力均較前有明顯提高。靳三針加TMS組VD大鼠腦組織中相關(guān)遞質(zhì)含量較靳三針組及假手術(shù)組均有不同程度的提高;靳三針加TMS組的治療效果優(yōu)于單純靳三針治療組,而后者又優(yōu)于假手術(shù)組。研究2:兩組治療前后MMSE、HDS總有效率比較有顯著性差異(P0.01),但兩組之間的比較無明顯統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論:靳三針及TMS治療均能顯著改善血管性癡呆患者臨床癥狀,效果顯著,安全可靠,但尚不能認(rèn)為哪一種方法更有效。
[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.

【學(xué)位授予單位】：廣州中醫(yī)藥大學(xué)
【學(xué)位級別】：博士
【學(xué)位授予年份】：2017
【分類號】：R246.6

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