本文選題：癡呆 + 腹型肥胖��； 參考：《北京中醫(yī)藥大學》2017年博士論文

【摘要】：目的:腹型肥胖的流行和快速蔓延已成為全球性的公共衛(wèi)生問題,近年來的研究表明,腹型肥胖不僅是多種心腦血管疾病的危險因素,對認知功能障礙、癡呆的發(fā)展也具有明顯的不利影響。作為影響認知功能的重要、且可預防的危險因素,干預腹型肥胖已成為醫(yī)學界早期防治認知功能障礙、癡呆的重要探索途徑之一。然而藥物、手術等減肥方法臨床適用性并不廣泛,故尋找普遍被患者接受、臨床效果明顯、實用性高的減肥手段對目前早期防治認知功能疾病具有重要意義。本研究通過通調(diào)帶脈針刺法干預腹型肥胖伴輕度認知功能障礙患者的臨床研究,探討該法對腹型肥胖伴輕度認知功能障礙患者的有效性,并初步探索針刺有效性在腹型肥胖與認知功能障礙之間相互作用中的可能機制。方法:將符合標準的60例患者隨機分為針刺組30例及對照組30例。針刺組采用通調(diào)帶脈針刺法及健康宣教干預,對照組予健康宣教干預,干預時間為3個月。比較兩組患者治療前后的神經(jīng)心理學量表測評,包括:簡易精神狀態(tài)檢查表(MMSE)、蒙特利爾認知評估量表(MoCA)、邏輯記憶測驗(LMT)、霍普金斯言語學習測試修訂版(HVLT-R)、畫鐘試驗(CDT);體脂參數(shù)測量指標,包括:腰圍(WC)、臀圍(HC)、腰臀比(WHR)、腰圍身高比(WHtR)、體重、體重指數(shù)(BMI)、體脂率;腹部脂肪厚度測量指標,包括:V1、V2、S1、S2、肝前脂肪厚度、右腎周脂肪厚度、內(nèi)臟脂肪指數(shù)(UVI);生化指標,包括:空腹血糖(FBG)、空腹胰島素(FINS)、胰島素抵抗指數(shù)(HOMA-IR)、胰島素敏感指數(shù)(HOMA-ISI)、總膽固醇(TC)、甘油三酯(TG)、低密度脂蛋白(LDL-C)、高密度脂蛋白(HDL-C);血壓:收縮壓(DBP)、舒張壓(SBP)。評價通調(diào)帶脈針刺法對腹型肥胖伴輕度認知障礙患者認知功能、肥胖指標、糖脂代謝的影響。結(jié)果:(1)神經(jīng)心理學量表評價:針刺組治療前后MoCA量表評分提高,有顯著性差異(P0.05);LMT、HVLT3、HVLT4、HVLT前三次評分之和呈上升趨勢,有顯著性差異(P0.01);HVLT2評分呈上升趨勢,但無顯著性差異(P0.05)。對照組治療前后MoCA、HVLT3、HVLT4量表評分無顯著性差異(P0.05);LMT評分下降,有顯著性差異(P0.01);HVLT2、HVLT前三次評分之和評分呈下降趨勢,且有顯著性差異(P0.05)。針刺組及對照組治療前后MMSE、HVLT1、HVLT保存百分比、CDT量表評分均無顯著性差異(P0.05)。兩組間比較MoCA、LMT、HVLT3、HVLT4、HVLT前三次評分之和具有顯著性差異(P0.01),HVLT2、MMSE評分具有顯著性差異(P0.05),針刺組對以上量表的改善程度優(yōu)于對照組。HVLT1上兩組作用無顯著性差異(P0.05)。(2)體脂參數(shù)測量指標:針刺組治療前后WC、HC、WHR、WHtR、體重、BMI、體脂率明顯降低,有顯著性差異(P0.01)。對照組治療前后WC下降,有顯著性差異(P0.05);HC下降,有顯著性差異(P0.01);WHtR、體重、BMI、體脂率下降,但無顯著性差異(P0.05);WHR上升,無顯著性差異(P0.05)。兩組間比較WC、WHR、WHtR、體重、BMI、體脂率具有顯著性差異(P0.01),針刺組的改善程度優(yōu)于對照組;HC上兩組作用無顯著性差異(P0.05)。(3)腹部脂肪厚度測量指標:針刺組治療前后V1、V2、S1明顯降低,有顯著性差異(P0.01);S2、右腎周脂肪厚度降低,有顯著性差異(P0.05)。對照組治療前后V1、V2、S1下降,有顯著性差異(P0.05);S2、右腎周脂肪厚度下降,但無顯著性差異(P0.05)。針刺組及對照組UVI均有上升、肝前脂肪厚度均有下降,但均無顯著性差異(P0.05)。兩組間比較V1具有顯著性差異(P0.01),V2有顯著性差異(P0.05),針刺組的改善程度優(yōu)于對照組;S1、S2、UVI、肝前脂肪厚度、右腎周脂肪厚度上兩組作用無顯著性差異(P0.05)。(4)生化指標:針刺組治療前后TC、TG、LDL-C明顯降低,有顯著性差異(P0.01);FINS、HOMA-IR降低,有顯著性差異(P0.05);HOMA-ISI有所提高,具有顯著性差異(P0.05)。對照組治療前后TC下降,有顯著性差異(P0.01);HOMA-ISI、LDL-C下降,無顯著性差異(P0.05);對照組FINS、HOMA-IR、TG有所上升,無顯著性差異(P0.05)。針刺組FPG下降,對照組FPG有所上升;針刺組HDL-C有所上升,對照組HDL-C有所下降,但均無顯著性差異(P0.05)。兩組間比較TG、LDL-C具有顯著性差異(P0.01),FINS、HOMA-IR、HOMA-ISI有顯著性差異(P0.05)針刺組的改善程度優(yōu)于對照組;FBG、TC、HDL-C上兩組作用無顯著性差異(P0.05)。(5)血壓:針刺組及對照組SBP、DBP均有下降,且均具有顯著性差異(P0.05)。兩組間比較,針刺組及對照組在SBP、DBP的改善方面無顯著性差異(P0.05)。(6)各指標與認知功能改變的相關分析中,MoCA評分的變化與WC、HC、WHtR、FINS的降低及胰島素敏感性的提高具有明顯相關性(P0.05);MMSE評分的變化與WC、WHR、V1、TG的下降有明顯相關性(P0.05);LMT評分的變化與WC、HC、WHR、WHtR、體重、BMI、體脂率、V1、V2、S2、肝前脂肪厚度、FINS、HOMA-IR、TG的降低具有明顯相關性(P0.01,P0.05)。HVLT3的變化與WC、HC、WHtR、體重、BMI、體脂率、S1的下降具有明顯相關性(P0.01,P0.05)。HVLT4的變化與WC、WHR、WHtR、S1呈負相關(P0.01,P0.05)。Logistic回歸分析,結(jié)果表明,MMSE的變化情況與TG相關(P=0.042),LMT的變化情況與HOMA-IR、LDL-C相關(P=0.034,P=0.049),HVLT4的變化情況與LDL-C相關(P=0.049),HVLT保存百分比的變化情況與WHR、TC、LDL-C相關(P=0.038,P=0.016,P=0.004)。結(jié)論:針刺組在對神經(jīng)心理學量表得分、體脂參數(shù)、腹部脂肪厚度及生化指標的改善上,具有較好的良性調(diào)整作用,其作用在多數(shù)指標上優(yōu)于對照組。說明通調(diào)帶脈針刺法可通過有效干預腹型肥胖,同時對其認知功能損害起到了延緩病程發(fā)展及治療提高的作用;而其可能機制與針刺在腹型肥胖與認知功能障礙之間相互作用的脂肪代謝、胰島素抵抗等機制中的調(diào)節(jié)作用有關。
[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.
【學位授予單位】：北京中醫(yī)藥大學
【學位級別】：博士
【學位授予年份】：2017
【分類號】：R246.1

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