Objective: To observe the clinical efficacy of acupuncture of revised acupoint combination around the skull base in treating post-stroke mild cognitive impairment (PSMCI), and preliminary explore its action mechanism.
Methods: A total of 76 PSMCI patients were randomly divided into an observation group (38 cases, 4 cases dropped off) and a control group (38 cases, 3 cases dropped off, 1 case was removed). In the observation group, acupuncture of revised acupoint combination around the skull base (bilateral Fengchi [GB 20], Wangu [GB 12], Tianzhu [BL 10] and Yamen [GV 15], Baihui [GV 20]) was used for treatment. In the control group, 8 non-meridian and non-acupoint points at the distal end were selected for shallow puncture treatment. Retaining the needles of 30 min, once every other day,3 times a week for 4 weeks in both groups. The scores of Montreal cognitive assessment (MoCA), mini-mental state examination (MMSE), Barthel index (BI) and serum levels of cystatin C (Cys-C) and homocysteine (Hcy) were compared in the two groups before and after treatment, and the clinical efficacy was evaluated.
Results: After treatment, the scores of MoCA were increased compared with those before treatment in the two groups (P<0.05), and the score in the observation group was higher than that in the control group (P<0.05). The scores of MMSE and BI were increased compared with those before treatment in the observation group (P<0.05), and the score of MMSE in the observation group was higher than that in the control group (P<0.05). After treatment, the serum levels of Cys-C and Hcy were decreased compared with those before treatment in the observation group (P<0.05), and lower than those in the control group (P<0.05). After treatment, the serum level of Cys-C was increased compared with that before treatment in the control group (P<0.05). The total effective rate of the observation group was 88.2% (30/34), which was higher than 32.4% (11/34) of the control group (P<0.05).
Conclusion: Acupuncture of revised acupoint combination around the skull base can improve cognitive function and daily living ability of PSMCI patients, which may be related to the down regulation of serum levels of Cys-C and Hcy.
目的：观察环颅底穴位化裁针刺治疗卒中后轻度认知障碍（PSMCI）的临床疗效，初步探讨其作用机制。方法：将76例PSMCI患者随机分为观察组（38例，脱落4例）和对照组（38例，脱落3例，剔除1例）。观察组采用环颅底穴位化裁（双侧风池、完骨、天柱，哑门、百会）针刺治疗；对照组选取8个远端非经非穴点行浅刺治疗。两组均留针30 min，隔日1次，每周3次，连续治疗4周。比较两组患者治疗前后蒙特利尔认知评估量表（MoCA）、简易智能状态检査量表（MMSE）、Barthel指数（BI）评分及血清胱抑素C（Cys-C）、同型半胱氨酸（Hcy）含量，并评定临床疗效。结果：治疗后，两组MoCA评分较治疗前升高（P<0.05），且观察组高于对照组（P<0.05）；观察组MMSE、BI评分较治疗前升高（P<0.05），且MMSE评分高于对照组（P<0.05）。治疗后，观察组血清Cys-C、Hcy含量较治疗前降低（P<0.05），且低于对照组（P<0.05）；对照组血清Cys-C较治疗前升高（P<0.05）。观察组总有效率为88.2%（30/34），高于对照组的32.4%（11/34，P<0.05）。结论：环颅底穴位化裁针刺治疗可改善PSMCI患者认知功能、日常生活能力，可能与下调血清Cys-C、Hcy含量有关。.
Keywords: acupoint combination around the skull base; acupuncture; cognitive function; cystatin C; homocysteine; post-stroke mild cognitive impairment; randomized controlled trial (RCT); sham-acupuncture.