主 办:北 京 中 医 药 大 学
ISSN 1006-2157 CN 11-3574/R

北京中医药大学学报 ›› 2020, Vol. 43 ›› Issue (6): 508-515.doi: 10.3969/j.issn.1006-2157.2020.06.011

• 临床研究 • 上一篇    下一篇

基于静息态功能性磁共振探讨中医辨证治疗重度阿尔茨海默病脑功能改变的临床研究*

俞璐1, 郁志华2, 汤伟军3, 黄品贤4, 董英4, 王健2, 林水淼2#   

  1. 1 上海中医药大学附属普陀医院中医综合科 上海 200062;
    2 上海市中医老年医学研究所;
    3 复旦大学附属华山医院放射科;
    4 上海中医药大学预防医学教研室
  • 收稿日期:2019-12-15 发布日期:2020-07-06
  • 通讯作者: #林水淼,男,主任医师,教授,博士生导师,主要研究方向:老年病、中医脑病研究,E-mail:lsm0096@sohu.com
  • 作者简介:俞璐,女,博士,主治医师
  • 基金资助:
    *科技部“十一五”支撑计划资助项目(No. 2006BAI04A11-2),国家自然科学基金资助项目(No. 81503370),上海市自然科学基金资助项目(No. 19ZR1447900),上海市“医苑新星”青年医学人才培养资助项目(No. 15S-RC-02),上海市普陀区中医临床重点专科建设资助项目(No. PTZYLCZDZK-2017003)

Clinical study on TCM pattern differentiation and treatment of brain function change in patients with severe Alzheimer’s disease based on resting-state functional magnetic resonance imaging*

Yu Lu1, Yu Zhihua2, Tang Weijun3, Huang Pinxian4, Dong Ying4, Wang Jian2, Lin Shuimiao2#   

  1. 1 General Department of TCM, Putuo Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai 200062, China;
    2 Shanghai Institute of Geriatrics of Traditional Chinese Medicine, Shanghai 200032, China;
    3 Department of Radiology, Huashan Hospital, Fudan University, Shanghai 200040, China;
    4 Department of Preventive Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China
  • Received:2019-12-15 Published:2020-07-06
  • Contact: Prof. Lin Shuimiao, Chief Physician, Doctoral Supervisor. Shanghai Institute of Geriatrics of Traditional Chinese Medicine. No. 365 Xiangyang South Road, Xuhui District, Shanghai 200031. E-mail: lsm0096@sohu.com
  • Supported by:
    National 11th Five-Year Plan Support Program Funded by Ministry of Science and Technology of PRC (No. 2006BAI04A11-2), National Natural Science Foundation of China (No. 81503370), Shanghai Natural Science Foundation (No. 19ZR1447900), Shanghai “New Stars in Medical Field” Young Medical Talents Cultivation Program (No. 15S-RC-02), Shanghai Putuo District TCM Clinical Key Specialty Construction Project (No. PTZYLCZDZK-2017003)

摘要: 目的 结合静息态功能性磁共振,观察中医辨证治疗方案对重度阿尔茨海默病(Alzheimer’s disease, AD)患者脑功能改变的干预作用。方法 采用国际公认的语言交流障碍和卒中研究所-老年性痴呆及相关疾病学会(NINCDS-ADRDA)有关阿尔茨海默病的诊断标准,纳入重度AD患者50人,随机分为中药组25人和西药组25人。中药组每4周进行中医辨证1次,心气虚证予调心方,肾精不足证予补肾方,挟痰者,加用礞石滚痰丸,挟瘀者,加用血府逐瘀胶囊;西药组予盐酸多奈哌齐5 mg治疗。疗程均为48周。观察并比较2组患者治疗前后简易精神状态检查量表(MMSE)、临床痴呆评定量表(CDR)疗效变化,通过静息态功能性磁共振观察并比较2组患者治疗前后脑功能改变。结果 治疗48周,中药组MMSE有效率45.00%,西药组38.89%;中药组CDR有效率30.00%,西药组22.22%。静息态功能性磁共振检查发现,治疗后2组患者后扣带回与脑功能区的连接性均有不同程度改善。中药组的作用范围主要分布在左侧额顶叶、左侧颞叶、枕叶;西药组的作用范围主要分布在右侧海马、左侧额叶和颞叶。结论 以调心、补肾法辨证施治能够有效提高重度AD患者的认知功能,减轻病情程度,且不同程度提高后扣带回和多个脑区功能活动的连接性,改善脑功能。

关键词: 中医辨证, 阿尔茨海默病, 重度患者, 静息态功能性磁共振, 临床研究

Abstract: Objective To explore the effects of TCM pattern differentiation and treatment on brain function of patients with severe Alzheimer’s disease (AD) using resting-state functional magnetic resonance imaging (fMRI). Methods According to the internationally recognized NINCDS-ADRDA Alzheimer’s Criteria, fifty patients with severe AD were enrolled in the study and were randomly divided into Chinese medicine group (CMG) (n=25) and Western medicine group (WMG) (n=25). Patients in the CMG were given TCM treatment based on pattern differentiation: patients with heart-qi deficiency received Tiaoxin Fang (Heart-regulating Formula), patients with kidney-essence insufficiency Bushen Fang (Kidney-supplementing Formula) and patients with patterns complicated by phlegm and blood stasis were additionally given Mengshi Guntan Wan (Chlorite Phlegm-Removing Pill) and Xuefu Zhuyu Jiaonang (Blood Mansion Stasis-Expelling Capsule) respectively. Patients in the WMG were treated with donepezil 5 mg once daily. The course of treatment lasted 48 weeks for both groups. Therapeutic effects were observed and compared using Mini-Mental State Examination (MMSE) and Clinical Dementia Rating (CDR). Changes in brain function of the AD patients before and after treatment were also examined and compared with resting-state fMRI. Results After 48 weeks of treatment, 45.00% and 38.89% patients scored higher in MMSE and 30.00% and 22.22% scored higher in CDR in the CMG and the WMG respectively. The results of fMRI demonstrated better connectivity between posterior cingulate gyrus and other brain regions in both groups of patients. In CMG, the improved regions involved primarily the left frontal and parietal lobes, left temporal lobe and occipital lobe, while in WMG, the improved regions included primarily the right hippocampus, the left frontal lobe and the temporal lobes. Conclusion The heart-regulating and kidney-supplementing TCM treatment based on pattern differentiation is effective in improving cognitive function and reducing disease severity of patients with severe AD and enhancing their brain function by increasing connectivity between posterior cingulate gyrus and specific regions in the brain.

Key words: TCM pattern differentiation, Alzheimer’s disease, patients with severe AD, resting-state functional magnetic resonance imaging, clinical study

中图分类号: 

  • R256.23