Xiao Wei, Zhang Xian-bao, Hu Hui-xing, Wang Zhen, Guo Xiao-li
Zhongguo Zhen Jiu. 2014 Nov;34(11):1051-6.
To explore the difference in the efficacy and effect mechanism of subcortical ischemic vascular disease (SIVD) complicated with depression between acupuncture and medication.
Sixty patients were randomized-into an acupuncture group and a medication group, 30 cases in each one. In the acupuncture group, acupuncture was applied to Baihui (GV 20), Shuigou (GV 26), Fengfu (GV 16), Fengchi (GB 20) and the others, once a day, 6 times a week. The treatment of 4 weeks made one session and totally 2 sessions were required. In the medication group, nimodipine 30 mg, three times a day and fluoxetine 20 mg, once a day were prescribed for oral administration, for 8 weeks totally. Before treatment, at the end of the 4th week and at the end of the 8th week of treatment, cerebral blood flow velocity (CBFV) and solubility CD40 ligand (sCD40L) were determined respectively. The scores in Montreal cognitive assessment (MoCA) and Hamilton' s depression scale (HAMD) were evaluated in the two groups. The efficacies on cognitive function and depression symptoms were compared in the patients between the two groups. Results Compared with the outcome before treatment, mean blood flow velocity (Vm) of middle cerebral artery (MCA), anterior cerebral artery (ACA) and posterior cerebral artery (PCA) was increased significantly at the end of the 4th week of treatment in the two groups (all P<0.05). At the end of the 8th week, Vm was increased much significantly (all P<0.01). The differences were not significant in comparison between the two groups (all P>0.05). Compared with the expression before treatment, sCD40L was reduced significantly after treatment in the patients of the two groups (all P<0.01), but the differ- ence was not significant between the two groups (all P>0.05). Compared with that before treatment, MoCA score was increased significantly after treatment in the two groups (all P<0.01), HAMD score was reduced sig- nificantly (all P<0.01), the differences were not significant in comparison between the two groups (all P>0.05). The total effective rate of cognitive improvement was 86.7% (26/30) in the acupuncture group and was 80.0% (24/30) in the medication group, the differences were not significant in comparison of the two groups (P>0.05). The total effective rate of the improvement in depression was 93.3% (21/30) in the acupuncture group and was 86.7% (26/30) in the medication group, the differences were not significant in comparison of the two groups (P>0.05).
Acupuncture could significantly increases CBFV and reduces serum sCD40L expressions in the patients of SIVD complicated with depression, and significantly improves cognitive function and relieves depression symptoms. The efficacy of it is similar to that of western medication. The increase of serum sCD40L expression is possibly involved in the occurrence and development of SIVD. Reducing sCD40L expression contributes to the alleviation of damage induced by cerebral ischemia and reperfusion.
探讨针刺与药物治疗皮质下缺血性血管病（SIVD）合并抑郁症的疗效及作用机制差异。
将60例患者随机分为针刺组和药物组，每组30例。针刺组针刺百会（GV 20）、水沟（GV 26）、风府（GV 16）、风池（GB 20）等穴位，每日1次，每周6次。4周为1个疗程，共治疗2个疗程。药物组口服尼莫地平30 mg，每日3次；氟西汀20 mg，每日1次，共治疗8周。分别于治疗前、治疗第4周结束时及治疗第8周结束时测定脑血流速度（CBFV）和可溶性CD40配体（sCD40L）。对两组患者进行蒙特利尔认知评估（MoCA）评分和汉密尔顿抑郁量表（HAMD）评分。比较两组患者认知功能和抑郁症状的疗效。结果与治疗前相比，两组治疗第4周结束时大脑中动脉（MCA）、大脑前动脉（ACA）和大脑后动脉（PCA）的平均血流速度（Vm）均显著升高（均P<0.05）。治疗第8周结束时，Vm升高更显著（均P<0.01）。两组比较差异无统计学意义（均P>0.05）。与治疗前表达水平相比，两组患者治疗后sCD40L均显著降低（均P<0.01），但两组间差异无统计学意义（均P>0.05）。与治疗前相比，两组治疗后MoCA评分均显著升高（均P<0.01），HAMD评分均显著降低（均P<0.01），两组比较差异无统计学意义（均P>0.05）。针刺组认知功能改善总有效率为86.7%（26/30），药物组为80.0%（24/30），两组比较差异无统计学意义（P>0.05）。针刺组抑郁症状改善总有效率为93.3%（21/30），药物组为86.7%（26/30），两组比较差异无统计学意义（P>0.05）。
针刺可显著提高SIVD合并抑郁症患者的CBFV，降低血清sCD40L表达，显著改善认知功能，缓解抑郁症状。其疗效与西药相似。血清sCD40L表达升高可能参与了SIVD的发生发展。降低sCD40L表达有助于减轻脑缺血再灌注损伤。
