Objectives: To compare the effects of pressing moxibustion at Baihui (GV 20) and Guanyuan (CV 4) combined with donepezil hydrochloride tablets and donepezil hydrochloride tablets alone on cognitive impairment in patients with mild to moderate Alzheimer's disease(AD), and to explore the mechanism of pressing moxibustion in the treatment of mild to moderate AD from the serum levels of β-amyloid 1-42 (Aβ1-42), microtubule-associated protein tau and phosphorylated tau (P-tau).
Methods: A total of 76 patients with mild to moderate AD were randomly divided into an observation group (38 cases, 4 cases dropped out) and a control group (38 cases, 2 cases dropped out). Patients in the control group were given oral donepezil hydrochloride tablets (5 mg each time, once a day). On the basis of the control group, patients in the observation group were treated with pressing moxibustion at Baihui (GV 20) and Guanyuan (CV 4), 5 cones per acupoint, once every other day, three times a week. Both groups were treated for 8 weeks. The scores of mini-mental state examination (MMSE) and Montreal cognitive assessment (MoCA) were compared between the two groups before treatment, after treatment and after 4 and 12 weeks of treatment completion. The serum levels of Aβ1-42, tau and P-tau were detected before and after treatment in the two groups, and the safety was evaluated.
Results: At each time point after treatment, the MMSE and MoCA scores of the two groups were higher than those before treatment (P<0.05), and the scores in the observation group were higher than those in the control group (P<0.05). After treatment, the serum levels of Aβ1-42, tau and P-tau in the two groups were lower than those before treatment (P<0.05), and above indexes in the observation group were lower than those in the control group (P<0.05). There was no significant difference in the safety level between the two groups (P>0.05).
Conclusions: The short-term and long-term effect of pressing moxibustion at Baihui (GV 20) and Guanyuan (CV 4) combined with donepezil hydrochloride tablets in improving cognitive impairment in mild to moderate AD is better than that of donepezil hydrochloride tablets alone, and can reduce serum levels of Aβ1-42, tau and P-tau, which may be one of the mechanisms of pressing moxibustion to improve cognitive impairment.
目的: 比较压灸百会、关元联合盐酸多奈哌齐片与单纯盐酸多奈哌齐片治疗轻中度阿尔茨海默病（AD）患者认知障碍的临床疗效，从血清β淀粉样蛋白1-42（Aβ1-42）、微管相关蛋白tau、磷酸化tau（P-tau）水平探讨压灸治疗轻中度AD的机制。方法: 将76例轻中度AD患者随机分为观察组（38例，脱落4例）和对照组（38例，脱落2例）。对照组予口服盐酸多奈哌齐片（每次5 mg，每天1次）；观察组在对照组基础上予压灸百会、关元治疗，每次每穴施灸5壮，隔日1次，每周3次。两组均连续治疗8周。比较两组患者治疗前后及治疗结束后4、12周简易精神状态检查量表（MMSE）评分、蒙特利尔认知评估量表（MoCA）评分，治疗前后血清Aβ1-42、tau、P-tau水平，并进行安全性评价。结果: 治疗后各时间点，两组患者MMSE、MoCA评分均较治疗前升高（P<0.05），且观察组高于对照组（P<0.05）。治疗后，两组患者血清Aβ1-42、tau、P-tau水平较治疗前降低（P<0.05），且观察组低于对照组（P<0.05）。两组患者安全等级比较差异无统计学意义（P>0.05）。结论: 压灸百会、关元联合盐酸多奈哌齐片改善轻中度AD认知障碍的近远期疗效优于单纯盐酸多奈哌齐片，且可降低血清Aβ1-42、tau、P-tau水平，这可能是压灸改善认知障碍的机制之一。.
Keywords: Alzheimer's disease (AD); Point CV 4 (Guanyuan); Point GV 20 (Baihui); microtubule-associated protein tau; pressing moxibustion; randomized controlled trial (RCT); β-amyloid protein 1-42 (Aβ 1-42).