Objectives: To investigate the cerebral metabolism in the patients with type 2 diabetes mellitus-associated cognitive dysfunction (T2DACD) and explore the mechanism of electroacupuncture (EA) at the acupoints for Tiaozang Xingshen (adjusting zangfu function and rescuing the spirit) in treatment of T2DACD, using magnetic resonance spectroscopy.
Methods: Fifteen patients with T2DACD (observation group) and 22 healthy subjects (control group) were enrolled. In the observation group, the patients were treated with EA for Tiaozang Xingshen at Baihui (GV 20) and Shenting (GV 24), and bilateral Feishu (BL 13), Pishu (BL 20), Shenshu (BL 23), Zusanli (ST 36), Sanyinjiao (SP 6), Hegu (LI 4) and Taichong (LR 3). EA was operated with disperse-dense wave, 2 Hz/100 Hz in frequency and 0.1 mA to 1.0 mA in current intensity; 30 min each time, once daily. One course of EA consisted of 5 treatments, at the interval of 2 days and the intervention lasted 8 courses. Before treatment in the control group, before and after treatment in the observation group, the score of Montreal cognitive assessment scale (MoCA), the score of clinical dementia rating (CDR), Flanker paradigm, Stroop paradigm, Nback paradigm, the score of self-rating anxiety scale (SAS), the score of self-rating depression scale (SDS), and the score of Hamilton depression rating scale (HAMD) were evaluated separately; the glycolipid metabolic indexes (fasting plasma glucose [FPG], glycosylated hemoglobin type A1c [HbA1c], total cholesterol [TC], triacylglycerol [TG], high-density lipoprotein cholesterol [HDL-C] and low-density lipoprotein cholesterol [LDL-C]) were determined；with the magnetic resonance spectroscopy technique adopted, the metabolites in the basal ganglia area were detected. The correlation analysis was performed for the metabolite values with MoCA score, CDR score , Flanker paradigm, Stroop paradigm, and Nback paradigm.
Results: Before treatment, compared with the control group, in the observation group, MoCA score was lower (P<0.001), CDR score and the levels of FPG and HbA1c were higher (P<0.001); the reaction times of Flanker non-conflict, Flanker conflict, Stroop neutrality, Stroop congruence, Stroop conflict, and 1-back were prolonged (P<0.05, P<0.001), and the accuracy of Flanker conflict, Stroop conflict, and 1-back decreased (P<0.05, P<0.01); the ratio of N-acetyl aspartate (NAA) to creatine (Cr) in the left basal ganglia area was dropped (P<0.001), and that of myo-inositol (MI) to Cr in the right side increased (P<0.05). In the observation group after treatment, compared with the levels before treatment, MoCA score was higher (P<0.001), the scores of CDR, SAS and HAMD were reduced (P<0.01, P<0.05), the reaction times of Flanker conflict and Stroop conflict shortened (P<0.001, P<0.05), and the accuracy of Flanker conflict and 1-back increased (P<0.001, P<0.05); the ratio of NAA to Cr in the left basal ganglia area and that of the gamma-aminobutyric acid (GABA) to Cr in the right increased (P<0.05), that of MI to Cr in the right decreased (P<0.05). Before treatment, in the observation group, the ratio of MI to Cr in the right basal ganglia area was positively correlated with the reaction time of Stroop congruence (r=0.671, P=0.012) and this ratio was positively correlated with the reaction time of Stroop conflict (r=0.576, P=0.039).
Conclusions: Electroacupuncture for "adjusting zangfu function and rescuing the mind" improves the cognitive function of T2DACD patients, which may be related to the regulation of NAA, MI and GABA levels in the basal ganglia.
目的: 基于磁共振波谱技术探究2型糖尿病相关认知功能障碍（T2DACD）患者脑内代谢，探讨“调脏醒神”电针治疗T2DACD的效应机制。方法: 招募15例T2DACD患者作为观察组，22例健康受试者作为对照组。观察组接受“调脏醒神”电针治疗，穴取百会、神庭，双侧肺俞、脾俞、肾俞、足三里、三阴交、合谷、太冲，疏密波，频率2 Hz/100 Hz，电流强度0.1~1.0 mA，每次30 min，每日1次，5次为一疗程，疗程间休息2 d，连续治疗8个疗程。对照组于治疗前、观察组于治疗前后评定蒙特利尔认知评估量表（MoCA）评分、临床痴呆评定量表（CDR）评分、Flanker范式、Stroop范式、Nback范式、焦虑自评量表（SAS）评分、抑郁自评量表（SDS）评分、汉密尔顿抑郁量表（HAMD）评分，检测糖脂代谢指标［空腹血糖（FPG）、糖化血红蛋白（HbA1c）、总胆固醇（TC）、三酰甘油（TG）、高密度脂蛋白胆固醇（HDL-C）、低密度脂蛋白胆固醇（LDL-C）］，应用磁共振波谱技术检测基底节区代谢物，并将代谢物值与MoCA评分、CDR评分、Flanker范式、Stroop范式、Nback范式进行相关性分析。结果: 与对照组比较，观察组治疗前MoCA评分降低（P<0.001），CDR评分、FPG、HbA1c升高（P<0.001），Flanker不冲突、Flanker冲突、Stroop中性、Stroop一致性、Stroop冲突和1-back反应时均延长（P<0.05，P<0.001），Flanker冲突、Stroop冲突和1-back准确率均降低（P<0.05，P<0.01）；基底节区左侧N-乙酰天门冬氨酸（NAA）/肌酸（Cr）值降低（P<0.001），右侧肌醇（MI）/Cr值升高（P<0.05）。与治疗前比较，观察组治疗后MoCA评分升高（P<0.001），CDR、SAS、HAMD评分降低（P<0.01，P<0.05），Flanker冲突、Stroop冲突反应时均缩短（P<0.001，P<0.05），Flanker冲突和1-back准确率均升高（P<0.001，P<0.05）；基底节区左侧NAA/Cr值、右侧γ-氨基丁酸（GABA）/Cr值升高（P<0.05），右侧MI/Cr值降低（P<0.05）。治疗前，观察组基底节区右侧MI/Cr值与Stroop一致性反应时呈正相关（r=0.671，P=0.012），右侧MI/Cr值与Stroop冲突反应时呈正相关（r=0.576，P=0.039）。结论: “调脏醒神”电针可改善T2DACD患者认知功能，可能与调节基底节区NAA、MI、GABA水平有关。.
Keywords: acupuncture; basal ganglia; electroacupuncture for Tiaozang Xingshen (adjusting zangfu function and rescuing the spirit); magnetic resonance spectroscopic imaging; metabolite; type 2 diabetes mellitus-associated cognitive dysfunction.