【作者】 刘健红；

【导师】 刘友章；

【作者基本信息】 广州中医药大学 ， 中医内科学， 2008， 硕士

【摘要】 目的:老年性痴呆症(阿尔茨海默病,Alzheimer′s disease,AD)是1907年AloisAlzheimer首先发现并命名的一种神经系统退行性疾病。随着世界人口的老龄化,AD的发病率呈不断上升趋势,目前该病列死亡原因第4位(仅次于心脏病、肿瘤和中风),成为当前老年医学所面临的最为严峻的问题之一。导师刘友章教授擅长治疗老年病,在长期韵临床实践中认为AD患者都不同程度地在肾虚的基础上兼有脾虚的表现。因此,针对AD患者脾肾虚衰、气血阴阳亏损、脑失所养、痰瘀蒙蔽清窍这一病理环节,刘友章教授立补益脾肾、化痰祛瘀的治疗方法和经验方—醒痴方,结合针刺百会、四神聪、神门、足三里等穴位进行早期治疗,显示出较好的临床效果。故本研究在使用常规西药治疗的基础上,加用醒痴方并结合针刺治疗脾肾两虚、痰浊阻窍型轻-中度AD患者20例,并与单纯中医、单纯西医治疗组各20例随机对照,以进一步探讨醒痴方加针刺在脾肾两虚、痰浊阻窍型轻-中度AD治疗中的疗效。方法:研究包括文献研究和临床研究。文献研究中,从西医对AD病因及发病机制的认识、与AD有关的血液生化标记物、AD的神经影像学和电生理改变及传统中医对AD的论述、AD的中药及针灸治疗进展、中医药治疗AD的优势等方面进行了详细的整理和总结。临床研究中,临床观察60例脾肾两虚、痰浊阻窍型轻-中度AD患者,采用随机对照方法将患者分成三组,单纯中医组、单纯西医组及中西医结合组各20例。单纯中医组给予醒痴方加针刺治疗;单纯西医组口服安理申、都可喜、脑复康片治疗;中西医结合组口服西药、醒痴方并行针刺治疗,三组的疗程均为4周。结果:经治疗4周后,口服西药、醒痴方并行针刺的中西医结合组的中医总疗效、对MMSE量表积分的改善、对AD患者的检测指标(血浆Hcy、脑电图)的改善均优于单纯中医及单纯西医组(P＜0.05)。结论:在常规西药治疗的基础上,醒痴方加针刺的中西医结合方案对脾肾两虚、痰浊阻窍型轻-中度AD患者疗效确切,临床试验中未发现该方案有不良反应,可考虑作为AD患者的常规治疗方案。更多还原

【Abstract】 Objective:Alzheimer’ s disease is one of the degenerative disease of nervous system found firstly and nominated by Alois Alzheimer in 1907.With the aging of world population,the incidence rat-e of AD.shows rising constantly tendency,Now AD list 4th of cause of death(second only heart disease,tumor and apoplexy),become one of the most severe questions of geriatric medicine faced with.My tutor Prof.Liu Youzhang is good at the treatment of senile disease, thinking that AD patients have kidney and spleen asthenia to different degree. So aiming at the pathological element of spleen and kidney asthenia,weakness of Qi,blood,Yin and Yang,brain loss the nourishment,phlegm and blood stasis blocking the upper orifices of AD patients,Prof.Liu Youzhang created treatment method of tonifying spleen and renal,dissipating phlegm and removing blood stasis and empirical formula xingchi Decoction combined,with acupuncture Baihui,Sishencong,Shenting etc acupoint for early treatment, displayed better clinical effects.So in this research,we adopted xingchi Decoction combined with acupuncture to treat 20 slight of midrange AD patients of both the spleen and kidney asthenia,phlegm and blood stasis blocking clear orifices on the basis of routine western medicine,and randomized control with 20 simple traditional Chinese medicine group,20 simple western medicine group, so as to further approaching the effects and possible mechanism of xingchi Decoction combined with acupuncture in treating AD of both the spleen and kidney asthenia,phlegm and blood stasis blocking clear orifices.Methods:The research consists of two parts:literature review and clinical research.In literature review,we made systematic summary on recognition of etiology and pathogenesis of AD ofmodern medicine,blood biochemical marker related to AD,neuroimaging and electrophysiological change of AD,the discuss of traditional Chinese medicine on AD,traditional Chinese medicine and acupuncture therapy progress and the advantages of traditional Chinese medicine therapy etc.In clinical research,we made clinical observation of 60 slight of midrange AD patients of both the spleen and.kidney asthenia,phlegm and blood stasis blocking clear orifices,60 AD patients were randomly divided into 3 groups:20 simple traditional Chinese medicine group,20 simple western medicine group and 20 combination of traditional Chinese medicine and western medicine group.We adopted xingchi Decoctioncombined with acupuncture to treat AD in simple traditional Chinese medicine group;adopted aricep、duxil、pisacetam tablets for oral administration in simple western medicine group and western medicine combined with xingchi Decoction and acupuncture in combination of traditional Chinese medicine and western medicine group,3 groups’ course of treatment were 4 weeks.Results:After 4 weeks treatment,traditional Chinese medicine therapeutic effects, improvement of measuring scale score of mini-mental state examination and detection index of AD patients(blood plasma homocysteine,EEG)were all better in combination of traditional Chinese medicine and western medicine group compared with simple traditional Chinese medicine group and simple western medicine group(P＜0.05).Conclusion:On the basis of routine western medicine,the effects of combination of traditional Chinese medicine and western medicine of xingchi Decoction combined with acupuncture were definite in treating slight of midrange AD patients of both the spleen and kidney asthenia,phlegm and blood stasis blocking clear orifices.There were no adverse effects in clinical research. and it can be used as conventional therapy plan for AD patients.更多还原