“调脏醒神”电针对2型糖尿病相关认知功能障碍患者脑内代谢的影响

姚琳; 刘雁泽; 李孟媛; 张子扬; 于硕; 孙树楠; 徐铭; 郑海珠; 马诗琪; 钟桢; 王洪峰

doi:10.13703/j.0255-2930.20230220-0005

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“调脏醒神”电针对2型糖尿病相关认知功能障碍患者脑内代谢的影响

针灸影像临床与基础 | 更新时间：2024-06-03

- “调脏醒神”电针对2型糖尿病相关认知功能障碍患者脑内代谢的影响
- Effect of electroacupuncture at the acupoints for Tiaozang Xingshen on cerebral metabolism in the patients with type 2 diabetes mellitus-associated cognitive dysfunction
- 中国针灸 2023年43卷第12期页码：1343-1350
- 作者机构：
  
  1.长春中医药大学东北亚中医药研究院，吉林长春 130117
  2.长春中医药大学附属第三临床医院针灸推拿中心
  3.长春中医药大学针灸推拿学院
  4.长春中医药大学，吉林长春 130117
- 作者简介：
  
  王洪峰，教授。E-mail：ccwhf@126.com
- 基金信息：
- DOI：10.13703/j.0255-2930.20230220-0005
  中图分类号： R 246.1
- 收稿：2023-02-20，
  
  网络首发：2023-09-20，
  
  纸质出版：2023-12-12
- 稿件说明：
移动端阅览
姚琳,刘雁泽,李孟媛等.“调脏醒神”电针对2型糖尿病相关认知功能障碍患者脑内代谢的影响[J].中国针灸,2023,43(12):1343-1350.

YAO Lin,LIU Yan-ze,LI Meng-yuan,et al.Effect of electroacupuncture at the acupoints for Tiaozang Xingshen on cerebral metabolism in the patients with type 2 diabetes mellitus-associated cognitive dysfunction[J].Chinese Acupuncture & Moxibustion,2023,43(12):1343-1350.
姚琳,刘雁泽,李孟媛等.“调脏醒神”电针对2型糖尿病相关认知功能障碍患者脑内代谢的影响[J].中国针灸,2023,43(12):1343-1350. DOI： 10.13703/j.0255-2930.20230220-0005.

YAO Lin,LIU Yan-ze,LI Meng-yuan,et al.Effect of electroacupuncture at the acupoints for Tiaozang Xingshen on cerebral metabolism in the patients with type 2 diabetes mellitus-associated cognitive dysfunction[J].Chinese Acupuncture & Moxibustion,2023,43(12):1343-1350. DOI： 10.13703/j.0255-2930.20230220-0005.

摘要

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（

0.001），CDR评分、FPG、HbA1c升高（

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（

0.05，

0.001），Flanker冲突、Stroop冲突和1-back准确率均降低（

0.05，

0.01）；基底节区左侧N-乙酰天门冬氨酸（NAA）/肌酸（Cr）值降低（

0.001），右侧肌醇（MI）/Cr值升高（

0.05）。与治疗前比较，观察组治疗后MoCA评分升高（

0.001），CDR、SAS、HAMD评分降低（

0.01，

0.05），Flanker冲突、Stroop冲突反应时均缩短（

0.001，

0.05），Flanker冲突和1-back准确率均升高（

0.001，

0.05）；基底节区左侧NAA/Cr值、右侧γ-氨基丁酸（GABA）/Cr值升高（

0.05），右侧MI/Cr值降低（

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（

=0.671，

=0.012），右侧MI/Cr值与Stroop冲突反应时呈正相关（

=0.576，

=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。

Abstract

Objective

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 detec

ted. 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 (

0.001)

CDR score and the levels of FPG and HbA1c were higher (

0.001); the reaction times of Flanker non-conflict

Flanker conflict

Stroop neutrality

Stroop congruence

Stroop conflict

and 1-back were prolonged (

0.05

0.001)

and the accuracy of Flanker conflict

Stroop conflict

and 1-back decreased (

0.05

0.01); the ratio of N-acetyl aspartate (NAA) to creatine (Cr) in the left basal ganglia area was dropped (

0.001)

and that of myo-inositol (MI) to Cr in the right side increased (

0.05). In the observation group after treatment

compared with the levels before treatment

MoCA score was higher (

0.001)

the scores of CDR

SAS and HAMD were reduced (

0.01

0.05)

the reaction times of Flanker conflict and Stroop conflict shortened (

0.001

0.05)

and the accuracy of Flanker conflict and 1-back increased (

0.001

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 (

0.05)

that of MI to Cr in the right decreased (

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 (

=0.671

0.012) and this ratio was positively correlated with the reaction time of Stroop conflict (

0.576

0.039).

Conclusion

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.

关键词

Keywords

references

Sperling RA , Aisen PS , Beckett LA , et al . Toward defining the preclinical stages of Alzheimer's disease: recommendations from the National Institute on Aging-Alzheimer's Association workgroups on diagnostic guidelines for Alzheimer's disease [J ] . Alzheimers Dement , 2011 , 7 ( 3 ): 280 - 292 .

McCrimmon RJ , Ryan CM , Frier BM . Diabetes and cognitive dysfunction [J ] . Lancet , 2012 , 379 ( 9833 ): 2291 - 2299 .

Geijselaers SLC , Sep SJS , Stehouwer CDA , et al . Glucose regulation, cognition, and brain MRI in type 2 diabetes: a systematic review [J ] . Lancet Diabetes Endocrinol , 2015 , 3 ( 1 ): 75 - 89 .

Stephenson MC , Gunner F , Napolitano A , et al . Applications of multi-nuclear magnetic resonance spectroscopy at 7T [J ] . World J Radiol , 2011 , 3 ( 4 ): 105 - 113 .

Aoki Y , Kasai K , Yamasue H . Age-related change in brain metabolite abnormalities in autism: a meta-analysis of proton magnetic resonance spectroscopy studies [J ] . Transl Psychiatry , 2012 , 2 ( 1 ): e69 .

Liu HH , Zhang DD , Lin HW , et al . Meta-analysis of neurochemical changes estimated via magnetic resonance spectroscopy in mild cognitive impairment and Alzheimer's disease [J ] . Front Aging Neurosci , 2021 , 13 : 738971 .

Sahin I , Alkan A , Keskin L , et al . Evaluation of in vivo cerebral metabolism on proton magnetic resonance spectroscopy in patients with impaired glucose tolerance and type 2 diabetes mellitus [J ] . J Diabetes Complications , 2008 , 22 ( 4 ): 254 - 260 .

d'Almeida OC , Violante IR , Quendera B , et al . The neurometabolic profiles of GABA and Glutamate as revealed by proton magnetic resonance spectroscopy in type 1 and type 2 diabetes [J ] . PLoS One , 2020 , 15 ( 10 ): e0240907 .

李晓丽 , 章秋 , 宋宏伟 , 等 . 糖尿病患者认知功能与海马结构及其功能变化的相关性研究 [J ] . 中国糖尿病杂志 , 2016 , 24 ( 9 ): 792 - 797 .

Riva D , Taddei M , Bulgheroni S . The neuropsychology of basal ganglia [J ] . Eur J Paediatr Neurol , 2018 , 22 ( 2 ): 321 - 326 .

Zhu YJ , Wienecke CF , Nachtrab G , et al . A thalamic input to the nucleus accumbens mediates opiate dependence [J ] . Nature , 2016 , 530 ( 7589 ): 219 - 222 .

Ongür D , Prescot AP , Jensen JE , et al . Creatine abnormalities in schizophrenia and bipolar disorder [J ] . Psychiatry Res , 2009 , 172 ( 1 ): 44 - 48 .

Cho E , Kim W . Effect of acupuncture on diabetic neuropathy: a narrative review [J ] . Int J Mol Sci , 2021 , 22 ( 16 ): 8575 .

Chen C , Liu J , Sun MX , et al . Acupuncture for type 2 diabetes mellitus: a systematic review and meta-analysis of randomized controlled trials [J ] . Complement Ther Clin Pract , 2019 , 36 : 100 - 112 .

Huang L , Yin X , Li W , et al . Effects of acupuncture on vascular cognitive impairment with no dementia: a randomized controlled trial [J ] . J Alzheimers Dis , 2021 , 81 ( 4 ): 1391 - 1401 .

Cao HJ , Wang YY , Chang D , et al . Acupuncture for vascular mild cognitive impairment: a systematic review of randomised controlled trials [J ] . Acupunct Med , 2013 , 31 ( 4 ): 368 - 374 .

Pan H , Huang HP , Zhang LY , et al . "Adjusting internal organs and dredging channel" electroacupuncture treatment prevents the development of diabetic peripheral neuropathy by downregulating glucose-related protein 78 (GRP78) and caspase-12 in streptozotocin-diabetic rats [J ] . J Diabetes , 2019 , 11 ( 12 ): 928 - 937 .

Zhang LY , Chen XH , Wang HL , et al . "Adjusting internal organs and dredging channel" electroacupuncture ameliorates insulin resistance in type 2 diabetes mellitus by regulating the intestinal flora and inhibiting inflammation [J ] . Diabetes Metab Syndr Obes , 2021 , 14 : 2595 - 2607 .

American Diabetes Association . Introduction:standards of medical care in diabetes-2022 [J ] . Diabetes Care , 2022 , 45 ( Suppl 1 ): S1 - S2 .

Lu JH , Li D , Li F , et al . Montreal cognitive assessment in detecting cognitive impairment in Chinese elderly individuals: a population-based study [J ] . J Geriatr Psychiatry Neurol , 2011 , 24 ( 4 ): 184 - 190 .

Williams MM , Storandt M , Roe CM , et al . Progression of Alzheimer's disease as measured by clinical dementia rating sum of boxes scores [J ] . Alzheimers Dement , 2013 , 9 ( 1 Suppl ): S39 - S44 .

Huyser C , Veltman DJ , Wolters LH , et al . Developmental aspects of error and high-conflict-related brain activity in pediatric obsessive-compulsive disorder: a fMRI study with a Flanker task before and after CBT [J ] . J Child Psychol Psychiatry , 2011 , 52 ( 12 ): 1251 - 1260 .

Stroop JR . Studies of interference in serial verbal reactions [J ] . J Exp Psychol Gen , 1935 , 18 ( 6 ): 643 - 662 .

Kane MJ , Conway ARA , Miura TK , et al . Working memory, attention control, and the N-back task: a question of construct validity [J ] . J Exp Psychol Learn Mem Cogn , 2007 , 33 ( 3 ): 615 - 622 .

Zung WW . A rating instrument for anxiety disorders [J ] . Psychosomatics , 1971 , 12 ( 6 ): 371 - 379 .

Zung WW , Richards CB , Short MJ . Self-rating depression scale in an outpatient clinic. Further validation of the SDS [J ] . Arch Gen Psychiatry , 1965 , 13 ( 6 ): 508 - 515 .

Zimmerman M , Martinez JH , Young D , et al . Severity classification on the Hamilton depression rating scale [J ] . J Affect Disord , 2013 , 150 ( 2 ): 384 - 388 .

黄海东 , 邓敬兰 , 宦怡 , 等 . 正常人基底节区质子磁共振波谱研究 [J ] . 中国医学影像技术 , 2004 , 20 ( 3 ): 388 - 390 .

Reijmer YD , Brundel M , de Bresser J , et al . Microstructural white matter abnormalities and cognitive functioning in type 2 diabetes: a diffusion tensor imaging study [J ] . Diabetes Care , 2013 , 36 ( 1 ): 137 - 144 .

Koekkoek PS , Kappelle LJ , van den Berg E , et al . Cognitive function in patients with diabetes mellitus: guidance for daily care [J ] . Lancet Neurol , 2015 , 14 ( 3 ): 329 - 340 .

李蕾 , 李清楚 , 康志强 , 等 . 海马体积及磁共振波谱变化在2型糖尿病认知功能障碍诊断中的价值 [J ] . 中国老年学杂志 , 2016 , 36 ( 20 ): 5028 - 5029 .

Moffett JR , Arun P , Ariyannur PS , et al . N-Acetylaspartate reductions in brain injury: impact on post-injury neuroenergetics, lipid synthesis, and protein acetylation [J ] . Front Neuroenergetics , 2013 , 5 : 11 .

Li SO , Yin CH , Zhao WN , et al . Application of hydrogen proton magnetic resonance technology combined with brain neurometabolite analysis in the treatment of cognitive impairment caused by type 2 diabetes mellitus [J ] . World Neurosurg , 2020 , 138 : 654 - 662 .

Karczewska-Kupczewska M , Tarasów E , Nikolajuk A , et al . The effect of insulin infusion on the metabolites in cerebral tissues assessed with proton magnetic resonance spectroscopy in young healthy subjects with high and low insulin sensitivity [J ] . Diabetes Care , 2013 , 36 ( 9 ): 2787 - 2793 .

Hwang JH , Choi CS . Use of in vivo magnetic resonance spectroscopy for studying metabolic diseases [J ] . Exp Mol Med , 2015 , 47 ( 2 ): e139 .

Last D , Alsop DC , Abduljalil AM , et al . Global and regional effects of type 2 diabetes on brain tissue volumes and cerebral vasoreactivity [J ] . Diabetes Care , 2007 , 30 ( 5 ): 1193 - 1199 .

Kantarci K , Jack Jr CR , Xu YC , et al . Regional metabolic patterns in mild cognitive impairment and Alzheimer's disease: a 1H MRS study [J ] . Neurology , 2000 , 55 ( 2 ): 210 - 217 .

Chang LD , Munsaka SM , Kraft-Terry S , et al . Magnetic resonance spectroscopy to assess neuroinflammation and neuropathic pain [J ] . J Neuroimmune Pharmacol , 2013 , 8 ( 3 ): 576 - 593 .

易显富 , 彭力 , 陈向军 , 等 . 电针对阿尔茨海默病模型SD大鼠学习记忆功能及海马神经细胞凋亡的影响 [J ] . 实用临床医药杂志 , 2015 , 19 ( 1 ): 1 - 6 .

孙剑端 , 任路 , 李静 , 等 . 电针对胃溃疡肝郁证模型大鼠镇痛作用研究 [J ] . 中国针灸 , 2015 , 35 ( 4 ): 361 - 366 .

顾媛 , 李志铃 , 汪燕玲 , 等 . 长时程睡眠剥夺对大鼠行为记忆和海马区递质的影响及四神聪电针的预防作用 [J ] . 中山大学学报(医学版) , 2018 , 39 ( 1 ): 54 - 60 .

史华 , 张璞 , 郭鑫 , 等 . 针灸对脑性瘫痪模型幼鼠脑组织中氨基酸和神经递质的影响 [J ] . 中国组织工程研究 , 2016 , 20 ( 40 ): 5959 - 5965 .

Stranahan AM , Jiam NT , Spiegel AM , et al . Aging reduces total neuron number in the dorsal component of the rodent prefrontal cortex [J ] . J Comp Neurol , 2012 , 520 ( 6 ): 1318 - 1326 .

张丽颖 , 王洪峰 . 基于数据挖掘技术针灸治疗阿尔茨海默病的选穴规律分析 [J ] . 长春中医药大学学报 , 2018 , 34 ( 5 ): 911 - 914,1031 .

Tan TT , Wang D , Huang JK , et al . Modulatory effects of acupuncture on brain networks in mild cognitive impairment patients [J ] . Neural Regen Res , 2017 , 12 ( 2 ): 250 - 258 .

Sun L , Yong Y , Wei P , et al . Electroacupuncture ameliorates postoperative cognitive dysfunction and associated neuroinflammation via NLRP3 signal inhibition in aged mice [J ] . CNS Neurosci Ther , 2022 , 28 ( 3 ): 390 - 400 .

Cai MD , Lee JH , Yang EJ . Electroacupuncture attenuates cognition impairment via anti-neuroinflammation in an Alzheimer's disease animal model [J ] . J Neuroinflammation , 2019 , 16 ( 1 ): 264 .

Liu SB , Wang ZF , Su YS , et al . A neuroanatomical basis for electroacupuncture to drive the vagal-adrenal axis [J ] . Nature , 2021 , 598 ( 7882 ): 641 - 645 .

Wei JA , Hu XF , Zhang BR , et al . Electroacupuncture activates inhibitory neural circuits in the somatosensory cortex to relieve neuropathic pain [J ] . iScience , 2021 , 24 ( 2 ): 102066 .

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