Effects of repetitive transcranial magnetic stimulation (rTMS) combined with scalp acupuncture at acupoints on cerebral circulation and neuroelectrophysiology in the treatment of vascular dementia

doi:10.19854/j.cnki.1008-2425.2026.03.0005

Abstract

Abstract: Objective To investigate the effect of repeated transcranial acupuncture combined with repeated transcranial electrical stimulation (rTMS) in the treatment of vascular dementia and its influence on cerebral circulation dynamics and neuroelectrophysiology. Methods A total of 126 patients with vascular dementia in our hospital from January 2021 to June 2023 were selected and divided into control group 1,control group 2 and combination group according to random number table method,with 42 cases each.On the basis of conventional Western medicine treatment,control group 1 was given rTMS treatment,control group 2 was given repeated transcranial acupuncture treatment,and combination group was given repeated transcranial acupuncture combined with rTMS treatment for 4 weeks.Compare the treatment effect of the 3 groups,as well as Cognitive function[Vascular Dementia Assessment Scale (VaDAS-Cog),Simple Intelligent Mental State Examination Scale (MMSE)] scores,cerebral circulation dynamics parameters[cerebrovascular bed characteristic impedance (ZCV),peripheral resistance (Rv),mean blood flow (Qm),mean blood velocity (Vm)] and neuroelectrophysiological parameters[P300 amplitude,P300 latency],(δ+θ)/(α+β) ratio],ability of daily living[ADL] score,quality of life[Dementia Quality of Life Scale (DQOL)] score and adverse reactions before and after treatment. Results The total effective rate of combination group was higher than that of control group 1 and control group 2 (P＜0.05),but there was no significant difference between control group 1 and control group 2 (P＞0.05).After 4 weeks of treatment,MMSE score in combination group was higher than that in control group 1 and control group 2,and VaDAS-Cog score was lower than that in control group 1 and control group 2 (P＜0.05).There was no statistical significance in MMSE and VaDAS-Cog scores between control group 1 and control group 2 after 4 weeks of treatment (P＞0.05).After 4 weeks of treatment,the average cerebral circulation blood flow and average blood flow velocity in combined group were higher than those in control group 1 and control group 2,the characteristic impedance and peripheral resistance of cerebral vascular bed in combined group were lower than those in control group 1 and control group 2,and those in control group 1 were lower than those in control group 2 (P＜0.05).After 4 weeks of treatment,P300 amplitude in combination group was higher than that in control group 1 and control group 2,control group 1 was higher than that in control group 2,P300 latency and (δ+θ)/(α+β) ratio were lower than that in control group 1 and control group 2,and control group 1 was lower than that in control group 2 (P＜0.05).After 4 weeks of treatment,ADL and DQOL scores in combination group were higher than those in control group 1 and control group 2 (P＜0.05),but there was no significant difference between control group 1 and control group 2 (P＞0.05).The incidence of adverse reactions in the combined group was 14.29%,11.90% in the control group and 7.14% in the control group (P＞0.05). Conclusion Transcranial repeated acupuncture combined with rTMS in the treatment of vascular dementia is more effective than rTMS alone or transcranial repeated acupuncture,which can effectively improve the cerebral circulation dynamic parameters and neuroelectrophysiological parameters of patients,thus improving cognitive function,and improving patients'daily living ability and quality of life,with high safety.

Key words: Repeated transcranial acupuncture, Repeated transcranial electrical stimulation, Vascular dementia, Cerebral circulation dynamics, Neuroelectrophysiology

摘要： 目的探讨重复经颅磁刺激(rTMS)联合头皮穴位针灸治疗血管性痴呆的效果及对脑循环动力学、神经电生理的影响。方法选取我院2021年1月至2023年6月血管性痴呆患者126例,按照随机数字表法分为对照1组、对照2组、联合组,各42例。在常规西医治疗基础上,对照1组给予rTMS治疗,对照2组给予重复经颅针刺法治疗,联合组给予重复经颅针刺法联合rTMS治疗,均治疗4周。比较3组治疗效果、治疗前后认知功能[血管性痴呆评估量表(VaDAS-Cog)、简易智能精神状态检查量表(MMSE)]评分、脑循环动力学参数[脑血管床特性阻抗(ZCV)、外周阻力(Rv)、平均血流量(Qm)、平均血流速度(Vm)]、神经电生理参数[P300波幅、P300潜伏期、(δ＋θ)/(α+β)比值]、日常生活能力[基本日常生活能力量表(ADL)]评分、生活质量[痴呆生活质量量表(DQOL)]评分及不良反应。结果联合组总有效率高于对照1组、对照2组(P＜0.05),对照1组与对照2组总有效率差异无统计学意义(P＞0.05);治疗4周后联合组MMSE评分高于对照1组、对照2组,VaDAS-Cog评分低于对照1组、对照2组(P＜0.05),对照1组与对照2组治疗4周后MMSE、VaDAS-Cog评分差异无统计学意义(P＞0.05);治疗4周后联合组脑循环平均血流量、平均血流速度高于对照1组、对照2组,对照1组高于对照2组,脑血管床特性阻抗、外周阻力低于对照1组、对照2组,对照1组低于对照2组(P＜0.05);治疗4周后联合组P300波幅高于对照1组、对照2组,对照1组高于对照2组,P300潜伏期、(δ＋θ)/(α+β)比值低于对照1组、对照2组,对照1组低于对照2组(P＜0.05);治疗4周后联合组ADL评分高于对照1组、对照2组(P＜0.05),对照1组与对照2组差异无统计学意义(P＞0.05),治疗4周后联合组DQOL评分高于对照1组、对照2组(P＜0.05),对照1组与对照2组差异无统计学意义(P＞0.05);联合组不良反应发生率14.29%与对照1组11.90%、对照2组7.14%比较差异无统计学意义(P＞0.05)。结论重复经颅磁刺激(rTMS)联合头皮穴位针灸治疗血管性痴呆相较于单纯使用rTMS或重复经颅针刺法治疗效果更加显著,能有效改善患者脑循环动力学参数和神经电生理参数,进而提升认知功能,同时也能提高患者日常生活能力和生活质量,具有较高安全性。

关键词: 重复经颅针刺法, 重复经颅电刺激, 血管性痴呆, 脑循环动力学, 神经电生理

CLC Number:

R749.16

Ma Cuixia, Wang Yanling, Ma Cui′e, Li Guoqiang, Li Wenbao, Zhang Meili, Lu Juan, Qiu Zhixin. Effects of repetitive transcranial magnetic stimulation (rTMS) combined with scalp acupuncture at acupoints on cerebral circulation and neuroelectrophysiology in the treatment of vascular dementia[J]. Chinese Journal of Stereotactic and Functional Neurosurgery, 2026, 39(3): 160-167.

马翠霞, 王艳苓, 马翠娥, 李国强, 李文宝, 张梅莉, 卢娟, 邱志新. 重复经颅磁刺激(rTMS)联合头皮穴位针灸治疗血管性痴呆对脑循环、神经电生理的影响[J]. 立体定向和功能性神经外科杂志, 2026, 39(3): 160-167.

References

[1] Rost NS,Brodtmann A,Pase MP,et al.Post-Stroke Cognitive Impairment and Dementia[J].Circ Res,2022,130(8):1252-1271.
[2] Wolters FJ,Ikram MA.Epidemiology of Vascular Dementia[J].Arterioscler Thromb Vasc Biol,2019,39(8):1542-1549.
[3] Emrani S,Lamar M,Price CC,et al.Alzheimer's/Vascular Spectrum Dementia:Classification in Addition to Diagnosis[J].J Alzheimers Dis,2020,73(1):63-71.
[4] 何建华,杨振,张敏燕,等.低频重复经颅磁刺激联合功能性电刺激对脑卒中后恢复期手功能障碍患者手功能的影响[J].中华物理医学与康复杂志,2021,43(9):804-806.
[5] 童心,卢燕,张永卿,等.重复经颅磁刺激和经颅直流电刺激治疗卒中后抑郁[J].国际脑血管病杂志,2023,31(1):67-71.
[6] 张斗凤,唐向阳,江伟,等.高频重复经颅磁刺激治疗无先兆偏头痛的临床研究[J].中华神经医学杂志,2021,20(7):711-715.
[7] 张杰,刘小溪,张雪竹.针刺调控miR-10a改善VD大鼠认知并减轻神经炎症的研究[J].天津中医药,2023,40(4):467-473.
[8] 李洪梅,王晓琴,郭洋,等.复元胶囊联合醒脑开窍针刺法治疗血管性痴呆研究[J].康复学报,2023,33(3):264-270.
[9] 李艳涛.重复经颅电刺激联合多哌奈齐治疗血管性痴呆的临床效果及对认知功能的影响分析[J].四川解剖学杂志,2021,29(1):117-118,133.
[10] 李蔚然,杨琪琪,周欣华,等.通调心肾针刺法结合温阳补肾灸治疗血管性痴呆的疗效及对认知功能的影响[J].中国中医药信息杂志,2025,32(1):158-163.
[11] 中华医学会神经病学分会.血管性痴呆诊断标准草案[J].中华神经科杂志,2002,35(4):246.
[12] 周小炫,谢敏,陶静,等.简易智能精神状态检查量表的研究和应用[J].中国康复医学杂志,2016,31(6):694-696,706.
[13] 周玲燕.潜阳育阴剂早期介入高血压治疗改善认知损害临床研究[D].南京中医药大学,2019.
[14] 巫嘉陵,安中平,王世民,等.脑卒中患者日常生活活动能力量表的信度与效度研究[J].中国现代神经疾病杂志,2009,9(5):464-468.
[15] 李晓静,陈菲菲,刘东梅,等.痴呆生活质量量表中文版的修订及信效度检测[J].护理学杂志,2011,26(21):35-37.
[16] 李硕,倪伟,田浩梅.“调心通督”针刺法联合经颅直流电刺激对血管性痴呆的临床观察[J].湖南中医药大学学报,2020,40(4):469-472.
[17] 郭颖,孙颖哲,周琛,等.重复经颅针刺法治疗抑郁症疗效观察[J].世界中西医结合杂志,2021,16(4):757-760.
[18] 李昌鑫.重复经颅针刺法治疗卒中后抑郁的临床观察[D].黑龙江:黑龙江中医药大学,2021.
[19] 李蕊彤,李岩,韩旭,等.重复经颅针刺法结合认知康复训练对血管性痴呆患者的疗效及对Hcy水平的影响[J].针灸临床杂志,2023,39(7):31-35.
[20] Aloizou AM,Pateraki G,Anargyros K,et al.Repetitive Transcranial Magnetic Stimulation in the Treatment of Alzheimer's Disease and Other Dementias[J].Healthcare (Basel),2021,9(8):949.
[21] 杨世喜.通督醒神针刺法联合丁苯酞胶囊对血管性痴呆患者血清炎性因子及脑循环动力学的影响[J].中医临床研究,2023,15(17):53-57.
[22] 马育轩,朱艺霞,于国强,等.“金钩钓鱼”针法联合重复经颅针刺法治疗血管性痴呆伴失语临床研究[J].针灸临床杂志,2021,37(11):36-40.
[23] 胡微澜,杨伟,韩威利,等.电针联合经颅磁刺激对血管性痴呆大鼠学习记忆能力的影响[J].中国脑血管病杂志,2021,18(7):458-464.
[24] 潘立民,陈雪岩,李岩,等.“重复经颅针刺激”治疗原发性失眠的临床随机对照试验[J].针灸临床杂志,2020,36(11):14-17.
[25] 袁媛,党宝齐,浦建能,等.重复经颅磁刺激联合醒脑开窍针法对脑梗死后血管性痴呆患者认知功能及日常生活能力的影响[J].现代中西医结合杂志,2020,29(22):2470-2473.