| ObjectiveAcupuncture combined with basic treatment was used to intervene amnestic mild cognitive impairment(aMCI),and comfort acupuncture combined with basic treatment was used to conduct a comparative study.The efficacy and safety of acupuncture were comprehensively evaluated through objective indicators,so as to provide a reliable reference basis for the standardized treatment of aMCI in clinic,and to provide reference basis for early diagnosis and prevention of Alzheimer’s disease(AD).MethodsBefore the clinical research,the traditional literature review was conducted,and then the domestic and foreign clinical control literature on acupuncture treatment of aMCI was searched according to the relevant research standards.The dialectical classification,acupuncture type,clinical point selection,needle retention,treatment frequency,course of treatment,actual treatment times in the total course of treatment,treatment effect and other aspects of aMCI were systematically statistically analyzed and summarized,Meta analysis was used to make a comprehensive statistical analysis and objective evaluation of the clinical effectiveness of acupuncture in the treatment of aMCI,so as to compare the clinical efficacy of acupuncture therapy and provide evidence-based medical reference for the formulation of acupuncture treatment scheme of aMCI in this clinical study.According to DSM-5,the diagnostic criteria of aMCI were formulated,and the inclusion criteria and exclusion criteria were drawn up.Then,according to the research criteria,36 patients with aMCI were selected from Jingtai community health service center from March 2019 to August 2021 and randomly divided into two groups:acupuncture group(18 cases)were treated with acupuncture+basic treatment(symptomatic support+cognitive rehabilitation training+health education of Down’s finger exercises),the comfort acupuncture group(18 cases)was treated with comfort acupuncture+basic treatment(symptomatic support+cognitive rehabilitation training+health education of Down’s finger exercises)One day before treatment and after treatment,the changes of cognitive function in the two groups were observed through neuropsychological evaluation scales such as MMSE,MoCA,DSR,ADL,HAMD,ADAS-cog and the determination of P300 latency and amplitude of event-related potential;if adverse reactions occurred during the study,they were recorded and dealt with at any time;MMSE,MoCA and ADAS-cog were followed up and retested one year after treatment to count the AD conversion rate.In this study,the subjects,the implementers of the experiment,the Measurers of the results and the statistical analysts were all blinded.Results40 articles were selected from the systematic review,and the study sample included a total of 2792 patients.The statistical analysis of acupuncture types showed that 65%only used filiform acupuncture;35%used electroacupuncture,6 items used continuous wave,7 items used density wave,and 1 item had unknown waveform.Syndrome differentiation:most studies did not carry out syndrome differentiation treatment for aMCI,and 35 of the 40 studies did not carry out syndrome differentiation and acupoint treatment,accounting for 87.5%;The acupuncturists who dialectically match acupoints to treat aMCI are based on their own clinical experience,so that the clinical dialectical classification of aMCI is a little confused,and the names of syndrome types are many and messy,but in fact,many syndrome types are only different in the names of syndrome types.According to the characteristics of syndrome types,they can belong to the same main syndrome types;After analysis and induction,these syndrome types can be basically summarized into six main syndrome types,which are blood stasis blocking collaterals,phlegm turbidity blocking orifices,liver and kidney deficiency,heart and spleen deficiency,heart and liver fire and marrow sea deficiency,among which the previous three syndrome types are the most common.The statistical analysis of acupoints shows that clinicians mostly select the main acupuncture points of aMCI according to their own clinical experience.Included in the literature,the main acupuncture points selected by the treatment group involve 276 different acupoints,of which the utilization rate of Baihui Point reaches 80%,indicating that its curative effect in the treatment of aMCI has been widely recognized.The statistical analysis of needle retention showed that the longest needle retention was 45 minutes,and 22 items were retained for 30 minutes,accounting for 55%,indicating that it is a common clinical practice to retain needles for 30 minutes each time in the treatment of aMCI.The statistical analysis of treatment frequency showed that 29 items were treated once a day,accounting for 72.5%;The second was once every other day,accounting for 17.5%;Both accounted for 90%,indicating that acupuncture treatment of aMCI once a day or once every other day is a common clinical practice.The statistical analysis of course of treatment showed that 17 items were treated for one course of treatment,accounting for 42.5%;6 items were treated for 2 courses,accounting for 15%;6 treatments,3 courses,accounting for 15%;One to three courses of treatment accounted for 72.5%;One study treated 36 courses;It shows that it is a common clinical practice to choose 1-3 courses of acupuncture in the treatment of aMCI.The statistical analysis of the actual treatment times showed that 8 items were treated 24 times in the total course of treatment,accounting for 20%;4 items were treated 28 times,30 times and 60 times,accounting for 10%respectively;One study treated 360 times;It shows that the total course of acupuncture treatment of aMCI is 24 times,which is the most common clinical practice.The combined statistical analysis of the total effective rate showed that a total of 20 studies observed the total effective rate of the acupuncture treatment group(76.99±13.79),of which 60%of the studies had a total effective rate≥80%,suggesting that acupuncture has a good clinical effect on aMCI.38 literatures were included in meta-analysis.The analysis of literature quality shows that 10 literatures with a total score of 3 points,5 with 4 points,1 with 5 points,and no literature with more than 6 points,suggesting that the quality of the included literature is relatively poor,and the high-quality literature accounts for 15.8%of the total included literature.The classified statistical analysis of total effective rate shows that when treating aMCI,filiform acupuncture and electroacupuncture are more effective than western drugs such as anlishen or nimodipine,acupuncture(regardless of electroacupuncture or filiform acupuncture)combined drugs(regardless of Chinese and Western drugs)are more effective than simple acupuncture or simple drugs(regardless of Chinese and Western drugs),and characteristic acupuncture methods(Jin San acupuncture,Tongdu Tiaoshen acupuncture,etc.)are more effective than conventional acupuncture methods,In electroacupuncture,the syndrome differentiation matching points are more effective than the main points alone,the non matching points of filiform needle penetration acupuncture are more effective than the conventional acupuncture matching points,the cognitive function training combined with filiform needle acupuncture is more effective than the cognitive function training alone,and the intervention of filiform needle acupuncture or Electroacupuncture combined with health education is more effective than the intervention of health education alone.The corresponding forest diagram suggests that the clinical effect of acupuncture is better than that of oral western medicine in the treatment of aMCI;Acupuncture can improve MoCA score more effectively than oral nimodipine or Allison western medicine;The clinical efficacy of acupuncture combined with western medicine is better than that of simple western medicine;Acupuncture combined with western medicine can effectively improve the MMSE score of patients than oral western medicine alone;Acupuncture combined with western medicine can shorten the latency of ERP-P300 and increase the amplitude of ERPP300;The clinical effect of characteristic acupuncture is better than that of conventional acupuncture,which can effectively improve the scores of MMSE and MoCA;It is impossible to judge whether acupuncture combined with health education or cognitive training or health education or cognitive training alone can more effectively improve the MMSE score of patients;Acupuncture combined with health education or cognitive training can more effectively improve patients’ MoCA score than health education or cognitive training.Sensitivity analysis showed that the sensitivity of meta-analysis in each study group was low,and the results were stable and reliable.Finally,only 35 cases of aMCI completed the study(1 case in the acupuncture group fell off due to factors unrelated to treatment),17 cases in the acupuncture group and 18 cases in the comfort acupuncture group.Before treatment,there was no significant difference between the two groups in gender,age,course of disease,education and scale scores(P>0.05).The baseline was the same,suggesting that the two groups were well comparable.After treatment,there was no change in ADL score between the two groups;The MMSE score of acupuncture group increased from 23.71±1.90 to 26.82±1.74(t=12.950,P=0.000<0.01),and that of comfort acupuncture group increased from 24.44±2.55 to 25.56±1.92(t=-2.473,P=0.024<0.02)The score of MoCA in acupuncture group increased from 21.06 ± 2.70 to 25.24±1.89(t=-11.732,P=0.000<0.01),and that in comfort acupuncture group increased from 21.00±1.85 to 23.22±1.52(t=-4.610,P=0.000<0.01).After treatment,the score of acupuncture group increased more(t=3.487,P=0.001).The DSR score of acupuncture group increased from 5.00 ± 1.84 to 7.71± 1.11(T/z=-3.639,P=0.000<0.01),and that of comfort acupuncture group increased from 5.11 ± 1.84 to 6.11± 1.61(t=-3.571,P=0.002<0.01).After treatment,the score of acupuncture group increased more(t=-3.040,P=0.002<0.01).The HAMD score of acupuncture group decreased from 7.06±2.68 to 4.12 ± 1.45(t=7.080,P=0.000<0.01),and that of comfort acupuncture group decreased from 7.83± 2.12 to 6.28±1.41(t=5.504,P=0.000<0.01).The score of acupuncture group decreased more significantly after treatment(t=-4.470,P=0.000<0.01).The score of ADAS-cog in acupuncture group decreased from 26.94± 4.37 to 22.41± 2.60(t=9.043,P=0.000<0.01),and that in comfort acupuncture group decreased from 26.00±3.73 to 24.39±2.45(t=3.692,P=0.002<0.01).After treatment,the score of acupuncture group decreased more significantly(t=-2.315,P=0.027<0.05);In the acupuncture group,10 cases were markedly effective(58.80%),4 cases were effective(23.53%),3 cases were ineffective(17.65%),and the total effective rate was 82.35%.In the comfort acupuncture group,4 cases were markedly effective(22.22%),8 cases were effective(44.44%),6 cases were ineffective(33.33%),and the total effective rate was 66.67%.The comparison between the total effective rate groups suggested that the acupuncture group was more effective(z=3.885,P=0.049<0.05)The blind test showed that the two groups were successful.There were no obvious adverse events in both groups.One year follow-up after treatment:the MMSE in the acupuncture group decreased from 26.82± 1.74 to 25.76±1.48,the difference was highly statistically significant(t=7.856,P=0.000<0.01),but it was still higher than the score before treatment,and the difference was highly statistically significant(t=-8.250,P=0.000<0.01).The comfort acupuncture group decreased from 25.56±1.92 to 24.94 ±2.13,the difference was statistically significant(t=2.374,P=0.030<0.05),but it was still higher than the score before treatment,the difference was statistically significant(t=2.153,P=0.046<0.05);in the comparison between the two groups,there was no statistically significant difference(t=1.316,P=0.197>0.05).In the comparison within the acupuncture group,MoCA decreased from 25.24±1.89 to 24.59±1.70,after treatment,the difference was highly statistically significant(t=3.801,P=0.002<0.01),but it was still higher than the score before treatment,the difference was highly statistically significant(t=-9.670,P=0.000<0.01);the comfort acupuncture group decreased from 23.22 ± 1.52 to 22.22±1.44,the difference was statistically significant(t=3.000,P=0.008<0.01),but still higher than the score before treatment,the difference was statistically significant(t=-5.905,P=0.000<0.01);in the comparison between the two groups,the difference was highly statistically significant(t=4.437,P=0.000<0.01),In the comparison within the group,ADAS-cog in the acupuncture group increased from 22.41±2.60 to 23.41±2.45 after treatment,the difference was highly statistically significant(t=-8.246,P=0.000<0.01),but it was still higher than the score before treatment,and the difference was highly statistically significant(t=6.581,P=0.000<0.01);the comfort needle group increased from 24.39± 2.45 to 25.28±3.16,and the difference was statistically significant(t=-3.189,P=0.005<0.01),but it was still higher than the score before treatment,and the difference was statistically significant(t=3.708,P=0.002<0.01);in the comparison between the two groups,the difference was not statistically significant(t=-1.944,P=0.06>0.05).Neither group found any cases transformed into ad.According to the follow-up data,according to the latest diagnostic criteria of AD and Related Diseases Association(NINCDS-ADRDA)of the National Institute of neurolinguistic disorders and stroke,no case was found to be transformed into ad in both groups.ConclusionAcupuncture combined with basic treatment(symptomatic support+Down’s finger exercise education+cognitive function rehabilitation training)and comfort acupuncture combined with basic treatment can effectively improve the cognitive function and depression of patients with aMCI,but it has no effect on the ability of daily living.The treatments used in both groups could not significantly improve the response ability reflected in the latency of ERP-P300,but acupuncture combined with basic treatment could improve the attention reflected in the amplitude.Acupuncture therapy can effectively improve the overall cognitive function and depression of aMCI patients,with good safety,simple and convenient operation,which is suitable for further clinical application.Symptomatic support combined with computerized cognitive rehabilitation exercise and Down’s finger exercise health education can effectively improve the overall cognitive function and depression of aMCI patients.It is necessary to further study the separate efficacy of cognitive rehabilitation exercise and Down’s finger exercise education.Acupuncture and basic treatment can effectively reduce the annual AD conversion rate of aMCI,and the combination of the two is more effective. |
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