【目的】 观察头针联合重复经颅磁刺激治疗轻中度血管性痴呆患者的临床疗效，并探讨其可能的作用机制。【方法】 选 取2021年7月至2023年5月河北省沧州中西医结合医院门诊及病房收治的102例明确诊断为轻中度血管性痴呆的患者为研究 对象。按照随机数字表将患者随机分为观察组和对照组，每组各51例。对照组给予重复经颅磁刺激治疗，观察组在对照组 治疗的基础上，给予头针疗法治疗，共治疗16周。治疗后，评价2组临床疗效。观察2组患者治疗前后简易智力状态检查量 表（MMSE）评分、蒙特利尔认知评估量表（MoCA）评分和中医证候积分的变化情况，以及血清中脑源性神经营养因子 （BDNF）、血管内皮生长因子（VEGF）、同型半胱氨酸（Hcy）水平的情况。比较2组患者治疗前后前动脉、中动脉、后动脉的 脑血流速度，以及氧化脂质（LPO）、丙二醛（MDA）及超氧物歧化酶（SOD）水平的变化情况。并评价2组的安全性及不良反应 的发生情况。【结果】（1）治疗后，2组患者的MMSE、MoCA评分均明显改善（P＜0.05），且观察组在改善MMSE、MoCA评分 方面明显优于对照组，差异有统计学意义（P＜0.05）。（2）治疗后，2 组患者的血清 BDNF、VEGF、Hcy 水平明显改善（P＜ 0.05），且观察组在改善血清 BDNF、VEGF、Hcy水平方面明显优于对照组，差异有统计学意义（P＜0.05）。（3）治疗后，2组 患者的后动脉、中动脉、前动脉的脑血流速度明显改善（P＜0.05），且观察组在改善后动脉、中动脉、前动脉的脑血流速度 方面明显优于对照组，差异有统计学意义（P＜0.05）。（4）治疗后，2组患者的 LPO、MDA、SOD 含量均明显改善（P＜0.05）， 且观察组在改善LPO、MDA、SOD含量方面明显优于对照组，差异有统计学意义（P＜0.05）。（5）治疗后，2组患者各项中医证 候积分均明显改善（P＜0.05），且观察组在改善各项中医证候积分方面均明显优于对照组，差异有统计学意义（P＜0.05）。 （6）观察组总有效率为 88.24%（45/51），对照组为 70.59%（36/51）。观察组疗效优于对照组，差异有统计学意义（P＜0.05）。 （7）观察组不良反应发生率为3.92%（2/51）；对照组为1.96%（1/51）。观察组与对照组的不良反应发生率比较，差异无统计学 意义（P＞0.05）。【结论】 头针联合重复经颅磁刺激治疗轻中度血管性痴呆，有助于调节患者的脑血流动力学及神经因子表达， 改善患者的认知功能，疗效显著，且安全性良好。

Objective To observe the clinical efficacy of scalp acupuncture combined with repetitive transcranial magnetic stimulation in the treatment of patients with mild to moderate vascular dementia and to explore its potential mechanism of action. Methods A total of 102 patients diagnosed with mild to moderate vascular dementia who were treated in the outpatient and inpatient departments of Cangzhou Hospital of Integrated Traditional Chinese and Western Medicine from July 2021 to May 2023 were selected as the study subjects. The patients were randomly divided into an observation group and a control group using a random number table，with 51 patients in each group. The control group received repetitive transcranial magnetic stimulation treatment， while the observation group received scalp acupuncture therapy in addition to the treatment given to the control group. The treatment lasted for 16 weeks. After treatment，the clinical efficacy of the two groups was evaluated. Changes in the Mini-Mental State Examination （MMSE） scores，Montreal Cognitive Assessment （MoCA） scores，and traditional Chinese medicine （TCM） syndrome scores were observed before and after treatment. Additionally， serum levels of brain-derived neurotrophic factor （BDNF）， vascular endothelial growth factor （VEGF）， and homocysteine （Hcy） were measured. The cerebral blood flow velocities in the anterior，middle，and posterior arteries，as well as the levels of lipid peroxide （LPO），malondialdehyde （MDA），and superoxide dismutase （SOD），were compared between the two groups before and after treatment. The safety and incidence of adverse reactions in both groups were also evaluated. Results （1） After treatment，the MMSE and MoCA scores of both groups were significantly improved （P＜0.05）， and the observation group showed significantly better improvement in MMSE and MoCA scores compared to the control group， with a statistically significant difference （P＜0.05）.（2） After treatment， the serum levels of BDNF， VEGF， and Hcy in both groups were significantly improved （P＜0.05）， and the observation group showed significantly better improvement in these levels compared to the control group，with a statistically significant difference （P＜0.05）. （3） After treatment， the cerebral blood flow velocities in the posterior， middle， and anterior arteries were significantly improved in both groups （P＜0.05）， and the observation group showed significantly better improvement in these velocities compared to the control group，with a statistically significant difference（P＜0.05）.（4）After treatment， the levels of LPO， MDA， and SOD were significantly improved in both groups（P＜0.05）， and the observation group showed significantly better improvement in these levels compared to the control group，with a statistically significant difference（P＜0.05）. （5）After treatment， the TCM syndrome scores improved significantly in both groups（P＜0.05）， and the observation group showed significantly better improvement in these scores compared to the control group，with a statistically significant difference（P＜0.05）.（6） The total effective rate in the observation group was 88.24% （45/51），while it was 70.59% （36/51） in the control group. The efficacy of the observation group was superior to that of the control group， with a statistically significant difference （P＜0.05）.（7） The incidence of adverse reactions in the observation group was 3.92% （2/51），while it was 1.96%（1/51） in the control group. There was no statistically significant difference in the incidence of adverse reactions between the two groups（P＞0.05）. Conclusion Scalp acupuncture combined with repetitive transcranial magnetic stimulation in the treatment of mild to moderate vascular dementia helps regulate cerebral hemodynamics and neurotrophic factor expression，improves cognitive function，and demonstrates significant efficacy with good safety.

R246.9

河北省中医药管理局资助项目（编号：2023265）