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The effect of electroacupuncture preconditioning on cognitive impairments following knee replacement among elderly: A randomized controlled trial
电针预处理对膝关节置换术后老年患者认知功能障碍的影响：随机对照试验
ARTICLE INFO
Fei-yi ZHAO (赵非一) a, Zhe-yuan ZHANG (张浙元) b, Ying-xia ZHAO (赵英侠) c, Hai-xia YAN (燕海霞) c, Yu-fang HONG (洪钰芳) a, Xiao-jie XIA (夏小芥) d, Hong XU (许红) a*
a. Shanghai Municipal Hospital of TCM affiliated to Shanghai University of TCM, Shanghai 200071, China (上海中医药大学附属市中医医院，上海200071，中国)
b. Haiyan People’s Hospital, Zhejiang 314300, China (海盐人民医院，浙江314300，中国)
c. School of Basic Medical Sciences, Shanghai University of TCM, Shanghai 201203, China (上海中医药大学基础医学院，上海201203，中国)
d. Department of Education, East China Normal University, Shanghai 200062, China (华东师范大学教育学部，上海200062，中国)
☆Supported by Key and Weak Discipline Construction Project (Gerontology of TCM), Shanghai Municipal Commission of Health and Family Planning(2015ZB050), Project of Science and Technology Commission of Shanghai Municipality(16401902600).
* Corresponding author.
E-mail address: 0449@szy.sh.cn (H. XU).
ABSTRACT
Objective: To investigate if electroacupuncture (EA) preconditioning can mitigate cognitive impairments and reduce the incidence of postoperative cognitive dysfunction (POCD) following knee replacement and its safety among elderly. Methods: Totally 60 participants met the inclusion criteria were enrolled in a randomized controlled trial a ratio of 1:1, with 30 cases allocated to the treatment group and 30 cases allocated to the control group, respectively. The participants in the treatment group were provided with real-EA therapy whereas participants in control group were provided with placebo-EA therapy (Streitberger Placebo-needle). In both groups, Tou sanshen (头三神) acupoints, including Sìshéncōng (四神聪EX-HN1), Shéntíng (神庭 GV24), and bilateral Běnshén (本神GB13) were adopted as the main acupoints, while Bǎihuì (百会GV20), bilateral Hégǔ (合谷LI4), and bilateral Tàichōng (太冲LR3) were adopted as matching acupoints. Interventions were offered 5 days prior to the surgery, once daily, and continued for total 5 days. The global scores of Mini-Mental State Examination (MMSE), and levels of serum inflammatory cytokines including interleukin 1β (IL-1β) and tumor necrosis factor-α (TNF-α), and S100-β protein were observed at 24 hours prior to the surgery, and postoperative 24 and 72 hours respectively for assessing the incidence of POCD and the severity of cognitive impairments among patients. Meanwhile, adverse effects were monitored and recorded. Results: (1) Compared with baseline, MMSE global scores in both treatment and control groups markedly decreased at postoperative 24 hours. MMSE global scores in treatment group decreased from 29.43±0.97 to 27.10±1.95 while that in control group decreased from 29.27±1.01 to 26.83±2.25 (all ?P<0.05), and this trend continued until postoperative 72 hours (at postoperative 72 hours, MMSE global scores in treatment group was 26.53±2.26 versus 24.79±3.03 in control group). Moreover, decline in control group was more significant than that in treatment group at postoperative 72 hours (P<0.05). (2) Compared with baseline, levels of serum IL-1β, TNF-α and S100-β in both groups increased markedly at postoperative 24 hours and 72 hours. IL-1β in treatment group increased from 43.13±5.51 to 73.13±2.32 at postoperative 24 hours and reached 83.17±5.95 at postoperative 72 hours, while IL-1β in control group increased from 44.87±5.83 to 91.10±3.55 at postoperative 24 hours and reached 111.93±9.18 at postoperative 72 hours; TNF-α in treatment group increased from 51.27±6.48 to 88.80±3.55 at postoperative 24 hours and reached 94.37±5.22 at postoperative 72 hours, while TNF-α in control group increased from 52.07±7.48 to 116.37±3.14 at postoperative 24 hours and reached 121.40±3.68 at postoperative 72 hours (both ?P<0.05), furthermore, increases of IL-1β and TNF-α levels in control group were more significant (P<0.05). Statistical difference in level of S100-β was not observed (P>0.05). (3) There was no statistical difference in POCD incidence at postoperative 24 hours and postoperative 72 hours between two groups (P>0.05), though the incidence of POCD in patients receiving real-EA therapy was indeed much lower than that in patients receiving placebo-EA therapy, particularly at postoperative 72 hours (POCD incidence rate at postoperative 24 hours in treatment group was 26.67%, 30.00% in control group; POCD incidence rate at postoperative 72 hours in treatment group was 30.00%, 46.67% in control group). (4) No serious adverse events were reported in this trial. No one dropped out from this trial.
Conclusion: EA preconditioning can mitigate cognitive impairments at post-knee replacement surgery 24 hours and 72 hours in elderly through inhibiting expression of inflammation. However, there is insufficient evidence to support that EA pretreatment can reduce the incidence of POCD.
Key Words: Postoperative cognitive dysfunction； Electroacupuncture； Preconditioning；
Knee replacement； Elderly
ABSTRACT IN CHINESE
[摘要]目的：调查电针预处理是否可以有效降低老年膝关节置换术后认知障碍(postoperative cognitive dysfunction，POCD)的发病率、减轻认知损害，观察其安全性。方法：将符合入组标准的60例受试者按1:1的比例随机分入治疗组和对照组，每组30例。治疗组的受试者接受真实电针治疗，而对照组的受试者则接受安慰电针治疗。两组均选择“头三神”穴（包括四神聪、神庭和双侧本神）作为主穴，百会、双侧合谷及双侧太冲作为配穴。两组受试者均在手术前5天开始接受治疗，每日1次，连续治疗5天。术前24小时、术后24小时以及术后72小时，分别予以简易精神状态评价量表(Mini-mental State Examination，MMSE)进行认知功能测试，并观察血清炎症因子IL-1β，TNF-α以及S100-β蛋白表达水平的变化，以此客观评价电针预处理对降低老年膝关节置换术后POCD发生率以及减轻术后认知损害的有效性，同时观察并记录不良反应事件。结果：(1)和基线相比，术后24小时，治疗组MMSE总分由29.43±0.97下降至27.10±1.95，对照组由29.27±1.01下降至26.83±2.25 (均P<0.05)，下降的趋势一直持续到术后72小时（术后72小时，治疗组MMSE总分为26.53±2.26，对照组为24.79±3.03）(均P<0.05)；对照组MMSE评分下降比治疗组更显著(P<0.05)。(2)术后24小时及72小时，治疗组IL-1β在术后24小时由43.13±5.51升高至73.13±2.32，并在术后72小时达到83.17±5.95；对照组IL-1β在术后24小时由44.87±5.83升高至91.10±3.55，并在术后72小时达到111.93±9.18。治疗组TNF-α在术后24小时由51.27±6.48升高至88.80±3.55，并在术后72小时达到94.37±5.22；对照组TNF-α在术后24小时由52.07±7.48升高至116.37±3.14并在术后72小时达到121.40±3.68 (P<0.05)，且对照组比治疗组升高更明显(P<0.05)。两组间S100-β水平无统计学差异(P>0.05)；(3)术后24小时，治疗组POCD发生率为26.67% ，对照组POCD发生率为30.00%；术后72小时，治疗组POCD发生率为30.00% ，对照组POCD发生率为46.67%，但两组相比差异无统计学意义(均P>0.05)。(4)研究过程中无明显不良反应事件，无受试者退出中途退出试验。结论：电针预处理可以在一定程度上减轻行膝关节置换术的老年患者术后24小时及72小时的认知损害的程度，其机制可能与抑制炎症表达相关，但尚无证据证明术前电针预处理可以有效降低POCD的发生率。
[关键词]术后认知障碍；电针；预处理；膝关节置换术；老年人
《世界针灸杂志 》World Journal of Acupuncture-Moxibustion
《世界针灸杂志》（英文版）创刊于1991年，是由国家中医药管理局主管，世界针灸学会联合会、中国中医科学院针灸研究所和中国针灸学会联合主办的国际性针灸学术期刊。《世界针灸杂志》全世界发行，同期发行意大利文版。
2012年，《世界针灸杂志》被收录进入Science Direct数据库。2015年，被中国科学引文数据库（CSCD）核心库收录。2016年被国际著名科学文献出版公司科睿唯安（原汤森路透集团） Emerging Sources Citation Index（ESCI）收录，可在Web of Science 核心集合子集中查询，与SCI源刊同路径检索与下载。《世界针灸杂志》编委会由全球范围内的46位知名专家组成，其中境外专家占58.7%。2018年起，《世界针灸杂志》成为爱思唯尔全流程合作期刊，全面实现了出版流程和排版的国际化。
World Journal of Acupuncture-Moxibustion (WJAM) was established in 1991, which has been administered by State Administration of Traditional Chinese Medicine of the People's Republic of China, sponsored by World Federation of Acupuncture-Moxibustion Societies (WFAS), Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences (CACMS) and China Association of Acupuncture and Moxibustion (CAAM). It is an English version academic journal from China and publish throughout the world, and the Italian version is published correspondingly.
In 2012, WJAM was collected by Science Direct. In 2015, WJAM was collected by Chinese Science Citation Database (CSCD). In 2016, WJAM was selected into the Emerging Sources Citation Index (ESCI) which is hold by the famous International scientific literature publishing company Clarivate Analytics (original Thomson Reuters). The papers of WJAM can be searched in the subset of Web of Science Core Collection and can be searched and downloaded the same way as the journals collected by Science Citation Index (SCI). The fifth editorial board of WJAM consists of 46 renowned experts all over the world and 58.7% of them are outside China mainland. From the beginning of 2018, WJAM has been the full-service journal of Elsevier, and the edit and production becoming more standard and international.
英文投稿网址：
https://www.journals.elsevier.com/world-journal-of-acupuncture-moxibustion
中文投稿网址：
http://sjja.cbpt.cnki.net/WKA3/WebPublication/index.aspx?mid=sjja
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