Study On The Effect Of Acupuncture In The Treatment Of Vascular Mild Cognitive Impairment Based On Plasma Metabolomics

Background: Vascular mild cognitive impairment(VaMCI)is a disease with cognitive impairment such as executive dysfunction and memory loss.It is an early clinical state of vascular dementia(VaD).Both belong to vascular cognitive impairment(VCI).VCI has been recognized as the second most common cause of dementia,second only to Alzheimer’s disease(AD).As the early stage of VCI,VaMCI is currently at a high incidence rate and has a more serious long-term effect.Early diagnosis and intervention therapy can significantly improve the quality of life of patients,delay or even prevent further development of irreversible dementia.Metabolomics is a technology used to determine low molecular metabolites with molecular weight of 100～1500 Da,and conduct qualitative and quantitative analysis to explore the correlation between physiological and pathological changes and metabolites in organisms.It has been applied to the study of central nervous system diseases.At present,a large number of clinical and basic studies have confirmed that acupuncture has a good curative effect on VCI,can effectively improve patients’ cognitive impairment,and has the advantages of safety,green,and almost no side effects.However,the mechanism of acupuncture action is still in the stage of continuous in-depth exploration.Most studies start from the perspective of inflammatory response and oxidative stress,and few literature studies explore the intervention effect of acupuncture on the prevention and treatment of VCI based on plasma metabolomics technology.Metabolomics can reflect the overall metabolic changes in the organism,capture the subtle expression differences of differential metabolites,more comprehensively and intuitively reflect the impact of acupuncture intervention on the organism,and provide more valuable information for explaining the law of acupuncture effect and biological basis.Objective: Taking patients with vascular mild cognitive impairment as the research object,observe the changes of plasma metabolite spectrum before and after acupuncture treatment,and preliminarily explore the intervention effect and mechanism of acupuncture on vascular mild cognitive impairment from the perspective of differential metabolites.Methods: The clinical data were collected from the outpatients and inpatients of the Department of Acupuncture of First Teaching Hospital of Tianjin University of Traditional Chinese Medicine from June 2021 to September 2021.34 patients were selected according to the inclusion and exclusion criteria of this study.The patients were treated with acupuncture on the basis of keeping their original routine treatment,and the acupoints were selected as "Sanjiao acupuncture method".The acupoints were Tanzhong,Zhongwan,Qihai,Waiguan,Xuehai and Zusanli.Add Baihui,Shenting,Taixi,Shenmen.Each treatment lasted 30 minutes,three times a week for 12 weeks.Before the first treatment and after the last treatment,4ml of the patient’s median cubital vein blood was taken,anticoagulated with heparin lithium.The plasma was separated and centrifuged,stored in the refrigerator at-80 ℃.Unified detection was carried out after the completion of all patients’ trials.Results: After 3 months acupuncture treatment,there were differences in plasma metabolic spectrum of VaMCI patients.Compared with before treatment,the expression of plasma cholesterol(P<0.01),phosphatidylcholine(PC(18:1(9Z)/22:5(4Z,7Z,10 Z,13Z,16Z)),PC(16:0/20:4(8Z,11 Z,14Z,17Z)),PC(20:1(11Z)/18:4(6Z,9Z,12 Z,15Z)),PC(20:4(5Z,8Z,11 Z,14Z)/16:0),PC(16:0/16:1(9Z)),PC(18:2(9Z,12Z)/P-18:1(11Z)),PC(16:0/18:2(9Z,12Z))(all P<0.01)and PC(18:1(11Z)/18:1(11Z))(P<0.05)),Lysopho phosphatidylchol(PC(16:0/0:0),PC(O-16:0/0:0),PC(16:0/0:0)[rac](all P<0.05)),sphingomyelin(SM(d16:1/18:0),SM(d18:1/16:1)(both P<0.05)),C16 Sphinganine(P<0.05),maltotriose(P<0.01),stachyose(P<0.01)were significantly up-regulated after treatment,while DL-acetylcarnitine(P<0.05),L-acetylcarnitine(P<0.05),sphingomyelin(SM(d18:0/16:1(9z)),SM(d18:0/22:0)(both P<0.01))were significantly down-regulated after treatment,and the difference was statistically significant.Through pathway enrichment analysis of the screened differential metabolites,the differential metabolites involved in choline metabolism in cancer,basal cell carcinoma,glycerophospholipid metabolish(all P<0.01),cholesterol metabolism,necroptosis,cortisol synthesis and secretion,fat digestion and absorption,Cushing syndrome,sphingolipid signaling pathway,retrograde endocannabinoid signaling,ovarian steroidogenesis,insulin resistance,aldosterone synthesis and secretion and Bile secretion(all P<0.05),the difference was statistically significant.Conclusion: Acupuncture treatment can affect the plasma metabolic spectrum of patients with vascular mild cognitive impairment through direct effect or synergistic effect,and repair nerve injury or play a neuroprotective role by regulating multiple metabolic processes such as cholesterol metabolism,phospholipid metabolism,glucose metabolism and energy metabolism,so as to improve the performance of cognitive function of patients.