针刺配合语言训练治疗早期缺血性中风失语症的临床与机理研究
|
摘要
目的:观察针刺配合语言训练治疗早期缺血性中风失语症的临床疗效,探讨针刺治疗本病的机理。
方法:将58例符合临床要求的早期缺血性中风失语症患者,随机分为治疗组(针刺配合语言训练)和对照组(语言训练)。应用醒脑开窍针刺法和Schuell氏刺激法分别对两组患者进行治疗,并在疗程前后以《汉语标准失语症检查表》(CRRCAE)各作一次语言检测评价;治疗组在疗程前采用经颅多普勒(TCD)进行针刺前后(即刻)脑血流检测;疗程前后进行事件相关电位(P_(300))检测;并且将脑血流检测与语言检测结果进行相关、回归分析。在针刺治疗本病的机理探讨方面,应用大鼠大脑中动脉阻塞(MCAO)再灌流模型,原位杂交方法,观察脑缺血再灌流后BDNF mRNA表达及时程变化。通过电针刺激大鼠臂丛神经干(穴位及其附近),观察针刺对缺血性脑损伤后BDNF mRNA的表达的调节作用。
结果:根据语言检测评价两组各项语言功能得分均有不同程度提高,治疗组各项语言功能(除书写外)得分及疗效方面,均优于对照组(p<0.05);治疗组针刺前后(即刻)脑血流检测,左侧大脑中动脉(MCA)、大脑后动脉(PCA)的平均血流速度(Vm)显著改善(p<0.05);搏动指数(PI)和阻力指数(RI),未见显著差异;左侧脑平均血流速度(Vm)的改善与言语功能得分提高率呈高度正相关(r=0.833);疗程前后事件相关电位(P_(300))的潜伏期明显缩短(p<0.01);波幅未见显著改变。机理探讨方面,皮层与文状体BDNF mRNA表达的时程变化,正常对照组大脑有基础水平的BDNF mRNA的表达;假手术对BDNF mRNA的表达无显著影响;在MCAO后脑缺血1h再灌流2h,6h,12h,24h,2d,3d后,BDNF mRNA的表达显著增加,并呈现双驼峰升高现象,皮层表达显著高于纹状体BDNF mRNA的表达;其中皮层分别在2h、24h时达到高峰,后一峰值较高且持续时间长;然后逐渐降低,再灌流7d阳性细胞数仍维持较高水平,14d时BDNF mRNA的表达降至基础水平。纹状体表达高峰分别在2h、2d至3d,然后逐渐降低,再灌流7d阳性细胞数仍显著低于皮层,14d时BDNF mRNA的表达降至基础水平。电针对缺血再灌
OBJECTIVE: To observe the therapeutic effect of acupuncture associated with language training treating early-stage aphasia from ischemic apoplexy, meanwhile to investigate the acupuncture therapy mechanism. Methods: Fifty-eight cases with early-stage aphasia from ischemic apoplexy were randomly divided into the treatment group (acupuncture associated with language training) and the control group (language training). The two groups were treated by "Xing Nao Kai Qiao"(XNKQ) acupuncture therapy and Schuell' stimulating method respectively, and given language examination evaluation before and after course of treatment according to(CRRCAE), the treatment group were given cerebral blood flow examination before and after acupuncture treatment instantly by transcranial Doppler (TCD) and given accident correlated electric potential (P300) examination before and after the course of treatment, and further the correlation and regression relationship was analyzed between cerebral blood flow examination results and language examination results. In order to study the acupuncture's therapeutic mechanism, we applied rats of middle cerebral artery obstruction (MCACO) reperfusion and in situ hybridization methods, and observed BDNF mRAN expression and time change after cerebral ischemic reperfusion. Through electro-acupuncture stimulating rat's brachial plexus nerve trunk (acupoints and their neighboring), we observed the function of acupuncture regulating the BDNF mRNA expression after cerebral ischemic reperfusion.RESULT: According to language examination evaluation, the scores of each language function in two groups increased in different degrees. Both the scores of each language function (except writing function) and the curative effect in treatment group were superior to those in control group
(P<0.05). After acupuncture, the treatment group had instantly remarkable improvement in the mean blood velocity (Vm) of middle cerebral artery (MCA) and posterior cerebral artery (PCA) in the left hemisphere (P<0.05), but there were no significant difference in pulsation index (PI) and resistance index (RI). It appeared highly positive correlated relationship between the improvement of the mean blood flow velocity in the left hemisphere and the elevation ratio of language function scores(r=0.883). After course of treatment, the incubation period of accident correlated electric potential (P300) had been markedly shortened (P<0.01), but the wave amplitude had no significant change. The time change of the BDNF mRNA expression in cortex and corpus striatum was different in different groups: BDNF mRNA expression in normal control rat brain was at basal level, sham-operation had no effect on BDNF mRNA expression, and after the MCAO rats had been in the state of cerebral ischemia for an hour, at reperfusion 2h, 6h, 12h, 24h, 2d and 3d, BDNF mRNA expression increased significantly, which appeared double-hump rising. BDNF mRNA expression in cortex was notably higher than that in corpus striatum, the peak in cortex was at 2h and 24h, the latter peak value was higher and lasted for a longer time, then decreased gradually. The amount of positive cells was still at higher level at reperfusion 7d,and at 14d BDNF mRNA expression decreased to basal level. The peak of BDNF mRNA expression in corpus striatum was at 2h and 2d to 3d, and then decreased gradually. The amount of positive cells was still significantly less than that of cortex at reperfusion 7d. and at 14d BDNF mRNA expression decreased to basal level. Electro-acupuncture had an effect on BDNF mRNA expression, which began to rise at reperfusion 6h and kept at high level at 24h, 2d, 3d, 7d and 14d, and had significant difference compared to the control group. CONCLUSION: The therapeutic effect of acupuncture associated with language training was obviously superior to the control group (simple language training) in five items of language function improvement and clinical effect. Acupuncture could instantly improve the patient's left
方法:将58例符合临床要求的早期缺血性中风失语症患者,随机分为治疗组(针刺配合语言训练)和对照组(语言训练)。应用醒脑开窍针刺法和Schuell氏刺激法分别对两组患者进行治疗,并在疗程前后以《汉语标准失语症检查表》(CRRCAE)各作一次语言检测评价;治疗组在疗程前采用经颅多普勒(TCD)进行针刺前后(即刻)脑血流检测;疗程前后进行事件相关电位(P_(300))检测;并且将脑血流检测与语言检测结果进行相关、回归分析。在针刺治疗本病的机理探讨方面,应用大鼠大脑中动脉阻塞(MCAO)再灌流模型,原位杂交方法,观察脑缺血再灌流后BDNF mRNA表达及时程变化。通过电针刺激大鼠臂丛神经干(穴位及其附近),观察针刺对缺血性脑损伤后BDNF mRNA的表达的调节作用。
结果:根据语言检测评价两组各项语言功能得分均有不同程度提高,治疗组各项语言功能(除书写外)得分及疗效方面,均优于对照组(p<0.05);治疗组针刺前后(即刻)脑血流检测,左侧大脑中动脉(MCA)、大脑后动脉(PCA)的平均血流速度(Vm)显著改善(p<0.05);搏动指数(PI)和阻力指数(RI),未见显著差异;左侧脑平均血流速度(Vm)的改善与言语功能得分提高率呈高度正相关(r=0.833);疗程前后事件相关电位(P_(300))的潜伏期明显缩短(p<0.01);波幅未见显著改变。机理探讨方面,皮层与文状体BDNF mRNA表达的时程变化,正常对照组大脑有基础水平的BDNF mRNA的表达;假手术对BDNF mRNA的表达无显著影响;在MCAO后脑缺血1h再灌流2h,6h,12h,24h,2d,3d后,BDNF mRNA的表达显著增加,并呈现双驼峰升高现象,皮层表达显著高于纹状体BDNF mRNA的表达;其中皮层分别在2h、24h时达到高峰,后一峰值较高且持续时间长;然后逐渐降低,再灌流7d阳性细胞数仍维持较高水平,14d时BDNF mRNA的表达降至基础水平。纹状体表达高峰分别在2h、2d至3d,然后逐渐降低,再灌流7d阳性细胞数仍显著低于皮层,14d时BDNF mRNA的表达降至基础水平。电针对缺血再灌
OBJECTIVE: To observe the therapeutic effect of acupuncture associated with language training treating early-stage aphasia from ischemic apoplexy, meanwhile to investigate the acupuncture therapy mechanism. Methods: Fifty-eight cases with early-stage aphasia from ischemic apoplexy were randomly divided into the treatment group (acupuncture associated with language training) and the control group (language training). The two groups were treated by "Xing Nao Kai Qiao"(XNKQ) acupuncture therapy and Schuell' stimulating method respectively, and given language examination evaluation before and after course of treatment according to
(P<0.05). After acupuncture, the treatment group had instantly remarkable improvement in the mean blood velocity (Vm) of middle cerebral artery (MCA) and posterior cerebral artery (PCA) in the left hemisphere (P<0.05), but there were no significant difference in pulsation index (PI) and resistance index (RI). It appeared highly positive correlated relationship between the improvement of the mean blood flow velocity in the left hemisphere and the elevation ratio of language function scores(r=0.883). After course of treatment, the incubation period of accident correlated electric potential (P300) had been markedly shortened (P<0.01), but the wave amplitude had no significant change. The time change of the BDNF mRNA expression in cortex and corpus striatum was different in different groups: BDNF mRNA expression in normal control rat brain was at basal level, sham-operation had no effect on BDNF mRNA expression, and after the MCAO rats had been in the state of cerebral ischemia for an hour, at reperfusion 2h, 6h, 12h, 24h, 2d and 3d, BDNF mRNA expression increased significantly, which appeared double-hump rising. BDNF mRNA expression in cortex was notably higher than that in corpus striatum, the peak in cortex was at 2h and 24h, the latter peak value was higher and lasted for a longer time, then decreased gradually. The amount of positive cells was still at higher level at reperfusion 7d,and at 14d BDNF mRNA expression decreased to basal level. The peak of BDNF mRNA expression in corpus striatum was at 2h and 2d to 3d, and then decreased gradually. The amount of positive cells was still significantly less than that of cortex at reperfusion 7d. and at 14d BDNF mRNA expression decreased to basal level. Electro-acupuncture had an effect on BDNF mRNA expression, which began to rise at reperfusion 6h and kept at high level at 24h, 2d, 3d, 7d and 14d, and had significant difference compared to the control group. CONCLUSION: The therapeutic effect of acupuncture associated with language training was obviously superior to the control group (simple language training) in five items of language function improvement and clinical effect. Acupuncture could instantly improve the patient's left
引文
1 高素荣.失语症北京.北京医科大学、中国协和医科大学联合出版社,1992
2 Wade DT, et al. JNcurol Neurosurg Psychiat 1986; 49: 11
3 Pedersen PM. et al. Ugeskr Laeger, 1997; 159(8): 1109—1113
4 李红玲.刘亚玲.任力,等.脑卒中患者言语功能障碍的发生及影响因素[J].中国康复医学杂志,2003,18(8):473-475.
5 许振亚,陈景礼,心脑血管病的诊断与治疗[M].北京:科学出版社,2001:311
6 胡超群 有关失语症康复实践的几点思考 中国康复医学杂志 1992年第7卷第5期:217
7 王荫华 白静 急性脑皿管病患者汉语失语症早期康复的研究 中国康复医学杂志.2001年.第16卷.第5期:273
8 高宗恩 编译 失语症的药物治疗 国外医学脑血管疾病分册 1995年第3卷第6期:319
9 汪洁 失语症的治疗及其进展 实用老年医学 2003年第17卷第1期:10
10. TanakaY, MiyazakiM, AlbertML. Effectofincreasedcholinergicactivityonnamingina phasia[J]. Lancet, 1997, 350(9071): 116
11. AlbertM L, BachmanDL, MorganA, etal. Pharmacotherapy foraphasia[J]. Neu-rology, 1988, 38
2 Wade DT, et al. JNcurol Neurosurg Psychiat 1986; 49: 11
3 Pedersen PM. et al. Ugeskr Laeger, 1997; 159(8): 1109—1113
4 李红玲.刘亚玲.任力,等.脑卒中患者言语功能障碍的发生及影响因素[J].中国康复医学杂志,2003,18(8):473-475.
5 许振亚,陈景礼,心脑血管病的诊断与治疗[M].北京:科学出版社,2001:311
6 胡超群 有关失语症康复实践的几点思考 中国康复医学杂志 1992年第7卷第5期:217
7 王荫华 白静 急性脑皿管病患者汉语失语症早期康复的研究 中国康复医学杂志.2001年.第16卷.第5期:273
8 高宗恩 编译 失语症的药物治疗 国外医学脑血管疾病分册 1995年第3卷第6期:319
9 汪洁 失语症的治疗及其进展 实用老年医学 2003年第17卷第1期:10
10. TanakaY, MiyazakiM, AlbertML. Effectofincreasedcholinergicactivityonnamingina phasia[J]. Lancet, 1997, 350(9071): 116
11. AlbertM L, BachmanDL, MorganA, etal. Pharmacotherapy foraphasia[J]. Neu-rology, 1988, 38
© 2004-2018 中国地质图书馆版权所有 京ICP备05064691号 京公网安备11010802017129号 地址：北京市海淀区学院路29号 邮编：100083 电话：办公室：(+86 10)66554848；文献借阅、咨询服务、科技查新：66554700 |