头针联合补阳还五汤对脑梗塞颈动脉粥样斑块患者IMT/r值、血清LP(α)水平及肢体功能的影响
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摘要
目的探讨头针联合补阳还五汤对脑梗塞颈动脉粥样斑块患者颈动脉内膜中层厚度/血管内径(IMT/r)值、血清脂蛋白(α)[LP(α)]水平及肢体功能的影响。方法选取2017年7月至2018年7月志丹县中医医院针灸科收治的120例脑梗塞伴颈动脉粥样斑块患者作为研究对象,按随机数表法将患者分为观察组和对照组,每组60例,对照组给予补阳还五汤治疗,观察组在对照组基础上联合头针针灸治疗,1次/d,10次为一个疗程,两组患者均治疗3个疗程,治疗结束后1周,比较两组患者的临床疗效以及治疗前后的血脂、颈动脉和肢体功能变化情况。结果观察组患者的临床治疗总有效率为95.00%,明显高于对照组的83.33%,差异有统计学意义(P<0.05);两组患者治疗后的总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白(LDL-C)水平均降低,高密度脂蛋白(HDL-C)水平升高,且治疗后观察组患者的TC、LDL-C水平分别为(3.81±1.06) mmol/L、(2.95±0.34) mmol/L,明显低于对照组的(4.53±1.13) mmol/L、(3.26±0.39) mmol/L,HDL-C水平为(1.39±0.40) mmol/L,明显高于对照组的(1.24±0.41) mmol/L,差异均有统计学意义(P<0.05);两组患者治疗后IMT、r、IMT/r和血清LP(α)水平均降低,且观察组IMT、r、IMT/r和血清LP(α)水平分别为(1.08±0.23) mm、(7.09±0.18) mm、(15.23±2.11)%、(17.12±4.28) ng/L,明显低于对照组的(1.28±0.29) mm、(7.20±0.20) mm、(17.78±2.15)%、(20.09±4.96) ng/L,差异均有统计学意义(P<0.05);两组患者治疗后ADL评分均升高,且观察组ADL评分为(91.35±8.28)分,明显高于对照组的(87.92±9.96)分,差异有统计学意义(P<0.05)。结论头针联合补阳还五汤治疗脑梗塞颈动脉粥样斑块可降血脂,稳定及消除颈动脉粥样斑块,促进患者肢体功能恢复,临床疗效显著。
Objective To investigate the effects of scalp acupuncture combined with Buyang Huanwu Decoction on carotid intima-media thickness/vascular internal radius(IMT/r), serum lipoprotein( α) [LP( α)] level, and limb function in cerebral infarction patients with carotid atherosclerotic plaque. Methods A total of 120 cerebral infarction patients with carotid atherosclerotic plaque admitted to Department of Acupuncture and Moxibustion, Zhidan Hospital of Traditional Chinese Medicine from July 2017 to July 2018 were selected as the study subjects. The patients were divided into observation group and control group according to random number table method, with 60 cases in each group. The control group was treated with Buyang Huanwu Decoction for 1 month, while the observation group was treated with scalp acupuncture for 3 month on the basis of the control group. One week after the end of treatment, the clinical effects of the two groups were observed, and the changes of blood lipid, carotid artery level, limb function before and after treatment were compared. Results The total clinical effective rate of the treatment group was 95.00%, which was significantly higher than 83.33% of the control group(P<0.05). The levels of total cholesterol(TC), triglyceride(TG), low density lipoprotein(LDL-C) decreased and high density lipoprotein(HDL-C) increased before and after treatment in both groups.After treatment, the levels of TC and LDL-C in the observation group were(3.81±1.06) mmol/L,(2.95±0.34) mmol/L, significantly lower than(4.53±1.13) mmol/L,(3.26±0.39) mmol/L in the control group, and the level of HDL-C were(1.39±0.40) mmol/L, significantly higher than(1.24±0.41) mmol/L in the control group(P<0.05). The levels of IMT, r, IMT/r,and serum LP(α) in the two groups were decreased before and after treatment(P<0.05). The levels of IMT, r, IMT/r, and serum LP(α) in the observation group were(1.08±0.23) mm,(7.09±0.18) mm,(15.23±2.11)%,(17.12±4.28) ng/L, significantly lower than(1.28±0.29) mm,(7.20±0.20) mm,(17.78±2.15)%,(20.09±4.96) ng/L in the control group(P<0.05).The ADL scores of the two groups before and after treatment increased, and the ADL score of the observation group was 91.35±8.28, significantly higher than 87.92±9.96 in the control group(P<0.05). Conclusion Scalp acupuncture combined with Buyang Huanwu Decoction is effective in treating cerebral infarction patients with carotid atherosclerotic plaque, which can reduce blood lipid, stabilize and eliminate carotid atherosclerotic plaque, and promote the recovery of limb function.
Objective To investigate the effects of scalp acupuncture combined with Buyang Huanwu Decoction on carotid intima-media thickness/vascular internal radius(IMT/r), serum lipoprotein( α) [LP( α)] level, and limb function in cerebral infarction patients with carotid atherosclerotic plaque. Methods A total of 120 cerebral infarction patients with carotid atherosclerotic plaque admitted to Department of Acupuncture and Moxibustion, Zhidan Hospital of Traditional Chinese Medicine from July 2017 to July 2018 were selected as the study subjects. The patients were divided into observation group and control group according to random number table method, with 60 cases in each group. The control group was treated with Buyang Huanwu Decoction for 1 month, while the observation group was treated with scalp acupuncture for 3 month on the basis of the control group. One week after the end of treatment, the clinical effects of the two groups were observed, and the changes of blood lipid, carotid artery level, limb function before and after treatment were compared. Results The total clinical effective rate of the treatment group was 95.00%, which was significantly higher than 83.33% of the control group(P<0.05). The levels of total cholesterol(TC), triglyceride(TG), low density lipoprotein(LDL-C) decreased and high density lipoprotein(HDL-C) increased before and after treatment in both groups.After treatment, the levels of TC and LDL-C in the observation group were(3.81±1.06) mmol/L,(2.95±0.34) mmol/L, significantly lower than(4.53±1.13) mmol/L,(3.26±0.39) mmol/L in the control group, and the level of HDL-C were(1.39±0.40) mmol/L, significantly higher than(1.24±0.41) mmol/L in the control group(P<0.05). The levels of IMT, r, IMT/r,and serum LP(α) in the two groups were decreased before and after treatment(P<0.05). The levels of IMT, r, IMT/r, and serum LP(α) in the observation group were(1.08±0.23) mm,(7.09±0.18) mm,(15.23±2.11)%,(17.12±4.28) ng/L, significantly lower than(1.28±0.29) mm,(7.20±0.20) mm,(17.78±2.15)%,(20.09±4.96) ng/L in the control group(P<0.05).The ADL scores of the two groups before and after treatment increased, and the ADL score of the observation group was 91.35±8.28, significantly higher than 87.92±9.96 in the control group(P<0.05). Conclusion Scalp acupuncture combined with Buyang Huanwu Decoction is effective in treating cerebral infarction patients with carotid atherosclerotic plaque, which can reduce blood lipid, stabilize and eliminate carotid atherosclerotic plaque, and promote the recovery of limb function.
引文
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[10]张宏伟,戴晓红,齐欢,等.头针配合补阳还五汤对脑梗死恢复期患者血浆同型半胱氨酸水平的影响[J].中医药信息,2015,32(3):112-114.
[11]张民英,赵阳.针灸联合中风防治灵对急性脑梗死患者脂联素、内皮素及血脂水平的影响[J].长春中医药大学学报,2018,34(3):505-508.
[12]YOU YN,CHO MR,KIM JH,et al.Assessing the quality of reports about randomized controlled trials of scalp acupuncture combined with another treatment for stroke[J].Bmc Complementary&Alternative Medicine,2017,17(1):452-458.
[13]黄东挺,蒋美媛,郭清,等.针刺联用普罗布考对老年性颈动脉粥样硬化颈动脉内膜中层厚度及血浆ox-LDL影响的研究[J].广西医学,2013,35(4):430-431.
[14]HIPPE DS,PHAN B,SUN J,et al.Lp(a)[Lipoprotein(a)]levels predict progression of carotid atherosclerosis in subjects with atherosclerotic cardiovascular disease on intensive lipid therapy:an analysis of the AIM-HIGH(atherothrombosis intervention in metabolic syndrome with low HDL/H[J].Arterioscler Thromb Vasc Biol,2018,38(3):673-678.
[15]徐传伟,刘华,李敏,等.互动式头针对脑梗死患者运动功能及日常生活能力的影响[J].针灸临床杂志,2015,31(3):11-13.
[2]NI T,CHEN M,YANG K,et al.Association of CD147 genetic polymorphisms with carotid atherosclerotic plaques in a Han Chinese population with cerebral infarction[J].Thrombosis Research,2017,156(5):29-35.
[3]纪永毅.补阳还五汤加减联合脂必泰对气虚血瘀型脑梗死患者炎性因子和颈动脉粥样硬化的影响[J].中西医结合心脑血管病杂志,2016,14(18):2168-2170.
[4]梁艳,赵杨,王琳,等.不同部位及刺激量头针治疗脑梗死的临床疗效与机理研究概述[J].针灸临床杂志,2016,32(8):92-94.
[5]中华神经科学会,中华神经外科学会.各类脑血管疾病诊断要点[J].中华神经科杂志,1996,49(6):379-380.
[6]闵瑜,吴媛媛,燕铁斌.改良Barthel指数(简体中文版)量表评定脑卒中患者日常生活活动能力的效度和信度研究[J].中华物理医学与康复杂志,2008,30(3):185-188.
[7]HORI YS,KODERA S,SATO Y,et al.Eosinopenia as a predictive factor of the short-term risk of mortality and infection after acute cerebral infarction[J].Journal of Stroke&Cerebrovascular Diseases,2016,25(6):1307-1312.
[8]KE J,JING M.Analysis of treatment effect of urinary kallidinogenase combined with edaravone on massive cerebral infarction[J].Biomedical Reports,2016,5(2):155-158.
[9]WANG JH,ZHAO M,BAO YC,et al.Effect of scalp-acupuncture treatment on levels of serum high-sensitivity C-reactive protein,and pro-inflammatory cytokines in patients with acute cerebral infarction[J].Acupuncture Research,2016,41(1):80-84.
[10]张宏伟,戴晓红,齐欢,等.头针配合补阳还五汤对脑梗死恢复期患者血浆同型半胱氨酸水平的影响[J].中医药信息,2015,32(3):112-114.
[11]张民英,赵阳.针灸联合中风防治灵对急性脑梗死患者脂联素、内皮素及血脂水平的影响[J].长春中医药大学学报,2018,34(3):505-508.
[12]YOU YN,CHO MR,KIM JH,et al.Assessing the quality of reports about randomized controlled trials of scalp acupuncture combined with another treatment for stroke[J].Bmc Complementary&Alternative Medicine,2017,17(1):452-458.
[13]黄东挺,蒋美媛,郭清,等.针刺联用普罗布考对老年性颈动脉粥样硬化颈动脉内膜中层厚度及血浆ox-LDL影响的研究[J].广西医学,2013,35(4):430-431.
[14]HIPPE DS,PHAN B,SUN J,et al.Lp(a)[Lipoprotein(a)]levels predict progression of carotid atherosclerosis in subjects with atherosclerotic cardiovascular disease on intensive lipid therapy:an analysis of the AIM-HIGH(atherothrombosis intervention in metabolic syndrome with low HDL/H[J].Arterioscler Thromb Vasc Biol,2018,38(3):673-678.
[15]徐传伟,刘华,李敏,等.互动式头针对脑梗死患者运动功能及日常生活能力的影响[J].针灸临床杂志,2015,31(3):11-13.