补阳还五汤联合子午流注纳甲法治疗脑中风后遗症及对炎症因子的影响
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摘要
目的探讨补阳还五汤联合子午流注纳甲法治疗脑中风后遗症病人的临床疗效以及对白细胞介素-10(interleukin-10,IL-10)、白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)的影响。方法以2014年3月—2017年3月收入我院的96例脑中风后遗症病人为研究对象。随机分为对照组和研究组,每组48例。所有病人给予相同的基础治疗,对照组病人进行子午流注纳甲法针灸,研究组病人在对照组基础上服用补阳还五汤。治疗3个疗程。比较两组的临床疗效及治疗前后Fugl-Meyel评分、Bathel评分和美国国立卫生研究院卒中量表(NIHSS)评分,比较两组病人治疗前后IL-10、IL-6及TNF-α水平。结果研究组总有效率为95.83%,显著高于对照组的81.25%(P<0.05)。治疗前两组各指标差异无统计学意义(P>0.05)。治疗后,两组病人的Fugl-Meyel评分和Bathel评分均显著升高(P<0.01),NIHSS评分均显著降低(P<0.01),且研究组Fugl-Meyel评分和Bathel评分均显著高于对照组(P<0.01),NIHSS评分显著低于对照组(P<0.01)。治疗后,两组病人血清IL-10显著升高(P<0.01),IL-6及TNF-α水平均显著下降(P<0.05),且研究组IL-10高于对照组(P<0.05),IL-6及TNF-α显著低于对照组(P<0.05)。结论补阳还五汤联合子午流注纳甲法可以有效改善脑中风后遗症病人的临床症状,提高其运动功能和生活质量,改善神经功能缺损,同时降低血清IL-6和TNF-α水平,升高IL-10水平,减轻炎症反应,改善机体免疫平衡。
Objective To investigate the effect of Buyang Huanwu decoction(BHD)and Ziwu Liuzhu Najia method in treating sequela of apoplexy and the influence on inflammatory factors.Methods Ninety-six patients with sequela of apoplexy in our hospital from March 2014 to March 2017 were selected as the research objects,and randomly divided into control group and observation group,with 48 cases each group.All patients were treated with basic treatment,patients in the control group were treated with Ziwu Liuzhu Najia Method,and patients in observation group were treated with BHD and Ziwu Liuzhu Najia method.All patients were treated for 3 course.The clinical effect of two groups were compared,the Fugl-Meyel score,Bathel score and NIHSS score were used to evaluate the physical activity function and nerve injury.The serum interleukin(IL)-10,IL-6 and tumor necrosis factor(TNF)-αlevels before and after treatment were compared.Results The total clinical effective rate was significantly higher in observation group than that in control group(95.83%vs 81.25%,P<0.05).After treatment,Fugl-Meyel score and Bathel score were increased in two groups(P<0.01),NIHSS score were significantly decreased(P<0.01).Fugl-Meyel score and Bathel score were significantly higher in observation group(P<0.01),the NIHSS score in observation group were significantly lower(P<0.01).After treatment,serum IL-10 level were increased in two groups(P<0.01),serum IL-6 and TNF-αlevel were significantly decreased(P<0.05).IL-10 level were significantly higher in observation group(P<0.01).IL-6 and TNF-αlevels in observation group were significantly lower than that in control group(P<0.01).Conclusion BHD and Ziwu Liuzhu Najia method can effectively improve the clinical symptoms,the physicalactivity function quality of life,neurological deficits,reduce serum IL-6 and TNF-αlevels,increase IL-10 levels,reduce inflammation and improve immunity balance in patients with sequela of apoplexy.
Objective To investigate the effect of Buyang Huanwu decoction(BHD)and Ziwu Liuzhu Najia method in treating sequela of apoplexy and the influence on inflammatory factors.Methods Ninety-six patients with sequela of apoplexy in our hospital from March 2014 to March 2017 were selected as the research objects,and randomly divided into control group and observation group,with 48 cases each group.All patients were treated with basic treatment,patients in the control group were treated with Ziwu Liuzhu Najia Method,and patients in observation group were treated with BHD and Ziwu Liuzhu Najia method.All patients were treated for 3 course.The clinical effect of two groups were compared,the Fugl-Meyel score,Bathel score and NIHSS score were used to evaluate the physical activity function and nerve injury.The serum interleukin(IL)-10,IL-6 and tumor necrosis factor(TNF)-αlevels before and after treatment were compared.Results The total clinical effective rate was significantly higher in observation group than that in control group(95.83%vs 81.25%,P<0.05).After treatment,Fugl-Meyel score and Bathel score were increased in two groups(P<0.01),NIHSS score were significantly decreased(P<0.01).Fugl-Meyel score and Bathel score were significantly higher in observation group(P<0.01),the NIHSS score in observation group were significantly lower(P<0.01).After treatment,serum IL-10 level were increased in two groups(P<0.01),serum IL-6 and TNF-αlevel were significantly decreased(P<0.05).IL-10 level were significantly higher in observation group(P<0.01).IL-6 and TNF-αlevels in observation group were significantly lower than that in control group(P<0.01).Conclusion BHD and Ziwu Liuzhu Najia method can effectively improve the clinical symptoms,the physicalactivity function quality of life,neurological deficits,reduce serum IL-6 and TNF-αlevels,increase IL-10 levels,reduce inflammation and improve immunity balance in patients with sequela of apoplexy.
引文
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[14]ZHAO L D,WANG J H,JIN G R,et al.Neuroprotective effect of buyang huanwu decoction against focal cerebral ischemia/reperfusion injury in rats-time window and mechanism[J].Journal of Ethnopharmacology,2012,140(2):339-344.
[15]金迪,吕丹.补阳还五汤配合针灸治疗脑中风后遗症42例[J].辽宁中医杂志,2017,44(6):1230-1232.
[16]ZHOU J W,WU J H,ZHANG J T,et al.Association of stroke clinical outcomes with coexistence of hyperglycemia and biomarkers of inflammation[J].Journal of Stroke and Cerebrovascular Disease,2015,24(6):1250-1255.
[17]李玉文.急性缺血性脑卒中患者血清IL-6的表达及与TOAST分型和OCSP分型的关系[J].中国老年学杂志,2015,35(17):4862-4863.
[18]MONIKA L L,RENATA Z,MALGORZATA K.Inhibition of TNF-αR1signaling can rescue functional cortical plasticity impaired in early post-stroke period[J].Neurobiology of Aging,2015,36(10):2877-2884.
[19]周惠芬,艾进超,万海同,等.参芎注射液对缺血再灌注损伤大鼠炎症损伤的影响[J].中国中药杂志,2015,40(12):2408-2412.
[20]田倩倩,刘建春,王晓庆.补阳还五汤抗炎作用研究进展[J].中华中医药学刊,2017,35(4):1673-1675.
[21]郑新杰,郑丹丹,张须学.补阳还五汤联合电针对中风后遗症患者血清IL-6及IL-1β水平影响研究[J].中华中医药学刊,2016,34(9):2208-2210.
[2]MADS H G,BETTINA H C,CHRISTINA D F,et al.Beneficial potential of intravenously administered IL-6in improving outcome after murine experimental stroke[J].Brain Behavior and Immunity,2017,65(4):296-311.
[3]李文娟,严世芸,姚洁敏.中风后遗症的诸家认识暨内治述要[J].中华中医药学刊,2015,33(9):2154-2156.
[4]翁銮坤.缺血中风诊断标准(行业标准)研究---中风病病名诊断标准的修订[D].广州:广州中医药大学,2011.
[5]王启才.针灸治疗学[M].北京:中国中医药出版社,2003:66-69.
[6]范学科,郭林.康复训练联合针刺对中风后遗症患者神经功能和运动能力的影响[J].南京中医药大学学报,2016,32(5):428-430.
[7]曾静波,王鹏,高学军,等.银杏内酯注射液辅助治疗高血压脑出血疗效及对神经功能恢复的影响[J].中国药理与临床,2016,32(6):217-220.
[8]DONG Y,CAO W J,CHENG X,et al.Risk factors and stroke characteristic in patients with postoperative strokes[J].Journal of Stroke and Cerebrovascular Disease,2017,26(7):1635-1640.
[9]KRISHNAMURTHI R V,MORAN A E,FEIGIN V L,et al.Stroke prevalence,mortality and disability-adjusted life years in adults aged 20-64years in 1990-2013:data from the global burden of disease 2013Study[J].Neuroepidemiology,2015,45(3):190-202.
[10]丁彩霞,盛蕾,张兰坤,等.国医大师周仲瑛治疗中风后遗症验案赏析[J].中华中医药杂志,2016,31(4):1267-1269.
[11]张玥,徐阳.针灸治疗脑卒中后遗症研究现状[J].中国老年学杂志,2015,37(10):2575-2577.
[12]杜金凯,赵福康,尤恩玉.子午流注纳甲法开穴的运用[J].中国中医基础医学杂志,2016,22(2):227-228.
[13]黄爱华.补阳还五汤治疗中风偏瘫后遗症临床疗效分析[J].中药药理与临床,2015,31(3):161-163.
[14]ZHAO L D,WANG J H,JIN G R,et al.Neuroprotective effect of buyang huanwu decoction against focal cerebral ischemia/reperfusion injury in rats-time window and mechanism[J].Journal of Ethnopharmacology,2012,140(2):339-344.
[15]金迪,吕丹.补阳还五汤配合针灸治疗脑中风后遗症42例[J].辽宁中医杂志,2017,44(6):1230-1232.
[16]ZHOU J W,WU J H,ZHANG J T,et al.Association of stroke clinical outcomes with coexistence of hyperglycemia and biomarkers of inflammation[J].Journal of Stroke and Cerebrovascular Disease,2015,24(6):1250-1255.
[17]李玉文.急性缺血性脑卒中患者血清IL-6的表达及与TOAST分型和OCSP分型的关系[J].中国老年学杂志,2015,35(17):4862-4863.
[18]MONIKA L L,RENATA Z,MALGORZATA K.Inhibition of TNF-αR1signaling can rescue functional cortical plasticity impaired in early post-stroke period[J].Neurobiology of Aging,2015,36(10):2877-2884.
[19]周惠芬,艾进超,万海同,等.参芎注射液对缺血再灌注损伤大鼠炎症损伤的影响[J].中国中药杂志,2015,40(12):2408-2412.
[20]田倩倩,刘建春,王晓庆.补阳还五汤抗炎作用研究进展[J].中华中医药学刊,2017,35(4):1673-1675.
[21]郑新杰,郑丹丹,张须学.补阳还五汤联合电针对中风后遗症患者血清IL-6及IL-1β水平影响研究[J].中华中医药学刊,2016,34(9):2208-2210.